Advanced Study Institute in Cultural Psychiatry Rethinking ...Advanced Study Institute in Cultural Psychiatry Rethinking Cultural Competence from International Perspectives April 27

DIVISION OF SOCIAL & TRANSCULTURAL PSYCHIATRY – MCGILL UNIVERSITY

Advanced Study Institute in Cultural Psychiatry

Rethinking Cultural Competence from International Perspectives

April 27 & 28, 2010 Institute of Community & Family Psychiatry 4333 Cote-Ste-Catherine Road Montréal, Québec, H3T 1E4

In recent years, cultural competence has become a popular term for strategies to address cultural diversity in mental health services. Alternative constructs that have been proposed include cultural safety, humility, sensitivity, responsiveness and appropriateness. Each of these metaphors draws attention to certain dimensions of intercultural work while downplaying or obscuring others. Each perspective is rooted in particular constructions of cultural identity and difference that have social origins. Approaches to cultural competence have been dominated by work in the U.S., which configures cultural difference in specific ways that reflect its history, demography, and politics. In New Zealand, cultural safety has been promoted as a term that draws attention to issues of power and vulnerability resulting from the history of colonization. Work in other countries has favoured other models and metaphors to address diversity. This workshop will bring together an international group of clinicians, researchers and educators to critically assess notions of culture competence in clinical care. Sessions will be devoted to a conceptual analysis and critique of cultural competence, strategies for addressing cultural diversity in health care organizations, the relevance of culture in global mental health, the cultural adaptation of psychotherapy and other clinical interventions, pedagogical approaches to professional training, and ways to improve the cultural responsiveness and appropriateness of clinical services. The conference will conclude with discussions of the place of culture in psychiatric nosology and in mental health policy. The Advanced Study Institute is part of the 16th Annual McGill Summer Program in Social and Cultural Psychiatry/ For information visit our website: www.mcgill.ca/tcpsych The ASI workshop will be followed by a conference held in conjunction with the annual meeting of the Society for the Study of Psychiatry and Culture, April 29 to May 1, 2010. For information on the SSPC Meeting see: www.psychiatryandculture.org

ADVANCED STUDY INSTITUTE IN CULTURAL PSYCHIATRY – Rethinking Cultural Competence from International Perspectives

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Program TUESDAY, APRIL 27, 2010, 9:00 – 12:30 9:00 – 9:10 Welcome: Laurence Kirmayer 1. Conceptual Issues 9:10 – 9:30 Rethinking cultural competence Laurence Kirmayer

9:30 – 9:50 The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context Arlene Katz

9:50 – 10:10 Revisioning the concept of culture in psychiatry: A critique Joan Koss-Chioino & Luis Vargas

10:10 – 11:30 Cultural competency: Meanings and models emerging from race equality policy Kamaldeep Singh Bhui

10:30 – 10:50 Break

10:50 – 11:10 Reframing cultural competence as a multi-level health equity intervention Kwame McKenzie

11:10 – 11:30 Is cultural competence the best concept for psychology? Luis Vargas & Joan Koss-Chioino

11:30 – 11:50 Religious competence as cultural competence Rob Whitley

11:50 – 12:30 Discussion

12:30 – 2:00 PM Lunch


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TUESDAY, APRIL 27, 2010, 2:00-6:00 PM 2. International Perspectives 2:00 – 2:20 Introducing cultural competence in a clinical practice with migrants in France: Evaluating the historical and therapeutic resistances within a systemic approach Rachid Bennegadi

2:20 – 2:40 Phenomenology, racist semiotic inversions, complex bloodlines and cultural competence in Caribbean migrants Frederick Hickling

2:40 – 3:00 The impact of American psychiatry on the Middle East Kemal Sayar


3:20 – 3:40 Break

3. Indigenous Perspectives 3:40 – 4:00 The Swampy Cree Suicide Prevention Team Brenda Elias

4:00 – 4:20 Rethinking cultural competence in Indigenous community treatment settings: Inflections of tradition, reclamation, and postcoloniality Joseph P. Gone

4:20 – 4:40 Irihapeti Ramsden: The public narrative on cultural safety Steve Koptie

4:40 – 5:00 Shielded minds: The paradox of cultural safety and youth engagement leadership [Film] Cynthia Wesley-Esquimaux

5:00 – 5:20 Adapting and transforming services and interventions across cultures: Identifying cultural services preferences Les Whitbeck & Melissa Walls



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WEDNESDAY, APRIL 28, 2010, 9:00 – 12:30 4. Culturally Competent and Responsive Interventions 9:00 – 9:20 Anthropology in the clinic: Cultural formulations as a clinical tool for better assessment in intensive care psychiatry [Film] Sushrut Jadhav

9:20 – 9:40 Exchanging time for space: The place of culture in acute psychiatry S. Jadhav, R. Lynch, S. Sengupta, J. Derges, S. Stevens & R. Littlewood

9:40 – 10:00 Mutual creative space: An action-model of cultural competence in cross-cultural work Gadi BenEzer


10:20 – 10:40 Break

10:40 – 11:00 Culturally sensitive treatment of traumatized refugees and ethnic populations: Emotion regulation therapy for PTSD Devon Hinton

11:00 – 11:20 Translating an aesthetics of connectedness Melissa Park

11:20 – 11:40 Is there a disconnect between police culture and policing with cultural sensitivity? Myrna Lashley

11:40 – 12:30 Discussion 12:30 – 2:00 PM Lunch


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WEDNESDAY, APRIL 28, 2010, 2:00 – 5:30 PM 5. The Place of Culture in DSM-V

2:00 – 2:20 Why include cultural factors in DSM-V? Roberto Lewis-Fernández

2:20 – 2:40 What to do with the culture-bound syndromes in DSM-V? Renato D. Alarcón

2:40 – 3:00 Cultural Formulation Scale: A tool for the improvement of cultural competence Renato D. Alarcón


3:30 – 3:50 Break

6. Institutionalizing Cultural Competence: Training, Policy and Practice

3:50 – 4:10 Cultural competence and diversity: LCME and ACGME accreditation standards Francis Lu

4:10 – 4:30 Concepts of cultural competence in health care organizations Kenneth Fung, Ted Lo, Lisa Andermann, Rani Srivastava & Janice Dusek

4:30 – 4:50 Incorporating diverse needs and strengths into the development of a mental health strategy for Canada Farah N. Mawani



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Abstracts

Cultural Formulation Scale: A tool for the improvement of cultural competence Renato D. Alarcón

Accurate diagnostic practices are considered a cardinal component of cultural competence in the psychiatric field. Such accuracy can only be thorough if the cultural factors are carefully assessed and duly taken into consideration. The inclusion of the Cultural Formulation (CF) in DSM-IV opened the way to a more systematic evaluation of key cultural variables in the diagnostic process, and was seen as a promising tool for clinical and research purposes. This presentation will examine the main reasons for an uneven utilization of the CF in both, educational/training and purely clinical areas. It will also address its consideration in the ongoing development of DSM-V, focusing on the advantages and disadvantages of the existing CF, as seen by clinicians, trainees, educators and researchers. The strong trend towards quantification in several areas of the DSM-V work, leading to the adoption of dimensional measures, cannot be ignored by those interested in a fully defined presence and acceptance of culture in the new nomenclature. In addition to an exclusively narrative form, a CF Scale can offer the practitioner a measurement instrument of high practical value. Accordingly, the main features of a CF Scale are described. They are based on the items or areas present in the existing DSM-IV’s CF, plus others extracted from recent literature and strong clinical experience. The ensuing discussion can enhance the purposes, structure and usefulness of the proposed Scale, conceived as a tool that could, advantageously, improve a much needed comprehensive cultural competence covering the diagnostic and the therapeutic fields of psychiatry. What to do with the culture-bound syndromes in DSM-V? Renato D. Alarcón

The immense amount of work demanded by the preparation of the 5th edition of the APA’s Diagnostic and Statistical Manual (DSM-V) has faced a great number of challenges at all levels. In the cultural area, the debates about the fate of the Culture-Bound Syndromes (CBSs) have increased with different opinions in the field, presented with equally compelling and passionate arguments from different sides. This presentation examines this phenomenon from conceptual and logistic perspectives, suggests a methodology to determine the presence and location of CBSs in DSM-V, and proposes a procedure to determine them in as objective a way as possible. With the discussion of reasons for three possible options and analysis of existing background literature, the methodology suggests the careful study of the clinical descriptions of a given CBS, the examination of similarities and differences vis-à-vis existing diagnostic categories in conventional nosologies, a quantitative weighing of their eminently clinical and eminently cultural variables (and variations), and its assignment of a score reflecting “minimal” to “extremely close” connection between CBS and existing DSM categories. Two examples of selected CBSs are presented and discussed, and the implications of this approach in a culturally competent psychiatric diagnosis are examined.


