There is considerable concern in countries such as the UK, USA and Canada about the access of people from Black and minority ethnic groups to appropriate healthcare (Dyson & Smaje, 2001). This may reflect real or perceived barriers to services because of disadvantage related to minority status. Several approaches have been proposed to address this problem, one of which has been to increase cultural diversity training for all clinical staff, including psychiatrists. It is the issues surrounding such training that we discuss in this chapter. Since our original article 5 years ago (Dogra & Karim, 2005) the same issues remain pertinent to good clinical practice, and the death of David ‘Rocky’ Bennett, the subsequent enquiry and the resulting policy remain in the consciousness of the profession. Internationally there have been some attempts to introduce a framework for the training of staff in cultural competence, with most of the literature originating from North America (Fung et al, 2008; Lim et al, 2008). A simple literature search on cultural competence using Medline reveals number of articles both nationally and internationally from various specialties, but only a few involve mental health. In this update we review some of the literature and present our interpretation of the progress or lack thereof in this area.

Defining concepts

Culture

Culture is not a value-free concept and it is defined in many ways, as are other widely used terms such as ethnicity and race (Bradby, 2003). One cannot dispute that the concept of culture, cultural identity or belonging to a cultural group is a dynamic process involving a degree of active engagement by individuals.