by Sheryl Bruce
Dr. Eric Jarvis recently gave an information conference on the cultural context of clinical assessment. The main premise is that “culturally-based attitudes and assumptions govern the perspectives that both patient and clinician bring to the clinical encounter”1 . This means that there is importance in assessing the individual in reference to the culture. He emphasized that all families have a cultural context that needs to be considered when assessing and providing treatment. The clinic at the Jewish Hospital operates in this manner by looking at the cultural context, or what is sometimes called the bigger picture. What is interesting about this approach is that it is a step away from recent thinking, where we would clump a group of people from the same area and assume they all respond to one code of behaviour. Now the goal is to understand each person within his or her context; It means talking to them and learning what mental illness means to them and how their beliefs affect them and their family. The clinician needs to have an open mind and not make judgments too early. Dr. Jarvis recommends that we not bring our assumptions about the cultural context and overlay it onto the client or their family. We must investigate, not assume, and we must be gentle. One example is that one must not assume that a woman who does not leave her home is abused or psychotic. Another example is to find out what the family believes about mental illness. I have met many families where a parent does not believe in the mental illness of their loved one. They feel that if the person just worked harder and applied themselves they would not be having this problem. Taking the time to understand the cultural context can help the interveners understand the dynamics at play. We also must be aware that clinicians may have a bias towards the medical model of illness and treatment, which the ill person and family may not adhere to. If the culture is not accepting of the medical model, the treatment needs to be tailored to suit the culture. Certainly, patients may consult various natural healers about possible treatments, and they may not feel it is necessary to disclose natural foods or medications provided by these others if they sense that the clinician is not open. The ill person or their family members may not realize that remedies like ginseng, St. John’s Wort and gingko biloba have significant effects on how medications work and may affect their loved one negatively.
Another aspect Dr. Jarvis mentioned is that we are called to be aware of what orientation the person has: Is it egocentric about themselves; or, socio-centric about their family and ancestors – i.e. their name is important; or are they eco-centric and more concerned about where they live on the land and what land means to them (aboriginal concerns); and some are concerned about their ancestorsworshiping them and having an impact on the family.
Kirmayer, Rousseau, Jarvis and Guzder emphasize that “Attention to these issues of social structure, power and inequality, along with respect for the history and aspirations of individuals and communities, can insure that cultural competence also results in cultural safety in the delivery of care 2 ”.
As of 2011, Montreal had 5 major linguistic groups: French, English, Arabic, Spanish and Italian. With recent refugee crises near and far, our clinicians need to be prepared to provide service to recent refugees from Syria and Haiti. But we have also seen increases of people from Asia, South America and Africa. As clinicians, we need to be aware of the power we hold over recent immigrants and what we represent. Their status in this country is fragile and they risk losing a lot. Their fears of mental illness affecting their status may affect the way they answer questions. The clinic at the Jewish Hospital, according to Dr. Jarvis, is not sectored but the individual does need a referral from a family doctor or treating psychiatrist. They work with trained interpreters, if necessary. If you find that your loved one’s clinician needs to understand your family situation better, you can suggest that the psychiatrist get a consult from this clinic. They will do an intake evaluation and then decide the priority. When it is your turn, there will be 1 to 3 meetings (each meeting is about 2 hours) with a language interpreter or a cultural broker that they have trained. They will make a preliminary recommendation and refer the person back to the treating psychiatrist for follow up. You can see the whole conference from our webinar located on our website at asmfmh. org.
Références : Cultural Competency in Psychiatric Care by Dr Eric Jarvis Cette conférence peut être visionnée à partir de notre site internet asmfmh.org 1 et 2 Kirmayer, L. , Rousseau, C. , Jarvis, E. et Guzder, J. The Cultural Context of Clinical Assessment. Chapitre 4