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Mutual creative space: An action-model of cultural competence in cross-cultural work Gadi BenEzer

While the term of "cultural competence" has become popular in recent years (Kirmayer 2010) there are not many "translations" of its general recommendations into systematic action-models within the inter-cultural encounter. This fact has led, I believe, to a significant gap between its potential application and its actual use. It has also led to an 'underuse' of alternative metaphors for dealing with diversity in mental health and other services. This paper aims at partially filling this gap by proposing a systematic way to approach the intercultural encounter. Following the last developments of the concept I termed "mutual creative space", seven categories would be presented for diagnostic/analytic and intervention/treatment as well as for training purposes. These include: recognizing the difference; acceptance; adoption; appreciation; ideal for action; invention; and full rejection. This action-model could be applied in working with individuals, families, groups, communities, and as a tool for organizational change in mental health and other organizations. Some examples, taken from an experiment of application of this concept in the last few years, will also be presented. Introducing cultural competence in a clinical practice with migrants in France: Evaluating the historical and therapeutic resistances within a systemic approach Rachid Bennegadi

Migrant and refugee care is considered an objective of the French health system, both in terms of public health, and in terms of social justice. To enable this, the French health system has developed several strategies: (1) Logically, in a political context, it was considered a specific theme, based on the fact that all healthcare should match the cultural expectations of patients. (2) Thanks to George Devereux’s discourse and his ethnopsychiatric approach, it was possible to theorize the cultural response, taking into account the economic and social conditions and the experience gained from the failures of migrant population integration in France. This approach has the merit of lifting migrant health out of a neo-colonialist discourse, but this has it’s limits, as it has essentially only highlighted cultural representations as if the French society was organised as a multi-cultural society, which it is not. (3) The Clinical Medical Anthropology approach has focused the debate on the confrontation of explanatory models giving meaning to cultural representations of mental illness among migrants (Illness) and the interpretation of mental illness and its nosographical classification (Disease). This latter approach includes all therapeutic practices, and at the same time takes into account the context and possibilities of the care system. Based on a fifty-year period of clinical practice, training, and networking, the Françoise Minkowska Centre proposes to synthesize all these paradoxes and paradigms in the concept of cultural competence. This presentation will develop the three bases of cultural competence, as seen by the health care system in France: (1) Cultural management; (2) The confrontation of explanatory models; (3) The role of health professionals in the health care system and the sense that they make of their therapeutic professions.


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Cultural competency: Meanings and models emerging from race equality policy Kamaldeep Singh Bhui

Cultural competency is a learning process to promote the delivery of effective and equitable health care to diverse cultural groups. However, a coherent set of processes and methods for a diverse range of professionals working in diverse contexts remains elusive. This paper presents the discourse about and forms of cultural competency that emerged as a consequence of race equality policy in England. These models reflect underlying tensions between organisational measures that protect and promote business efficiency above clinical impacts, and training processes that target individuals. Few approaches accommodate and properly reflect a life long learning process that includes in-depth exploration of dynamic and systemic relationships between patient and professional in the context of their respective worlds. The Swampy Cree Suicide Prevention Team Brenda Elias

The Swampy Cree Suicide Prevention team, a university and First Nation partnership, emerged to address youth suicide in the Swampy Cree territory in northern Manitoba. The team has achieved many accomplishments: 1) A qualitative studied expanded the teams understanding of indigenous knowledge about suicide and suicide prevention; 2) An annual suicide prevention meeting; 3) Community Advisory Councils to review potential suicide interventions and to revamp prevention programs and therapeutic approaches in keeping with Cree ways of understanding, communicating, and practicing health and wellbeing; 4) Several peer-reviewed publications in international journals; 5) Several national and international presentations; and 4) Mentoring students and junior staff to pursue research in this area. Next steps include: 1) Improving the capacity of Swampy Cree community members to identify those at risk for suicide; 2) Development of a First Nations needs assessment tool for suicide prevention; 3) Undertake a morbidity and mortality of children in care study; 4) Understand the impact of suicide on families; 5) Identify risk factors for suicidal behavior among youth in detention settings; 5) Support culturally based family centered mental health promotion for Aboriginal youth. Concepts of cultural competence in healthcare organizations Kenneth Fung, Ted Lo, Lisa Andermann, Rani Srivastava, Janice Dusek

Cultural Competence (CC) is increasingly recognized as an essential component of effective mental healthcare delivery to address diversity and equity issues. Drawing from the literature and our own experience in providing CC consultation and training, we will explore various concepts of cultural competence. In particular, we will further focus on cultural competence as it applies to a healthcare organization, its programs and services, as well as to healthcare providers. We will present an organizational cultural competence framework, which may be applicable to other healthcare settings. This framework, consisting of eight domains, can be used for organizational assessment and cultural competence planning, ultimately aiming at enhancing mental healthcare service to the diverse patients, families, and communities.


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Rethinking cultural competence in Indigenous community treatment settings: Inflections of tradition, reclamation, and postcoloniality Joseph P. Gone

Multiculturalist mental health professionals in the United States routinely assert that counseling requires cultural adaptation for ethnoracial minority clients. Termed cultural competence, such adaptations typically consist of specialized knowledge, skills, and experiences that promote psychotherapeutic change while protecting the distinctive cultural orientations of “diverse” clients. Indigenous communities in North America represent interesting sites for rethinking received notions of cultural competence, owing to widespread aboriginal commitments to indigenous cultural reclamation in the context of postcoloniality. In this paper, research partnerships with diverse Native-controlled treatment settings afford opportunity for reimagining cultural competence in light of local discourses concerning “traditional” culture. Specifically, alternative conceptualizations of cultural competence will be situated along a continuum of therapeutic integration that ranges between global psychotherapeutic approaches at one end and local healing traditions on the other. Brief case studies of treatment programs in two Native communities will illuminate the prospects and pitfalls of embracing alternative construals of cultural competence along this continuum. Phenomenology, racist semiotic inversions, complex bloodlines and cultural competence in Caribbean migrants Frederick W. Hickling

The migratory proclivity of people of Caribbean origin has created a burgeoning psychopathological conundrum worldwide. Few mental health professionals have diagnostic and therapeutic experience of Caribbean psychopathology, and little has been written on satisfactory cultural competence in this ethnic group. Diagnostic and therapeutic mental health controversies in Caribbean migrants, especially to First World countries have triggered an urgent need for understanding and training in these cultural differences. The four-decade clinical experience of this African Caribbean psychiatrist in the Caribbean, North America Europe and New Zealand has determined encounters between therapist and patient, and between therapists, which have crystallized phenomenological concerns, semiotic inversions and issues of complex bloodlines as three main areas for cultural competency clarification. Cultural and linguistic neologisms have sculpted phenomenological nuances not well articulated or understood outside of the Caribbean. Linguistic misunderstandings underpinned by semiotic inversions also confuse the Caribbean neophyte, often leading to unsuspected and unwitting racist conflict. Complex ethnic and familial bloodlines that are the norm in Caribbean life provide the third element in this matrix of Caribbean cultural competence presented in this analysis. Clinical case studies are outlined to demonstrate the analytic grid that reveals and underpins the cross-cultural learning objectives of this Caribbean diagnostic and therapeutic encounter.


