Author'sreply

The debate on specialist services for Black and minority groups is a most welcome opportunity to compare and contrast international models of culturally capable services. Whitley, Kirmayer & Jarvis echo the proposal by Waheed et al (2003) that the consultation model established in Canada is to be commended, irrespective of the context in which service models are located. The Canadian approach to diversity in society and in mental health services appears to be more welcoming and supportive in terms of financial investment; furthermore, such an approach endorses the view that specialist rather than separate provision can be useful and is necessary to meet the needs of ethnic minority citizens.

The issue in the UK is that separate funding for special services is rarely available and, as outlined in the original debate (Bhui/Sashidharan, 2003), is ideologically opposed by providers in favour of an integrationist solution. However, this strategy has failed to ensure that generic mental health services are culturally capable or appropriate. Two recent policy documents launched by the Department of Health (2003a , b ) attack this issue from quite distinct perspectives, but neither promotes specialist service provision or the consultation model, which, in the UK at least, has often been championed by charismatic and highly motivated clinicians, without the support of sustained investment or a spread of learning throughout the workforce. The first of these policy documents (Inside Outside; Department of Health, 2003a ) recommended a cultural capability framework in which a consultation model may have been usefully located but, to date, there is no implementation plan. In some ways these issues are not dissimilar to debates about models of assertive outreach or early intervention, and whether such services are similarly valuable in different cultural and service contexts, irrespective of the transferability of the model. By default, specialist services are being provided in the voluntary sector in the UK; perhaps the consultation model can be commended to policy makers and service providers in the UK as an approach worthy of investment and evaluation. This will need commitment to improve clinical practice skills, and a reorganisation of services, including specialist provision where appropriate.