Some reflections on cultural and social considerations in mental health nursing

Abstract

This article critiques the contribution of two main theoretical perspectives on mental health care and ethnicity, with particular reference to Asian women. It considers the work of those who highlight the impact of culture on the health and illness experience (Kleinman 1980, Rack 1982, Fernando 1989) and the work of authors who argue that the impact of broader socio‐economic structures must be considered (Donovan 1989, Pearson 1989, Ahmad 1993). It is posited that the emphasis on cultural difference results in crude monolithic generalizations about Asian culture and operates as a smokescreen for the impact of poverty and racism. The backdrop to this article is provided by an assessment of the problematic conceptual framework of Western mental health and the role it plays in perpetuating stereotypes. It is concluded that mental health nurses need a thorough understanding of the complexity of the cultural and social factors that influence health and illness; an understanding which falls somewhere between these two theoretical perspectives. Such an approach needs to be grounded in the experience of mental health clients themselves if it is to be appropriate.

Racialized Women with Severe Mental Illness: An Arts-Based Approach to Locating Recovery in Intersections of Power, Self-Worth, and Identity

“…Clearly, this would involve a fairly sensitive and sophisticated set of clinical skills-one that goes beyond the acknowledgement of cultural differences such as Asians-make-less-eye-contact types of messages that characterize and compromise cultural-competence training and skills in many settings (Bhui, Warfa, Edonya, McKenzie, & Bhugra, 2007). Simplifying in this manner maintains the structures of discrimination within communities and the mental health system (Burr & Chapman, 1998 …”

Psychiatric nursing care experiences of immigrant patients: A Focused ethnographic study

“…; Sainola‐Rodriguez ; Wilson ). Nurses must understand the different views on the ‘normality’ of people who come from different cultures and should be able to comprehensively assess their mental health by taking into account cultural factors (Burr & Chapman ; Flaskerud & Kim ; Leininger ; Rashidi & Rajaram ).…”

“…Without transcultural knowledge, many psychiatric patients may be misunderstood, misdiagnosed or may receive insufficient treatment. Transcultural care is known to decrease conflicts and stressful situations, and it leads to an efficient and appropriate care experience (Burr & Chapman ; Flaskerud & Kim ; Leininger ; Rashidi & Rajaram ; Sandhu et al . ).…”

Factors that influence Asian communities' access to mental health care

“…Traditionally, many western health‐care interventions have been based on the concept that illness is culturally neutral and, therefore, interventions were applicable to all clients (Burr & Chapman 1998). Nevertheless, research has demonstrated that health and illness are culturally constructed experiences (Manderson 1990), which are manifested in different variations of illness (Balarajan & Soni Raleigh 1993).…”

“…According to Sheikh and Furnham (2000), the beliefs in more traditional cultures are deep‐rooted and more structured than in many western societies with religion playing a significant role in understanding the cause and treatment of illness. Burr and Chapman (1998; p. 434) claimed that ‘within each cultural system, illness, the response to illness and the method of treating illness, have different cultural and symbolic meanings’. However, knowledge of these cultural variations has failed to move health care out of its ethnocentric paradigm (Manderson & Mathews 1985).…”