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Culturally sensitive treatment of traumatized refugees and ethnic populations: Emotion regulation therapy for PTSD Devon Hinton, Stefan Hofmann, David Barlow & Michael Otto

In this presentation, we will describe a culturally sensitive treatment for traumatized refugees, a treatment we refer to as Emotion Regulation Therapy (ERT) for PTSD because of its emphasis on emotion regulation techniques. The treatment has been shown to be effective for treating PTSD in several randomized controlled trials: several with Cambodian refugees in the United States, one with Vietnamese refugees in the United States, and one with Spanish-speaking patients in the United States. The treatment involves multiple emotion regulation techniques—a visualization that promotes flexibility, practice in mindfulness, yoga-like stretching exercises paired with self-statements of flexible adjustment, a trauma-processing protocol—that are adapted for the culture in question. It also includes standard cognitive-behavioral techniques: education, modifying catastrophic cognitions, and interoceptive exposure. Exchanging time for space: The place of culture in acute psychiatry S. Jadhav, R. Lynch, S. Sengupta, J. Derges, S. Stevens & R. Littlewood

Preliminary research findings from a randomised control trial in acute psychiatric units in London, UK, have demonstrated that Cultural Formulation interviews (CF) improve patient engagement and clinical assessment during their in-patient stay. This paper builds upon these findings, through a qualitative analysis of a sub-set of 10 involuntarily admitted subjects selected by age, ethnicity, religion and history of contact with psychiatric services, to an inner London Psychiatric Intensive Care Unit, with diagnosis of severe and enduring mental disorder. The paper compares the biographies of suffering as constructed through Clinic notes and with CF narratives, with reference to cultural identity, idioms of distress, explanation of suffering, inter-cultural relationships, and the notions of the self. Findings suggest that CF interviews generate a rich imaginative space in exchange for precious clinical time, presenting an alternate ‘deep’ narrative of the patient through which patients are not viewed exclusively through their identified pathologies. The process validates patient experience and provides the clinician with an opportunity for reflexivity; highlighting and nourishing the ambiguities present in the clinician/patient relationship. Through these interviews, the “patient’s identity” as well as their “identity as patient” is presented, providing a tool for investigating the culture of acute psychiatric units themselves. In view of several constraints for busy clinical staff in acute psychiatry, CF interviews offer a valuable new space for dialogues that offer scope to reconfigure patient identity, and patient-clinician relationship. However, the necessity of this space is currently undervalued by clinicians, in part, because clinicians do not know how to best deploy insights gained from the CF interviews in a setting where risk management, forced medication, restraint and control are the overarching priorities. The paper hypothesises ways in which CF approach could be integrated into patient management. The authors conclude that this has major implications for clinical anthropology training, institutional culture, and mental health policy.


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The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context Arlene Katz

This paper presents findings and implications for cross cultural care of a recent study of the process of the clinical encounter – exemplars of how assumptions of both clinicians and their patients can shift or transform in the course of a diagnostic interview (Katz & Alegría, 2009) We examine the process as it is recalled, and further elaborated, in post-diagnostic interviews as part of a collaborative inquiry during reflections with clinicians and patients in the northeastern United States. Rather than treating assumptions by patients and providers as a fixed attribute of an individual, we treat them as occurring between people within a particular social context, the diagnostic interview. We explore the diagnostic interview as a landscape in which assumptions occur (and can shift), navigate the features of this landscape, and suggest that our examination can best be achieved by the systematic comparison of views of the multiple actors in an experience-near manner. We describe what might be gained by this shift in assumptions and how it can make visible what is at stake for clinician and patient in their local moral worlds-for patients, acknowledgment of social suffering, for clinicians how assumptions are a barrier to engagement with minority patients. It is crucial for clinicians to develop this capacity for reflection when navigating the interactions with patients from different cultures, to recognize and transform assumptions, to notice 'surprises', and to elicit what really matters to patients in their care. Katz, A. & Alegría, M. (2009). The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context. Social Science & Medicine, 68(7): 1238-1246. Irihapeti Ramsden: The public narrative on cultural safety Steve Koptie

The magnificent voices of Indigenous women who want to restore, preserve and extend the beauty of Indigenous culture must be relocated and honoured as the last best hope of escaping the tragic impacts of colonization. This paper started as an exploration of New Zealand Indigenous scholar Irihapeti Ramsden’s extraordinary efforts to imbed Cultural Safety as a foundation for nursing training and unity of purpose for all community helpers to alter the trajectory of colonization and its tragic impacts on Indigenous peoples. It morphed into a celebration of the powerful ‘reflective topical auto-biographies’ or meta-narratives of adaptability and resilience all Indigenous people need to share as we recover and heal from intergenerational traumas inflicted in the name of civilization and racial supremacy. Transformative change starts with self discovery as Irihapeti Ramsden taught her student nurses. Women and children are the most poignant victims of the global colonial project and their survival stories can lead all humanity back to respectful and loving sustainability. Indigenous women’s resilience stories need a special space in academic literature. Their enduring women-spirit has always guided me to be a better Indigenous man and more importantly a better human being. Irihapeti Ramsden’s journey to put Cultural Safety out there in mainstream academia began with a powerful reflective inner healing journey. The title of this paper derives from Chapter Nine of her PhD thesis, which must be shared throughout all the worlds’ spaces in need of decolonization. Her political meta-narrative to alter ignorance and arrogance within education, government and society is one all Indigenous writers and scholars must study and articulate across often culturally unsafe places and spaces within Canada’s colleges and universities.


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Revisioning the concept of culture in psychiatry: A critique Joan D. Koss-Chioino & Luis A. Vargas

This paper examines the concept and use of “cultural competence” in psychiatry, focusing particularly on the separate meanings and relevance of “culture” and “competence” for practice, research and training. It proposes that the use of “cultural competence” as a guideline in clinical practice with patients who are viewed as culturally different from mainstream North Americans presents a conundrum and serious difficulty because: 1) the term itself is confusing if deconstructed into its two opposite meanings; and 2) it does not work with the way “culture” should be conceived and integrated into psychiatric practice. The relationship of psychiatry as a discipline to a concept of culture relevant and useful for practice and training can be explicated through an understanding of the epistemological bases of the discipline. Is there a disconnect between police culture and policing with cultural sensitivity? Myrna Lashley

Police officers are trained to act with a certain homogeneity of thought. In other words, it is assumed that all officers confronting similar situations would make similar decisions. These decisions are not only based on academic and legal training, but on police codes and expectations which are instilled in students from the time they enter into the training programme. Over time, this homogeneity of thought leads to the development of a defensive mechanism which can be seen as an ‘us’ versus ‘them’ mentality. The ‘us’ is always the police force, as represented by it members, whereas the ‘them’ is frequently the citizens whom they are sworn to protect and serve. Citizens feel the brunt of being ‘them’ when they are subjected to such things as geographical profiling; racial profiling; and, plain abuse of police authority. However, members of the fraternity are sometimes ‘them’ when they behave in ways which may lead to the contravening of the code (for example, siding with a citizen against the actions of other members of the Department) with the result that the behavior of the ‘offending’ officer may lead to him or her being ostracized. It is, therefore, being posited that the regulations and codes – written and unwritten – of police departments suggests that only partial cultural sensitivity can be obtained when police interact with the general public. Why include cultural factors in DSM-V? Roberto Lewis-Fernández

The phenomenology of psychiatric disorders across cultures shows strong differences as well as commonalities. Cultural groups may describe psychopathology in more psychological or more somatic terms, or cluster syndromes in alternate ways, connecting symptoms together that other cultures do not acknowledge as related. Psycho-anthropological research on this cultural variation reveals that our current psychiatric diagnoses are somewhat arbitrary confluences of pathological processes that are fundamentally dimensional and contextual, an awareness that is also emerging from neurobiological research. Our diagnostic manuals, however, classify illnesses on the basis of descriptive, reified categories rather than contextualized dimensions. What is the role of this categorical type of nosology in a contemporary program of research on mental illness and its treatment? In particular, does categorical description and classification add anything beyond a more dimensional study of psychopathology? This talk will present an approach that uses cross-cultural categorical classifications of mental illnesses as heuristically useful natural experiments in the clustering of psychological dimensions, socio-cultural contexts, and neurobiological substrates. By observing the inter-relationships among these levels of analysis as they covary across cultural


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settings – “triangulating” them – this approach should help clarify the core phenomenological elements of the disorders as well as their socio-biological underpinnings. To illustrate this approach, we will focus on two cultural syndromes that are related to dissociative symptoms and disorders: ataque de nervios (attack of nerves) and pathological possession trance. The role of DSM-V in this research agenda will be discussed, including specific suggestions for revisions to the Manual. Cultural competence and diversity: LCME and ACGME accreditation standards Francis Lu

This presentation will review cultural competence and diversity as seen in accreditation standards for medical schools in the US and Canada (LCME) and general psychiatry residency training programs in the US (ACGME). Following the Liaison Committee on Medical Education (LCME)’s 2000 standards on cultural competence curriculum (ED 21, 22), the LCME enacted IS-16 effective July 2009 that focused on infrastructure, polices, and procedures that support diversity and inclusion. The Association of American Medical Colleges has responded to these new standards with both the 2005 Tool for Assessing Cultural Competence Training (TACCT) to assist medical schools in assessing training in cultural competence and the 2009 AAMC Group on Diversity and Inclusion to support medical school infrastructure on diversity and inclusion with a focus on faculty and house staff. The Accreditation Council for Graduate Medical Education (ACGME) accreditation standards effective July 2007 for general psychiatry residency training programs will be reviewed focusing on sociocultural issues found in 5 of the 6 core competencies. The ACGME standards are in the initial stages of review for the 2012-3 revision; ongoing advocacy for cultural competence and diversity will be needed Incorporating diverse needs and strengths into the development of a mental health strategy for Canada Farah N. Mawani

The Mental Health Commission of Canada (MHCC) is an arms-length, federally funded, non-profit organization. As part of its mandate, the MHCC is working to develop a mental health strategy for Canada. The first phase of mental health strategy development was completed in November 2009, with the release of the strategy framework document ‘Toward Recovery and Well-Being’. The document presents the vision and seven high level goals for mental health system transformation, which draw on input reflecting the experience and thinking of thousands of people from across Canada. The second phase of strategy development focuses on translating the framework into a comprehensive strategic plan for HOW to achieve the framework vision and goals. This workshop focuses on Goal Three of the strategy: “The mental health system responds to the diverse needs of all people in Canada.” A Diverse Needs and Strengths background paper will be circulated prior to the workshop. It will outline what we know now, what further work needs to be developed, and potential strategic directions to realize Goal Three. Input will be sought for an Issues and Options Paper that will inform priority setting on meeting diverse needs and incorporating diverse strengths within a transformed mental health system.


