Mental Health Across Cultures: a Practical Guide for Health Professionals

219 Pages·2016·1.55 MB·English

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psychotherapists and other professionals Edited by Charles Kaye and Michael Howlett io
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Child Mental Health in Primary Care Edited by Bob Grove, Jenny Secker and
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Mental Health Across Cultures
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Mental Health
Across Cultures
A PRACTICAL GUIDE FOR HEALTH PROFESSIONALS
JILL BENSON
General Practitioner, Migrant Health Service and Yalata Aboriginal Community
Director, Health in Human Diversity Unit
Discipline of General Practice, University of Adelaide
and
JILL THISTLETHWAITE
Professor in Clinical Education and Research
Director, Institute of Clinical Education
University of Warwick School of Medicine
Foreword by
PROFESSOR MICHAEL KIDD
Professor of General Practice, The University of Sydney
Member at Large, World Organization of Family Doctors (WONCA)
Formerly President, The Royal Australian College of General Practitioners (2002–06)
Radcliffe Publishing
Oxford (cid:129) New York
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2009 by Jill Benson and Jill Thistlethwaite
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20160525
International Standard Book Number-13: 978-1-138-03089-3 (eBook - PDF)
This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts
have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any
legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that
any views or opinions expressed in this book by individual editors, authors or contributors are personal to them
and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this
book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement
to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant
manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical
science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader
is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material
manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or
materials mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suit-
able for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her
own professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also
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Contents
Foreword by Professor Michael Kidd vi
About the authors viii
Acknowledgements x
List of boxes, fi gures and tables xi
Section A: Overview and model
1 Introduction 3
2 Model for working in mental health across cultures 14
Section B: Psychotherapy across cultures
3 General principles of psychotherapy and counselling 43
4 Modifi ed cognitive behavioural therapy (CBT) 67
5 Modifi ed narrative therapy 78
6 Resilience and spirituality 88
Section C: Putting cultural mental health into context
7 The people: doctors, health professionals and patients from
diverse backgrounds 109
8 Consultations across cultures 130
9 Basic neuropsychiatry and the quest for normality 151
10 Cross-cultural pharmacotherapy 171
11 Cross-cultural learning 186
Index 204
Foreword
We live in a world where close to 200 000 000 people are living outside their
country of origin and where 20 000 000 people are refugees who have fl ed
their own countries because of war, ethnic cleansing or starvation. These
extraordinary fi gures include not just many of the patients attending healthcare
facilities, but also many of the people who are providing healthcare services
in their adopted countries.
As the different cultures that make up our world become ever more
mixed, clinicians face daily challenges in providing care to people of different
backgrounds with different beliefs and experiences. Each culture has different
styles of communication, problem solving and decision-making. These
differences can impact on the presentation and management of mental health
concerns.
Jill Benson and Jill Thistlethwaite, the two Jills, are both respected general
practitioners and academics with international reputations in mental health
and medical education. They have extensive clinical experience working in
areas as diverse as refugee health, student health and indigenous health and
in urban, rural and remote locations in countries like Australia, Nepal and the
United Kingdom.
Together they have authored a brilliant book about mental healthcare
across cultures. Cultural challenges can be among the most diffi cult aspects
of clinical medicine. As the two Jills demonstrate, they can also be among the
most enjoyable and rewarding.
Every clinician in the world experiences cultural challenges as part of her or
his daily work. As we do our best to provide appropriate care to each person
who trusts us for their medical care and advice, we are often challenged by
cultural barriers. This book provides practical guidance on how to identify,
address and overcome these barriers.
vi
FOREWORD vii
The fundamental lesson of this book is that we should listen to our patients
and respond appropriately. One of the joys of medicine is that each day our
patients confront us with new ways of looking at the world. It is a rare day
when a doctor doesn’t learn something new about human existence from her
or his patients.
The two Jills have interwoven stories from their own patients throughout
the book. These are stories of real people who have made an impact on the two
authors in their own work as doctors. These stories add great richness to the
book’s key messages. While some of the stories will make you teary and others
will make you laugh, the extraordinary courage of people like Kebedesh,
Maggie, Razzaq and Alimamy will inspire you in your own work.
The book discusses different therapies that can be utilised by clinicians and
their use in transcultural consultations. The two Jills don’t hesitate to tackle
the biggest challenges in cross-cultural healthcare delivery; the challenge of
prescribing across cultures, the challenge of working through interpreters, the
challenge of working alongside traditional healers, the challenge of working
with people with different health beliefs to your own. They provide simple
advice which can transform these challenges into rewarding aspects of your
experience as a clinician.
I commend this book to you and I congratulate the two Jills on their work.
This is a book for all healthcare professionals, from students to seasoned clini-
cians. There are practical lessons in here for us all.
I hope that reading this book helps you to provide better care to all of your
own patients, no matter what their and your cultural backgrounds might be.
Michael Kidd
Professor of General Practice, The University of Sydney
Member at Large, World Organization of Family Doctors (WONCA)
President, The Royal Australian College of General Practitioners (2002–06)
August 2008
About the authors
Dr Jill Benson is a general practitioner who is currently Director of the Health
in Human Diversity Unit in the Discipline of General Practice, University of
Adelaide. She is also a senior medical offi cer working with refugees at the
Migrant Health Service, works at the University Health Practice of the University
of Adelaide and with Aboriginal people in the remote community at Yalata.
She graduated from Sydney University in 1978, has a Diploma of Child Health
from the College of Physicians in London and is a Fellow of the Australian
College of Psychological Medicine. She is a member of the Board of STTARS
(Survivors of Torture and Trauma Assistance and Rehabilitation Service) and
of SAPMEA (South Australian Postgraduate Medical Education Association).
In 2005 and 2006 she worked as a locum at a teaching hospital in Dharan
in rural Eastern Nepal. She teaches other GPs, students, health professionals
and the general public on psychological topics and transcultural health, and
sits on various committees, has published papers and presented many times
on these topics. Jill is the Australasian representative for the WONCA (World
Organization of Family Doctors) Working Party on Mental Health and is an
examiner for the AMC (Australian Medical Council). She has presented papers
at many conferences and seminars throughout Australia as well as in Lebanon,
Florida, Pakistan, Italy, Abu Dhabi, Singapore and Spain.
Professor Jill Thistlethwaite is Professor in Clinical Education and Research,
and Director of the Institute of Clinical Education at the University of Warwick
School of Medicine from January 2009. She was previously associate professor
in medical education in the Faculty of Medicine at the University of Sydney.
Jill trained as a general practitioner in the UK and was a full-time principal
in general practice in West Yorkshire for 10 years, during which time she
became a GP trainer and then course organiser for the Calderdale Vocational
viii
ABOUT THE AUTHORS ix
Training Scheme. In 1996, she was appointed senior lecturer in community-
based education at the University of Leeds, where she was responsible for
the Personal and Professional Development Core Unit of the undergraduate
medical programme. She has continued to work part-time as a GP. In 2003, she
moved to Australia, fi rst to James Cook University Medical School and then
to Sydney. Her interests are consultation skills, interprofessional education
and practice, professionalism and women’s health. She has published widely
in these areas.