This well written, multi-authored book delivers everything that its title promises, and much more! It includes chapters previously published as articles in Advances in Psychiatric Treatment, updated with recent references, and some new chapters as well. The authors and editors are acknowledged experts in the field of cultural psychiatry, who have all contributed significantly to the understanding of this important area.
The book is divided into three sections – ‘Theoretical and general issues’, ‘Specific mental health conditions across cultures’ and ‘Management issues in the cultural context’. Clinically relevant, important work in cultural psychiatry is covered in a very readable and understandable format. Several authors make reference to the same papers and it is interesting to see how they approach the same subject from differing angles.
The chapter on the mental health of refugees and asylum seekers is especially helpful as clear definitions highlight the implications for access to resources and treatment. Despite media hype, only 20% of the world’s refugees are being hosted by high-income countries. Worryingly, 44% of refugees and asylum seekers are below the age of 18. The implications for psychiatrists include ensuring that the sensitivity of personal information is not compromised, establishing trust with people whose basic value systems have been destroyed, and promoting engagement with other agencies. Individualising care packages and taking language and culture into consideration are also necessary. Sadly, arrival in another country does not necessarily give refugees peace of mind. Satisfying basic human needs such as food, shelter and money through employment continue to promote well-being.
The chapter on schizophrenia in African–Caribbean people is especially commended, not least because it incorporates information from the most recent sources. The consistently higher-than-expected rate of schizophrenia in people of African–Caribbean descent is acknowledged. Various hypotheses to explain this discrepancy are reviewed, including biological and social factors, and an attempt is made to look at the role of institutional racism, even though some professionals find this terminology unfashionable. The proposition that living in proximity to others from the same culture is protective against serious mental illness is also helpful.
The call for training in cultural diversity to be made available for all healthcare professionals, including psychiatrists, is loud and clear. Unless there is clarity about what constitutes cultural diversity, training will not be effective and runs the risk of merely becoming a tick-box exercise. Having a culturally competent workforce must remain the top priority of all trusts’ chief executives, particularly at a time when health ministers and governments are worryingly tiptoeing away from established and accepted approaches regarding multiculturalism. The discussion about lip service, political correctness and cultural sensibility is sensitively explored, with clear suggestions about how clinicians can establish reflective practices.
This book is highly recommended to all professionals working with refugees, asylum seekers and people from Black and minority ethnic backgrounds. It will also be of considerable value to anyone interested in how to incorporate cultural psychiatry issues into clinical practice.
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