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Reframing cultural competence as a multi-level health equity intervention Kwame McKenzie

Cultural competence was initially considered a multi-level intervention to promote health equity. The challenge was for systems and organizations to improve access and outcomes. The plan was that they would do this by being embedded in their communities. Through this they would provide clinicians and populations with an infrastructure that would allow an equitable access to services directed by the diverse community. Unfortunately there is a stereotyped reaction to such challenges. Unless there is significant political will the system delegates responsibility for improved outcomes to the provider organisations and they in turn pass the responsibility to the clinician. This leads to a number of problems. Clearly the ability of the clinician to improve outcomes is significantly constrained by the infrastructure and support of the organization and the system. Clinicians target individuals, however, the perceived initial challenge was ecological. Indeed the discourse and science of improving outcomes is different at the organizational, hospital and direct care giver levels. So much so that it is not clear that these different levels mean the same things when they talk about improved outcomes and cultural competence. This is further complicated by the fact that in most complex systems differences in values and perceptions of “good” are not articulated but perceived lack of progress leads to frustration. Could re-turning to its roots and re-formulating cultural competence as a multi-level health equity intervention help communication across the different cultures within the system and so deliver a better outcomes? Translating an aesthetics of connectedness: Integrating narrative-phenomenological focused ethnography with Rasch analysis in a cross-sectional, cross-cultural pilot study of therapeutic relationships Melissa Park

Globalization shifted the focus on culture from the center to the margins. Dusting off such metaphors as crossing, contact, brokering, translation and the like led to the reframing of clinics as “borderlands,” (1, 2) heightening attention to the multiple perspectives involved in healthcare encounters and the work that families do to enter into and become competent in the discourses of biomedical culture. Resituating cultural competence as emergent and improvisational competency between subjectivities deepens understanding of how providers and patients mutually cross cultural borders by drawing on such imaginative resources as popular and mundane narratives to create common horizons of understanding across differences in race and class (3). Yet, manualization of such a reframing of both “culture” and “competency” remain superficial if only geared toward unidirectional and highly discursive guideposts, which miss the tight entanglement between imaginative practices and bodily-sensing experiences with others (4, 5). Drawing from an ethnography of children/therapist interactions, this paper examines the missing aesthetics of and resulting embodied relational knowing it takes to cross cultural borders. Reframing cultural competency as an aesthetic practice integrates the senses back into culture (6-8), while also affording a way to reflect on how and when such embodied relational ways of knowing emerge in clinical care across multiple border zones. The utility of translating an aesthetic of connectedness, as a working conceptual framework, will be explored in a cross-cultural, mixed-methods study using pre-existing instruments of the therapeutic relationship in Canada and Norway.


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The impact of American psychiatry on the Middle East Kemal Sayar

In Turkey and the Middle East, American psychiatry has had more and more influence over the past decades. The most prominent textbooks remain the major American textbooks and American psychiatric journals are studied carefully. Post-DSM-III nosology is used widely and treatment with psychiatric medications has increased markedly. Psychotherapies have always had limited usage in the Middle East, partly due to stigma, partly due to cultural differences with the West. For instance, in Islamic countries, intimate discussion of one’s sexual and private life is more avoided than in the West. As Middle Eastern countries have become gradually more influenced by Western culture, however, psychiatric practice has also become gradually more open to Western methods, such as psychotherapies, particularly cognitive behavioral therapy. Yet, various aspects of Western nosology seem limited: for instance, major depression does not tend to present in the Middle East with the DSM criteria, which are mostly psychological, but rather with somatic symptoms. The DSMs represent, in many ways, the nosology of mental illness in the Western hemisphere, but not the nosology of mental illness in general for all humanity. Further, the religious aspect of life is mostly left out of both nosology and treatment in Western psychiatry, whereas it is difficult to avoid in the Middle East. Political conflicts with the US have also hindered the ability of psychiatrists in much of the Middle East to sufficiently interact with American counterparts, so as to better appreciate and analyze American views in psychiatry. Is cultural competence the best concept for psychology? Luis A. Vargas & Joan D. Koss-Chioino

This article questions whether cultural competence is the best concept for psychology. It examines culture from the perspectives of anthropology and psychology. Four aspects related to the concept of cultural competence are examined to explain how American psychology came to espouse this concept and show its limitations: (1) the Age of Enlightenment and psychology's cult of expertise; (2) the process of legitimization of the study of culture by aligning the concept of competence with culture; (3) the isolation of culture as a variable; and (4) psychology-as-a-science in which science is equated with empiricist methods. The authors suggest that psychology needs to endorse alternative epistemologies, and the methods that derive from them, to develop culturally responsive theory, research, and practice. Shielded minds: The paradox of cultural safety and youth engagement leadership Cynthia Wesley-Esquimaux

Aboriginal people in Canada are poised on the edge of the 21st century armed with a traditional knowledge base, rapidly reconstructing cultural values and practices, national reclamation of languages, undeveloped on-reserve lands and human resources, and a growing demographic of potential young leaders. Taking a pragmatic approach to resolving Indigenous difference means operationalizing existing traditional and cultural tools and mobilizing young people towards a collaborative effort within Canada in order to build a veritable (real) identity and a new socio/political relationship with western society. This paper will look to Aboriginal and non-Aboriginal youth as the source of an emerging “deep practice” leadership model forming out of an action-based hybridized Indigenous framework for leadership and reconciliation called the Canadian Roots Exchange. This study highlights the current state of youth engagement in Canada, especially in regards to Aboriginal youth across this country, and examines the roadblocks,


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successes and the challenges, and the failures of policy and practice when it comes to nurturing and supporting specific kinds of youthful “deep practice” leadership and cultural safety initiatives. Adapting and transforming services and interventions across cultures: Identifying cultural services preferences Les B. Whitbeck & Melissa L. Walls

This paper addresses services preferences of 971 parents/caretakers of Indigenous adolescents ages 10-12 years who live on or near reservations and reserves in the northern Midwest U.S. and Western Ontario, Canada. The adults were asked about the perceived effectiveness of formal and informal sources of help for emotional problems and alcohol and drug problems for themselves and for their children. For emotional problems, the adults’ top eight preferences for help were traditional: 1) family member, 2) talking to an elder, 3) offering tobacco and praying, 4) traditional healer, 5) healing circle, 6) traditional ceremony, 7) sweat lodge, 8) pipe ceremony. All of these were listed prior to mention of a formal services provider: counselor on reservation. The least preferred sources of help were social workers off-reservation/reserve (ranked 21st, 12.6%) and on-reservation (ranked 22nd, 10.4%). Rankings differed slightly for emotional problems of their children. The top five sources of help were informal traditional sources: 1) family member, 2) talking to an elder, 3) offering tobacco and praying, 4) traditional healer, 5) traditional ceremony. The first formal source of help was an on-reservation/reserve psychiatrist which was ranked 6th. This was followed by two more traditional sources: healing circle, ranked 7th and sweat lodge, ranked 8th,. Preferences for alcohol and drug services followed similar patterns for both adults and children. However, when adults who said they actually had an emotional problem were asked to whom they turned, family doctor was the second most mentioned source of help after family member. A similar pattern was found for alcohol/drug problems with substance abuse counselor mentioned after family members. It appears that although there are strong preferences for traditional sources of help few actually sought these out in times of need. Possible reasons for this apparent gap in preferences and behaviors will be discussed as well as the need to interface traditional and formal services to increase services utilization. Religious competence as cultural competence Rob Whitley

Definitions of cultural competence often refer to the need to be aware and attentive to the religious needs and orientations of patients. However the institution of psychiatry has become increasingly averse to religious interpretation of mental illness or religiously-oriented interventions/ involvement. This is despite the fact that many patients, especially those from underserved and underprivileged minority backgrounds, are devotedly religious and find much solace and support in their religiosity. I argue that psychiatric services must become more closely attuned to matters religious. This may aid in the development of culturally-competent accessible services, in turn increasing engagement and service-satisfaction among minority populations.


