S-24-01

Cultural sensitivity for institutions of mental health

C. Haasen. University Hospital Eppendorf Hamburg, Germany

There is sufficient evidence in different countries, that migrants from different cultural backgrounds do not use mental health services to the same extent as natives. Reasons are several different barriers in the access to care for migrants with mental health problems. These barriers can be found both on the institutional level as well as on the subjective level of the patients and caregivers themselves. The institutional barriers are mainly a lack of information about and for migrants, as well as a lack of more specific treatment modalities. The subjective barriers are associated with issues of discrimination as weI1 as preconceptions about mental health services and disorders. Several measures are being undertaken in different countries to reduce these barriers in the access of care for mentally ill migrants in Europe.

S-24-02

Cultural aspects of psychosocial interventions

M. Kastrup. Rigshospitalet Psycluatry Clinic, Copenhagen, Denmark

A comprehensive assessment of the patient is a necessary prerequisite for adequate psychosocial interventions. It comprises e.g. an evaluation of the level of social functioning, habitually as well as presently; the psychosocial and circumstantial factors contributing to the present situation; a psychological understanding of the self and its abifities, and an overview of the total life situation. Assessing patients from other etlmic backgrounds comprises similar elements, but certain aspects require particular attention. The cultural formulation in DSMIV (1994) underlines the need for the clinician to assess e.g. any cultural explanation of the illness, cultural factors related to psychosocial functioning, cultural elements in the physician-patient relationship, as well as the cultural identity of the individual. Furthermore, special emphasis should be paid to the cultural competence of the professionals responsible for the intervention. According to Tseng (2003) clinicians need to sharpen their cultural sensitivity, be perceptive to cultural differences and willing to learn from patients and families, their value systems and ways of handling the problems. Family involvement in all decision-makings should be taken into account. In the light hereof the paper will discuss strategies to optimise psychosocial interventions.

S-24-03

Ethnic factors in pharmacology and pharmacogenetics

A.-M. Pezous. ECIMUD Service de Psychiatrie, Paris, France

S-24-04

Cultural mediators for mental health services

W. Machleidt, R. Salman. Med. Hochschule Sozialpsychiatrie, Hannover, Germany Hannover

Objective: Within the in- and out-patient psychological and (social-)psychiatric services migrants are underrepresented. So far they could not be reached via the usual informational and motivational pathways.

Methods: In order to enable an access to these services a concept to train "key persons" as cultural mediators has been developed. Cultural mediators are key persons having on one hand the specific linguistic and cultural access to the different migrant groups and on the other the knowledge about the language and structures of the host country. They are trustworthy "authorities" as well as for the migrants' groups and the institutions of the majority population. Coming from different cultures these key persons are trained to pass on medical and social information through multilingual and cultural sensible campaigns during which they inform their countrymen about addiction, mental health etc. as well as about the available health services.

Results: The Ethno-Medical Center Hannover trained more than 400 mediators in the fields health system, addiction, AIDS, dental hygiene, mother-child health etc. Since 1995 more than 600 preventive organisations which reached more than 10.000 migrants. As a consequence the migrants' use of psychosocial services in this region increased.

Conclusion: It can be concluded that the concept of cultural mediatiors has been proved to be very effective. Especially socially disadvantaged migrants can be reached by the psychosocial services via native speakers and cultural sensible information. It is recommended that each institution of the psychosocial and psychiatric service network sets up a certain group of mediators who are trained and educated well and continously.

S-24-05

Cultural competency training in mental health

A. Qureshi, F. Collazos. Hopital Val d'Hebron, Barcelona, Spain

Objective: Cultural competence refers to the capacity, be it clinically or institutionally, to respond effectively to the treatment needs of culturally diverse patients. Cultural competence involves the ability or skills to effectively apply a rather complex knowledge base. The complexity of this knowledge base, combined with the sensitivity of contemporary intercultural relations requires that the clinician attend to attitudes, beliefs, and values associated with race and culture. Cultural competency training, thus, extends considerably beyond the impartation of a knowledge base--which, in the intercultural context is itself rather complex----to the development of the skills necessary to apply the abstraction of cultural knowledge to the therapeutic context. The knowledge and skills components of cultural competency, however, cannot be effectively put into action without cultural sensitivity, which means that cultural competency training requires exploration of, and, if necessary, changes to, cultural and racial attitudes and beliefs. The basis of the knowledge domain in cultural competence, contrary to common perception, does not require detailed knowledge of the cultures of the patients one treats, rather, it demands a profound awareness of the different ways in which culture, minority group membership, and the immigration process can affect psychosocial development, symptom presentation, and treatment response. Further, it is essential that cultural competency training provide a foundation in cultural and medical anthropology as a means of contextualizing entry into academic terrain which has not been sufficiently prepared for by medical or psychological training.