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7 - Ethnic inequalities and cultural capability framework in mental healthcare

from Part I - Theoretical background

Published online by Cambridge University Press:  11 August 2009

By
Kamaldeep Bhui  and
Dinesh Bhugra
Edited by
Dinesh Bhugra  and
Kamaldeep Bhui
Kamaldeep Bhui
Affiliation:
Department of Cultural Psychiatry and Epidemiology Institute of Community Health Sciences Queen Mary London E1 4NS UK
Dinesh Bhugra
Affiliation:
Mental Health and Cultural Diversity Section of Cultural Psychiatry Institute of Psychiatry King's College London De Crespigny Park London SE5 8AF UK
Dinesh Bhugra
Affiliation:
Institute of Psychiatry, London
Kamaldeep Bhui
Affiliation:
Barts & The London, Queen Mary School of Medicine and Dentistry
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Summary

EDITORS' INTRODUCTION

There is considerable evidence in literature, as has been shown consistently in this volume, that rates of some types of mental illness are higher in black and ethnic minority groups when compared with others. This has been attributed to a number of reasons, of which misdiagnosis keeps being referred to. The explanations for ethnic inequalities are multi-layered, and include social inequalities. A large number of factors influence help seeking as well as clinical assessments and outcomes of therapeutic consultations. There is no doubt that values of majority cultures dramatically influence these processes. Explanatory models held by patients and carers will dictate which pathways to professional care they follow. Help seeking is also determined by the personal, folk and social resources an individual has.

Bhui and Bhugra explore the major causes of ethnic variations in the patterns of health-service usage, which are many, and include cultural variations in explanations of distress, knowledge about the local care systems, geographical and emotional accessibility of services. The culture of healthcare delivery can also influence attitudes towards patients, their carers and their problems. There is no doubt that these processes are mediated through social and cultural factors, including lifestyle. They suggest that a cultural-capability framework which assesses cultural identity, explanatory models, individual and organizational dynamics with a clear emphasis on reflexivity in the assessment may enable the clinician to engage cultural minorities in decision-making and engagement in therapeutic alliances. Inequalities in mental healthcare are particularly stark in some clinical settings, such as forensic care or primary care.

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Textbook of Cultural Psychiatry , pp. 81 - 92
Publisher: Cambridge University Press
Print publication year: 2007

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