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Biographical Notes

Renato D. Alarcon, MD, MPH, is currently Professor in the Department of Psychiatry and Psychology at Mayo Clinic College of Medicine, Consultant in Psychiatry at Mayo Clinic, and Medical Director of the Mood Disorders Unit, Mayo Psychiatry and Psychology Treatment Center (MPPTC) in Rochester, MN. He also is the holder of the Honorio Delgado Chair from his Alma Mater, the Universidad Peruana Cayetano Heredia (UPCH), in Lima, Perú. Between 1993 and 2002, he was Chief of the Mental Health Service Line at the Atlanta VA Medical Center, and Professor and Vice Chairman of the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, in Atlanta, GA. A Corresponding Member of Perú’s National Academy of Medicine, he is author or co-author of over 200 peer-reviewed articles, 14 books (Identity of Latin American Psychiatry, Personality Disorders and Culture, The Mosaics of Hope, among others) and 70 book chapters, mostly in the areas of Diagnosis and Nosology, Mood and Personality Disorders, and Cultural Psychiatry. He is Senior Editor of the standard psychiatric textbook in Latin America, and of the three-volume Ibero-American Encyclopedia of Psychiatry, Co-Editor of Archivos de Psiquiatría, the oldest psychiatric journal in Spain, and member of the Editorial Boards of 18 psychiatric journals in the United States, Latin America and Europe. He was the recipient of APA’s Simon Bolivar Award in 1999, is a Distinguished Life Fellow of the American Psychiatric Association (APA), Fellow of the American College of Psychiatrists (ACP), and former Chair of the Cultural Psychiatry Committee of the Group for the Advancement of Psychiatry (GAP). Former President of the American Society of Hispanic Psychiatry (ASHP), he is also a member of the Mental Health Task Force of the Carter Center in Atlanta, Honorary and Visiting Professor in several Latin American and European Universities. Currently, he is a member of the Scientific Program Committees of APA (Chair of the New Research Section), ACP, and belongs also to APA’s DSM-V Task Force, as a member of the Personality Disorders Work Group and the Cultural and Gender Issues Study Group.

Lisa Andermann, MPhil, MD, FRCPC, is an Assistant Professor in the Department of Psychiatry at the University of Toronto and psychiatrist at Mount Sinai Hospital, where she works in the Psychological Trauma Clinic as well as the Ethnocultural Assertive Community Treatment Team. She is also is a psychiatric consultant with the Canadian Centre for Victims of Torture. Her main areas of interest in research and teaching focus on cultural psychiatry. She has been part of the Toronto-Addis Ababa Psychiatry Program (TAAPP), assisting in the development of the first psychiatry residency training program in Ethiopia.

Gadi BenEzer, PhD, is a senior lecturer of Psychology and Anthropology in the Department of Behavioral Sciences, The College of Management, Israel. His training includes clinical and organizational psychology, and anthropology. Over the last three decades he has worked cross-culturally as a psychotherapist and organizational psychologist with the various groups, particularly Ethiopian Jewish immigrants in Israel. He has written extensively on Ethiopian Jews, trauma and life stories, and cross-cultural psychotherapy. Among his books are: The Ethiopian Jewish Exodus: Narratives of the Migration Journey to Israel 1977-1985 Routledge, 2002; also republished as "The Migration Journey", Transaction, 2006, and As Light within A Clay Pot: Migration and Integration of Ethiopian Jews in Israel (Ruben). His papers include “Group-Work across the Cultural Divide" (Transcultural Psychiatry, 2006) and “Cross Cultural Misunderstandings” (ISSR, 1985). He has been a visiting scholar and lecturer at major universities, including the Refugee Studies Centre, University of Oxford, and delivered the 2007 Sherman Lectures at the University of Manchester, England.


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Rachid Bennegadi, MD, General Secretary of the Transcultural Psychiatry Section of the World Psychiatry Association is the Director of the Research and Teaching Pole at Minkowska Centre, a medico-psycho-social centre for migrants and refugees in and around the Parisian area. He has a long experience in the paradigm of migration and mental health. Former president of the Migration and Health Association, psychiatrist and anthropologist, he worked on a research project on “Culture and Personality” at the Institute of Personality, Assessment and Research (IPAR) at UC Berkeley on a Fulbright Senior Grant. He is Teaching Director of the University Diploma “Health, Care, Illness and Cultures” with the Paris V University Rene Descartes. He is the co-editor in chief of the new clinical medical anthropology review produced by Minkowska Centre, TranSfaire & Cultures. He is also the vice editor in chief of the French version of the World Psychiatry newsletter. He and his team have developed many multi-media tools concerning cultural training and cultural competence. They also produced a background paper for the European Community and IOM on “Cultural Competence and training in mental health practice in Europe: Strategies to implement competence and empower practitioners.” He is a founding member of the Euromed Network on migration and mental health.

Kamaldeep Singh Bhui is Professor of Cultural Psychiatry & Epidemiology at Barts & The London Medical School, Queen Mary University of London and Hon Consultant Psychiatrist at East London Foundation Trust. He qualified in Medicine at the United Medical Schools of Guy's & St Thomas, where he was later worked as a research associate and research fellow. He completed his psychiatry training at the Maudsley Hospital, and his MD at the Institute of Psychiatry as a Wellcome Fellow, investigating common mental disorders among Punjabi and English primary care attendees. He completed a BSc in Pharmacology and UCL, and MSc Epidemiology at the London School of Hygiene and Tropical Medicine. His research interests include social exclusion and environmental effects of health, health services research, the integration of anthropological and epidemiological research methods, and investigations of risk factors such as cultural identity, explanatory models of mental disorders, geographical mobility and racism.

Janice Dusek, RN, BSN, MS, MBA, CHE, is the CNE/Vice-President, Interprofessional Affairs, Quality & Safety at Ontario Shores Centre for Mental Health Sciences. She provides strategic leadership in interprofessional practice and in the operation of several key hospital portfolios including Corporate Quality, Risk, Safety, Interprofessional Research and Academics. She is the executive lead for the development of the corporate cultural competence plan. She has extensive experience in the health care sector, which is complemented by previous leadership positions in academic health science centres and community hospitals. Janice is an assistant professor in the Faculty of Nursing at the University of Toronto and the Faculty of Health Sciences at the University Of Ontario Institute Of Technology. She is currently pursuing her PhD at the University of Toronto.

Brenda Elias, PhD, presenting on behalf of the Swampy Cree Suicide Prevention Team, is a CIHR New Investigator, Co-Director of the Manitoba First Nation Centre for Aboriginal Health Research, Assistant Professor at the University of Manitoba, Faculty of Medicine, Department of Community Health Sciences, First Nations, Metis and Inuit Health Section. The Swampy Cree Suicide Prevention Team is funded by the Canadian Institutes of Health Research. The team is led by Drs. Jitender Sareen, Brenda Elias and Mr. Garry Munro. The funding brings together representatives from eight Swampy Cree Tribal Council communities with University-based researchers and international consultants Kenneth Fung, MD, FRCPC, MSc, is a Staff Psychiatrist and Clinical Director of the Asian Initiative in Mental Health Program at the Toronto Western Hospital, University Health Network. He is also Assistant Professor with Culture, Community, and Health Studies Program at the


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Department of Psychiatry, University of Toronto. His primary research, teaching, and clinical interests include both cultural psychiatry and psychotherapy. He is a member of Toronto Central LHIN Mental Health and Addictions Steering Committee.

Joseph P. Gone, PhD, is assistant professor in the Department of Psychology (Clinical Area) and the Program in American Culture (Native American Studies) at the University of Michigan in Ann Arbor. Gone received his doctorate in clinical and community psychology at the University of Illinois at Urbana-Champaign. His research interests include cultural psychology and American Indian mental health.

