Opening Up Mental Health Service Delivery to Cultural Diversity: Current Situation, Development and Examples from Three Northern European Countries

Abstract

There are inequalities in health among migrants and local populations in Europe. Due to migration, Germany, Norway and Sweden have become ethnic culturally diverse nations. There are barriers to mental health care access for refugees, migrants and minorities, and problems with quality of culturally sensitive care in the three countries. This is despite tax-funded health care systems based on equity in service provision. There is a need to develop culturally sensitive mental health services that respond to the increasing diversity of the populations. In this chapter, we will take a closer look at cultural diversity in the countries in question, discuss challenges and give examples of current work to open up mental health services to cultural diversity. The German example will focus on the movement of Interkulturelle Öffnung (cross-cultural opening of the health care system) and work on creating national guidelines and quality standards. From Norway, the work of the National Centre for Mental Health for the indigenous Sámi population will be presented. The Swedish example will focus on the work carried out by the Transcultural Centre. The latter is a competence centre supporting development of culturally sensitive care as an integrated part of the regional health and mental health care system in Stockholm. Finally, the relevance of mental health care for a culturally diverse population, as a part of the larger social project of building tolerant multicultural societies, will be discussed.

Clinical approaches to cultural diversity in mental health care and specificities of French transcultural consultations: A narrative review.

“…The patient's culture and various attachments are thus an integral part of the process of therapy. In this sense, the French transcultural approach is radically different from the models proposing to adapt the standard framework of care by training professionals in cultural competence (5,13,16,19,22,23,31,(51)(52)(53) or via integration through using interpreters or cultural mediators (35,38,54).…”

“…In Sweden, Finland, Norway, and Denmark, special focus has been placed on developing services to treat the sequelae of violence and trauma as well as on training in cultural competence in general healthcare facilities. Mental health services specific for indigenous populations have also been set up (5,(36)(37)(38).…”

“…In particular, Italy has developed cultural mediators, as in Milan (Crinali) (41). Germany and the Netherlands are trying to guarantee greater cultural openness in public mental health facilities (5,42), while in Belgium this initiative depends more on non-profit organizations (9).…”

Between Don Quixote and Hamlet: vicissitudes of contemporary Cultural Psychiatry

“…But it also faces the risk of inexactitudes bordering on the sophisticated lies of fiction, as Hamlet warns. Its content (and teaching) obviously goes beyond descriptive psychiatry or the psychopathology of distant lands, the study of ethnic minorities or of issues related only to migrants or refugees, and the process of acculturation even if faithfully described or measured (Bäärnhielm, Javo, & Mösko, 2013).…”

Differences in predictors of permanent work disability between immigrants and natives: a cohort study of adults with sick leave due to common mental disorders

“…These discrepancies may not only be a reflection of differences in the severity of the underlying morbidity, but may also reflect differences in access and acceptance of specialised healthcare, culturally sensitive diagnostics, reporting of mental symptoms and treatment in terms of psychiatric medication. [17][18][19][20][21] Preconceptions on the part of healthcare professionals could also contribute to differential treatment. 19 22 Future studies are warranted to elucidate potential differences in immigrant groups and native Swedes with SA due to CMDs regarding the type of treatment provided and the role of healthcare in preventing transition from temporal to permanent work disability.…”