Training in cultural psychiatry: Translating research into improvements in mental health care for migrants

Abstract

This special issue of Transcultural Psychiatry on training in cultural psychiatry discusses translating research into improvements in mental health care for refugees and migrants. This topic is timely because, in addition to a global increase in migration, the number of forcibly displaced people is growing rapidly due to war and conflicts. We know that migrants, particularly refugees, are at increased risk of psychiatric disorders, including psychotic disorders and post—traumatic stress. Despite this, there is evidence of major disparities in care for minorities, migrants, and refugees. The gap between needs related to mental health care for migrants, refugees, and minority groups and available services points to the need to improve accessibility and adapt systems, services, and interventions. Health professionals have a key role in ensuring the quality of care. Their capacity to cope with new challenges depends on their competence, knowledge, skills, and attitudes toward their patients' needs. Mental health professionals need training in working with cultural diversity and structural competence to understand, treat, and support migrant and refugee patients—and to respond to racial discrimination. Mental health care services need to reduce barriers to providing adequate resources, including supporting skills training for mental health professionals. Hopefully, this thematic special issue will motivate further research, discussion, and sharing of local experience and pedagogical methods in this vital field.

Association of common mental disorders and related multimorbidity with subsequent labor market marginalization among refugee and Swedish-born young adults

“…Lack of adequate support from the health care system and labor market may contribute to this observation. Moreover, somatic disorders might be underdiagnosed due to inadequate treatment of CMDs among the refugee young adults, which may further marginalize this vulnerable group ( 36 , 43 , 44 ).…”

“…Furthermore, CMDs among refugees may not be detected to the same extent as in their Swedish counterparts due to educational differences and a lack of consideration of cultural diversity competences in the assessment by health care professionals and other barriers such as stigmatization. Perceived CMDs symptoms differ by cultural background and could be underdiagnosed given a lack of culturally sensitive instruments ( 43 , 44 ). This may lead to lower psychiatric utilization and inadequate screening among refugee youths.…”

“…Refugee or migration status alone were shown to be strong risk factors for UE, with estimated two to three times higher likelihood of UE than for their native-born counterparts without CMDs (5,7). The greater severity of mental disorders due to the migration experience may result in obtaining disability benefits other than UE (42).…”

Refugees and asylum seekers who have experienced trauma: Thematic synthesis of therapeutic boundary considerations

“…The importance of redefining therapeutic boundaries and the necessary implications this could have for the therapeutic care of refugees and asylum seekers is established in the literature (Bäärnhielm & Schouler‐Ocak, 2022; Karageorge et al, 2017; Kroll, 2001; Martinez, 2000; Savin & Martinez, 2006; Sandhu et al, 2013; Shors & Kroll, 2022). Traditional therapeutic boundaries have been highlighted as not being appropriate nor optimal in supporting refugees and asylum seekers and may disrupt rapport‐building.…”

“…A body of literature highlights that the mental health needs of refugees and asylum seekers have been best addressed through interdisciplinary and psychosocial work, practical interventions and advocacy; all of which lies within the remit of therapeutic boundary considerations (Karageorge et al, 2017). Reconsiderations and re‐conceptualizations of psychiatric and psychological boundaries with refugees have included modifying interactions with clients; offering interventions to clients based on their own cultural traditions; appropriate self‐disclosure as opposed to therapist anonymity; considering advocacy‐based, dual‐agency work as opposed to remaining neutral and transcending above therapeutic needs to address practical needs; and accepting small gifts and accepting clients' invitations to external events (Bäärnhielm & Schouler‐Ocak, 2022; Karageorge et al, 2017; Kirmayer, 2012; Savin & Martinez, 2006; Shors & Kroll, 2022). Extensive research has shown that refugee and asylum seeker clients identify practical assistance (e.g.…”