Frederick W. Hickling, BSc (Anat.), MBBS, DM, MRCPsych (UK), FRSM, DLFAPA, was born in Jamaica, attended Wolmers Boys School on a Wolmers Foundation Scholarship (1954-1961), and educated in medicine and psychiatry at the University of the West Indies, Mona. He received specialist training in anatomy at St. Thomas’ Hospital Medical School, University of London, and postgraduate training in psychiatry at the Royal Edinburgh Hospital, University of Edinburgh. Professor Hickling helped to establish a unique community psychiatric service and to pioneer cultural therapy in Jamaica in the 1970’s. In the 1980’s he established a private psychiatric research and clinical service in Kingston, and in the 1990’s he was instrumental in helping to shape policy for African Caribbean Mental Health in the United Kingdom. With wide international experience in the Caribbean, North America, the UK and New Zealand, he was Head, Section of Psychiatry, University of the West Indies Mona, from 2000 to 2006, and is presently Professor of Psychiatry, University of the West Indies, Mona, and Executive Director of the UWI Caribbean Institute of Mental health and Substance Abuse (CARIMENSA). His research interests are in African Caribbean mental health, schizophrenia, personality disorder, community psychiatry, psychotherapy, political psychology and cultural therapy. He has more than 100 articles and book chapters in peer reviewed journals and books. He is the author and editor of five books. He was elected a Distinguished Fellow of the American Psychiatric Association in 2008. He is married to Dr. Hilary Robertson-Hickling PhD, and has three children, Deborah, Daniella and Akindele.

Devon E. Hinton, MD, PhD, is an anthropologist and psychiatrist, and an Associate Professor at Massachusetts General Hospital, Harvard Medical School. He has written extensively on the culturally specific presentations of panic attacks, panic disorder, and PTSD among Southeast Asian populations, particularly Cambodian and Vietnamese refugees. He and his team have developed a manualized treatment that can be culturally adapted for the treatment of traumatized refugees, a treatment that has been shown to be effective (in controlled trials) for Cambodian and Southeast Asian refugees, and for Spanish-speaking populations. He is the co-editor, with Byron Good, of the volume Culture and Panic Disorder (Stanford University Press). He is a member of the DSM-V Advisory Committee for the Anxiety Disorders.

Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, is Senior Lecturer in Cross-cultural Psychiatry at the department of Mental Health Sciences, University College London (UCL); and Honorary Consultant Psychiatrist, Homeless Outreach Services, Camden and Islington NHS Foundation Trust. He is Founding Editor of the international journal, Anthropology and Medicine (Taylor & Francis), & Director, University College London Masters in Culture and Health. Dr Jadhav graduated from Grant Medical College, Mumbai, and completed his postgraduate MD training in psychiatry at the National Institute of Mental Health & Neurosciences, Bangalore. He subsequently obtained his PhD in cultural psychiatry at UCL researching white British natives of London. His current interests include 1) the development of cultural dialogues to engage with acutely unwell psychiatric patients; 2) mental health dimensions of marginal groups with a focus on South Asia. He currently supervises doctoral candidates on the cultural appropriateness of community psychiatric services in rural Uttar


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Pradesh & the trajectory of Child Soldiers in Nepal. Dr Jadhav is Co-Director of the UCL-BALM Research Unit, Kovalam, Tamil Nadu, India.

Steven Koptie is from the Six Nations of the Grand River, and a latecomer to academia, returning to graduate school after 35 years of community work in Southern Ontario and the far north. He is dedicated to the idea that Native people have a right to be fully recognized as a distinct people, and this means that the question of "Cultural Safety" and recognition of an Indigenous identity guides the community work he does. He has a special place in his heart for children with complex needs, doing battle on their behalf since his early years in the field. He has taken up the cause of implementing “cultural safety” as the only true mechanism for reconciliation and Aboriginal well-being in Canada.

Arlene M. Katz, EdD, is an Instructor in the Department of Global Health and Social Medicine at Harvard Medical School, and senior consultant in qualitative/ethnographic research at the Center for Multicultural Research at Cambridge Health Alliance. Her work emphasizes the importance of hearing the 'voice' of the patient and the community in care, training and research. As former Director of the CHA Community Councils Project she collaborated with community elders and professionals to develop program to address ageism by creating a 'Council of Elders' to make visible the lived experience of aging (Katz, Conant, et al., 2000). A series of community-based participatory ethnographic research projects followed involving the development of 'resourceful communities' of those involved in clinical practice, training and research, in part to address issues of inequality and access to care, and to create among healthcare professionals a greater sense of responsiveness and answerability to the needs of their multicultural community. Her studies and projects have resulted in several papers and reports on the poetic dialogic approaches to the changing face of healthcare (Katz, 1998); understanding and elaboration of diagnostic practices in primary care, and in the process of mentorship (Katz and Shotter, 1996; Shotter and Katz, 1996; Katz, Siegel and Rappo, 1996); the experience of research ethics in a Children's hospital (Katz and Fox, 2004) and of minority women in maternal and infant health; most recently the clinical encounter as ‘local moral world’, shifts of assumptions in multicultural care (Katz and Alegría, 2009).

Joan Koss-Chioino, PhD, is a Professor of Anthropology (Emerita) at Arizona State University, Research Professor of Psychology at George Washington University in Washington, DC and Visiting Professor in the Department of Psychiatry and Neurology at Tulane University School of Medicine. As a medical anthropologist she works at the interface between anthropology, psychiatry and psychology. Her primary interest is the treatment of illness and emotional problems, whether traditional, alternative or psychotherapeutic, primarily in Latino cultures in the Southwest (treatment research), in Puerto Rico, and Spain. Currently, she in analyzing data from a study of mood change and depression among older women in Andalucia, Spain and studying doctors who are Spiritists in Puerto Rico compared to doctors who do not use spirituality in their clinical work and effects on their patients. These projects are all ethnographic and phenomenological (with the exception of the project on outcomes of family therapy for Mexican American and Mexican immigrant youths); most to a large extent. Qualitative data analytic techniques (with triangulation in some projects) have been used to produce over eighty chapters and articles. Koss-Chioino serves as a board member of the Metanexus Institute for Religion and Science and advisor to the Spiritual Transformation Scientific Research Program. In addition to articles and chapters her publications include: Women as Healers, Women as Patients: Mental Health Care and Traditional Healing in Puerto Rico (Westview Press, 1992), Working With Culture: Psychotherapeutic Interventions with Ethnic Minority Children and Adolescents (Jossey Bass, 1992); Working With Latino Youth: Culture, Context and Development (Jossey Bass, 1999), the latter two with Luis A. Vargas, and


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Medical Pluralism in the Andes, (Edited.) (Routledge, 2003). Her latest book is Spiritual Transformation and Healing (Rowman and Littlefield, 2006) with Philip Hefner.

Myrna Lashley holds a PhD in counseling psychology from McGill University. She is a professor of psychology at John Abbott College and a lecturer in the McGill University Summer School on Transcultural Psychiatry. She is an internationally recognized clinical, teaching and, research authority in cultural psychology, and serves as an expert psychological consultant to institutions, including the juvenile justice system. She has worked both as a consultant to First Nations and the Jewish communities, and as the Cross Cultural Trainer for the Grievance Committee office of the secretariat for McGill University. She has also conducted training workshops locally, nationally, and internationally and has acted as a consultant to the Brazilian health care system. She was a director of the Canadian Race Relations Foundation and has also served on the Comité consultatif sur les relations Interculturelles et Interraciales de la Communauté Urbaine de Montréal. Currently, she is the Chair of the Cross Cultural Roundtable on Security, as well as Vice-chair of the board of the École Nationale de Police du Québec. She has also been appointed to the Comité expert en matière de profilage racial of the Service de Police de la Ville de Montréal. In addition, she has also authored two training manuals on intercultural issues in the workplace. She has received several awards including the 2006 Friends of Simon Wiesenthal Award for Holocaust studies; the 2004 Martin Luther King legacy award; as well as the 1995 Merit Award for the Kahnawake Native survival school. She is currently Barbados’s Honorary Consul to Montreal.

Roberto Lewis-Fernández, MD, is Director of the NYS Center of Excellence for Cultural Competence and the Hispanic Treatment Program at New York State Psychiatric Institute, Associate Professor of Clinical Psychiatry at Columbia University, and Lecturer on Social Medicine at Harvard University. His research focuses on the socio-cultural determinants of illness experience, symptomatology, help-seeking behavior, and treatment outcome among U.S. Latinos and African Americans diagnosed with anxiety, depressive, and dissociative disorders. Dr. Lewis-Fernández is a member of the National Advisory Mental Health Council of the NIMH, of the Anxiety Disorders Work Group and the Culture and Gender Study Group of the DSM-V, and of the Community Services Board of the NYC Department of Health and Mental Hygiene, as well as chair of the Cultural Psychiatry Committee of the Group for the Advancement of Psychiatry. From 1996 to 2007, he served as Editor of the Cases Section of Culture, Medicine and Psychiatry, which publishes clinical cases illustrating the impact of culture on the symptoms, course, and outcome of psychiatric disorders and patients' help-seeking choices.

Hung-Tat (Ted) Lo, MBBS, MRCPsych, FRCPC, is a community psychiatrist in Toronto and is an Assistant Professor at the University of Toronto, consulting to the Culture Community and Health Studies Program in the Department of Psychiatry. He participates in various cultural psychiatry initiatives in the Centre for Addiction and Mental Health, Mt. Sinai Hospital, and various community agencies. He is the Secretary of the Transcultural Section of the Canadian Psychiatric Association, a member of the Service Systems Advisory Committee of the Mental Health Commission of Canada, and Chair of the Steering Group of the Diversity Project. Francis Lu, MD, is the Luke and Grace Kim Endowed Professor in Cultural Psychiatry, Director of Cultural Psychiatry, and Associate Director of the General Psychiatry Residency Training Program. His career has focused on cultural competence and diversity, mental health disparities, psychiatric education with an emphasis on recruitment and mentorship, and the interface of psychiatry and religion/spirituality especially through film. He currently works with both the Asian American Center on Disparities Research and the Center for Reducing Health Disparities at UC Davis and has served on the California State Department of Mental Health Cultural Competence Advisory


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Committee since 1996. The American Psychiatric Association (APA) awarded him the 2001 Kun-Po Soo Award for his work in integrating Asian issues into psychiatry; in 2002, he received a Special APA Presidential Commendation for his work in cross-cultural psychiatry. In 2008, the American Psychiatric Foundation awarded him one of its Advancing Minority Mental Health Awards and the Association for Academic Psychiatry honored him with its Lifetime Achievement in Education Award.

Farah N. Mawani, MSc, PhD (C), is a Senior Policy & Research Analyst with the Mental Health Strategy team of the Mental Health Commission of Canada. Farah is leading development of the Diverse Needs and Strengths, Data, and Research/Knowledge Topic Areas for the second phase of development of Canada’s first national mental health strategy. She is also the Mental Health Strategy’s lead liaison with the Mental Health Commission’s Science and First Nations, Inuit and Metis Advisory Committees. She has global research and teaching experience in social and cultural determinants of health. In addition to work in Kenya, Pakistan, India, China, South Africa, Switzerland and the United States, she has extensive Canadian policy research experience. She also gained invaluable insight in her role as Chair of the Board for Access Alliance Multicultural Health and Community Services. Her primary areas of expertise are inequalities in mental health, social and cultural determinants of mental health, immigrant and refugee mental health, and community-based research. She is also committed to indigenous people’s health, inspired by extensive and ongoing community-based work with the Maasai in East Africa, her region of origin. She has pursued that interest in Canada in work with the National Forum on Health and the Public Health Agency of Canada.

Kwame Julius McKenzie trained in medicine at the University of Southampton, England. His psychiatric training was principally at the Maudlsey Hospital and Institute of Psychiatry, London but included a year as a visiting scholar at Harvard University and two years undertaking the first description of community mental health services in Brussels Belgium. Dr. McKenzie is a psychiatrist, researcher and policy advisor. He has worked in the field of the cause of psychosis and in cross cultural mental health for 19 years. He has set up innovative mental health services, has advised national and provincial government on mental health policy and has over 100 academic publications including four books. His work spans basic science and applied policy research. He has experience of working in Europe, the Caribbean, the UK and the United States of America. Dr McKenzie is an expert on the social causes of psychosis, social capital and the impact of racism on mental health. Dr McKenzie is the Director of the Social Aetiology and Mental Illness Canada Institutes of Health Research training program. He is a Professor of Psychiatry at the University of Toronto and a Senior Scientist in Social Equity and Health Research, Medical Director for Diversity and Deputy Director of the Schizophrenia Program at the Centre for Addictions and Mental Health. He serves on the Service System Advisory Committee of the Mental Health Commission of Canada.

Melissa M. Park, PhD, OTR/L, is currently an international CoFAS Marie Curie Postdoc at Karolinska Institutet and will be starting as an assistant professor at McGill University in the summer of 2010. Current research interests evolve from doctoral work looking at the interactions in "gaps between" individuals with preschoolers with autism and sensory-integration trained occupational therapists, postdoctoral work on NIH funded grants using (1) longitudinal ethnography of ethnic minority families with children with disabilities and (2) mixed methods on policy changes in a community based mental health clinic, including: clinical reasoning, impact of systems on therapeutic relationships, bodily-sensing forms of knowing and intersubjectivity in clinical care. Her scholarship is informed by an extensive background in visual arts, film, symbolic modes of representation, and aesthetics.


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Kemal Sayar, MD, is Professor of Psychiatry at Fatih University, Istanbul, Turkey. He is the author of the book Psychiatry and Culture, and editor of another volume in Turkish that brings together papers presented by eminent international scholars, entitled Psychiatry and Mental Health. He has been the vice director of Turkey’s largest mental health institution Bakirkoy Mental Hospital and has taught at several universities. His research is focused on psychosomatic disorders and he is one of the propagators of cultural psychiatry in Turkey. Besides his medical career, he makes TV programmes and documentaries.

Rani Srivastava, RN, PhD, is a nursing professional practice leader with extensive experience in practice, education, consultation, administration, and research. Currently she is the Deputy Chief, Nursing Practice at Centre for Addiction and Mental Health, Adjunct Professor and part time faculty at the School of Nursing, York University, and Assistant Professor at the Lawrence Bloomberg Faculty of Nursing. She worked with the College of Nurses of Ontario to develop practice guideline on Culturally Sensitive Care. She chaired a national panel to develop best practice guidelines for Embracing Cultural Diversity in Health Care through the Registered Nurses Association of Ontario. She is the author and editor the Healthcare Professional’s Guide to Clinical Cultural Competence.

Luis A. Vargas, PhD is an Associate Professor in the Department of Psychiatry at the University of New Mexico. He was previously the director of the clinical psychology internship program for fourteen years. His clinical and scholarly work has focused on providing culturally responsive services to diverse children and adolescents, particularly in Latino communities. He is co-editor (with Joan D. Koss-Chioino) of "Working with Culture: Psychotherapeutic Interventions with Ethnic Minority Children and Adolescents" and a co-author (with Joan D. Koss-Chioino) of "Working with Latino Youth: Culture, Development, and Context," both published by Jossey-Bass. He is a past president of Division of Child and Family Policy and Practice (Div. 37) of the American Psychological Association, a Fellow of the American Psychological Association (Div. 12, 37 & 45) and a fellow of the Association of State and Provincial Psychology Boards (ASPPB).

Cynthia Wesley-Esquimaux, PhD is an assistant professor in Aboriginal Studies and the Factor Inwentash Faculty of Social Work, at the University of Toronto. She has dedicated her life to building bridges of understanding between people. She has a particular interest in developing creative solutions to complex social issues and sees endless merit in bringing people from diverse cultures, ages, and backgrounds together to engage in practical dialogue. Cynthia is an Advisory Member of the Mental Health Commission of Canada, holder of the Nexen Chair for Aboriginal Leadership out of the Banff Centre, a returning member of the Lake Simcoe Science Advisory Committee, and an active and engaging media representative. In addition, she is the new Liberal Candidate for the York Simcoe Riding and is busy campaigning for the next Federal Election. Cynthia is a member of the Chippewa of Georgina Island First Nation in Lake Simcoe and has made a life-long commitment to educating the public about the history and culture of the Native peoples of Canada. Her areas of interest include historical and political relations, historic trauma, national reconciliation, and positive national youth engagement through the Canadian Roots Exchange project.

Les B. Whitbeck, PhD, is the John G. Bruhn Professor of Sociology at the University of Nebraska-Lincoln. He received his B.A. in philosophy from Western Washington State University in 1969, a M.A. in Religion from Earlham School of Religion in 1973, a Masters in Social Work from Indiana University-Purdue University at Indianapolis in 1975 and his Ph.D. in sociology from Washington State University in 1986. He was principal investigator for the Midwest Longitudinal Study of Homeless Adolescents and is currently heading a NIH-funded program of research that focuses on


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homeless women and children. He is principal investigator for an eight-year diagnostic study of American Indian children aged 10-12 years. Dr. Whitbeck has authored or co-authored two books on homeless adolescents and over 100 refereed journal articles. He received the 2007 Community, Culture, and Prevention Science Award from the Society for Prevention Research.

Rob Whitley, PhD, is Research Assistant Professor of Psychiatry at Dartmouth Medical School and Research Associate, Division of Social and Transcultural Psychiatry, McGill University. He is a health services researcher with considerable experience conducting mixed-methods studies on mental illness and recovery among minority and marginalized populations across the globe. He is currently principal investigator on a large-scale project on recovery from severe mental illness amongst African-Americans. Whitley has also conducted research on health and illness in London, Montreal, New York City, Washington DC, Kingston (Jamaica) and rural Ethiopia. Whitley was awarded the Degree of Doctor of Philosophy from King’s College London, and received post-doctoral training at the Division of Social and Transcultural Psychiatry, McGill University.


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Contact Information Renato D. Alarcón, MD, MPH Mayo Clinic 200 1st St. SW GE 1 B Rochester, MN 55905 Tel: (507) 284-3352 E-mail: [email protected]

Dr. Lisa Andermann Department of Psychiatry University of Toronto Mount Sinai Hospital 600 University Avenue 9th Floor Toronto, ON M5G 1X5 Tel: (416) 586-4800 x 4514 E-mail: [email protected]

Dr. Gadi BenEzer Dept. of Behavioural Sciences College of Management Rishon Letzion, Israel 75190 Tel: +972(0)36414875(h) Mobile: +972(0)522594638(w) E-mail: [email protected]

Dr. Rachid Bennegadi Mikowska Centre 12 Rue Jacquemont 75017 Paris, France Tel: +33(0)153068484 E-mail: [email protected]

Professor Kamaldeep Bhui Centre for Psychiatry at the Wolfson Institute of Preventive Medicine Barts and The London School of Medicine & Dentistry Queen Mary University of London Joseph Rotblat Building Charterhouse Square London EC1M 6BQ Tel: 020 7882 2012 (DL)/2021 (PA) Fax 0207 882 5728 E-mail: [email protected]

Janice Dusek, CNE & VP Interprofessional Affairs, Quality & Safety Ontario Shores Centre for Mental Health Sciences 700 Gordon Street Whitby, ON L1N 5S9 Tel: (905) 430-4030 E-mail: [email protected] Dr. Brenda Elias


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Centre for Aboriginal Health Research University of Manitoba J. Buhler Research Centre, Room 715 715 McDermot Avenue Winnipeg, Manitoba, Canada R3E 3P4 Tel: (204) 789-3250 Fax: (204) 975-7783 E-mail: [email protected]

Dr. Kenneth Fung Assistant Professor, University of Toronto Clinical Director, Asian Initiative in Mental Health Toronto Western Hospital 399 Bathurst Street, 9 EW Toronto, ON M5T 2S8 Tel: (416) 603-5349 Fax: (416) 603-5661 E-mail: [email protected] Joseph P. Gone, PhD Assistant Professor of Psychology & American Culture Department of Psychology University of Michigan 2239 East Hall, 530 Church Street Ann Arbor, Michigan 48109-1043 Tel: (734) 647-3958 Fax: (734) 615-0573 Cell: (734) 255-1420 E-mail: [email protected] Website: http://sitemaker.umich.edu/joseph.p.gone/home

Professor Frederick Hickling Department of Community Health and Psychiatry University of the West Indies Mona, Kingston 7, Jamaica Tel: 876 927 2492 Fax: 876 927 2116 Mobile: 876 399 1809 E-mail: [email protected]

Devon E. Hinton, MD PhD Massachusetts General Hospital 15 Parkman Street, WACC 812 Boston, MA 02114 Phone: (617) 620-4522 Fax: (978) 970-5595 E-mail: [email protected]


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Dr. Sushrut Jadhav UCL Research Department of Mental Health Sciences Charles Bell House, 67 -73, Riding House Street London W1W 7EJ, United Kingdom Tel: +44 (0)20 7679 9452/9292 Fax: +44 (0)20 7679 9426 E-mail: [email protected] http://www.ucl.ac.uk/mental-health-sciences/specialities/Unit%20of%20Clinical%20Anthropology.htm UCL-‐BALM Research Unit: http://www.balm.in/doc/UCLBALMResearchUnit.pdf Arlene M. Katz, EdD Center for Multicultural Mental Health Research Cambridge Health Alliance, HMS 227 Concord Ave. Cambridge, MA 02138 Tel: (617) 868-2132 E-mail: [email protected]

Laurence J. Kirmayer, MD Institute of Community & Family Psychiatry 4333 Cote Ste Catherine Rd. Montreal, Quebec H3T 1E4 Tel: (514) 340-7549 Fax: (514) 340-7503 E-mail: [email protected] URL: www.mcgill.ca/tcpsych

Steven W. Koptie, MEd NaMeRez Men's Residence, Housing Coordinator 16 Vaughan Road Toronto, Ontario Tel: 1-289-338-1114 E-mail: [email protected]

Joan Koss-Chioino Research Professor in Psychology George Washington University 2753 Bon Haven Lane, Annapolis, MD 21401 E-mail: [email protected]

Myrna Lashley, PhD Culture and Mental Health Research Unit Institute of Community and Family Psychiatry 4333 Cote Ste Catherine Road Montreal, Quebec Canada H3T 1E4 Tel: (514) 340-7549 E-mail: [email protected]


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Roberto Lewis-Fernández, MD Associate Professor, Department of Psychiatry, Columbia University NYSPI, Rm 3200 (Unit 69) 1051 Riverside Drive, NY NY 10032 Tel: (212) 543-6512 Fax: (212) 543-6515 E-mail: [email protected]

Francis G. Lu, MD Luke & Grace Kim Endowed Professor in Cultural Psychiatry Dept. of Psychiatry & Behavioral Sciences UC Davis Health System 2230 Stockton Blvd., Sacramento, CA, 95817 (916) 734-4986 / (916) 734-3384 fax / (916) 708-5542 cell Preferred e-mail: [email protected] UC Davis faculty profile: www.ucdmc.ucdavis.edu/psychiatry/ourteam/faculty/lu.html

Farah N. Mawani, MSc, PhD (C) Senior Policy and Research Analyst, Mental Health Strategy Mental Health Commission of Canada 1145 Carling Avenue Ottawa, ON CANADA K1Z 7K4| (613) 683-1862 E-mail: [email protected]

Dr. Kwame McKenzie Social Equity and Health Research Centre for Addiction and Mental Health 455 Spadina Avenue, Suite 300 Toronto, Ontario M5S 2G8 (416) 535-8501 ext. 7636 E-mail: [email protected]

Melissa Park, PhD OTR/L Guest researcher / Postdoctoral Fellow Karolinska Institutet Stockholm SWEDEN E-mail: [email protected]

Cécile Rousseau, MD Transcultural Research and Intervention Team (TRIT) CSSS de la Montagne (Parc Extension) 7085 Hutchison Street, Local 204.2 Montréal QC H3N 1Y9 Tél: (514) 273-3800 (poste 6452) Télécopieur/Fax: (514) 380-8147 E-mail: [email protected]


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Kemal Sayar, MD Bagdat Caddesi 162/13 Hisar Apartmani Selamicesme Kadikoy Istanbul, Turkey

Dr. Rani Srivastava Deputy Chief, Nursing Practice Centre for Addiction and Mental Health 1001 Queen Street West Toronto, ON M6H 1J4 Tel: (416) 535-8501 x 2006 E-mail: [email protected] Luis A. Vargas, PhD Children's Psychiatric Center - Outpatient Services 2600 Marble, N.E., Bldg. 2 MSC 10 8000 1 University of New Mexico Albuquerque, NM 87131-0001 Cell: (505) 362-5533 Office: (505) 272-2190 Fax: (505) 272-3466 E-mail: [email protected]

Cynthia C. Wesley-Esquimaux, PhD Centre for Aboriginal Initiatives 563 Spadina Avenue, Room 226 Toronto, Ontario M5S 2J7 [email protected] (905) 252-5441

Les B. Whitbeck, PhD Bruhn Professor of Sociology University of Nebraska-Lincoln 739 Oldfather Hall Lincoln, NE 68588-0324

Rob Whitley PhD Culture and Mental Health Research Unit Institute of Community and Family Psychiatry 4333 Cote Ste Catherine Road Montreal, Quebec Canada H3T 1E4 Tel: (514) 340-7549 E-mail: [email protected]

Documents

Advanced Study Institute in Cultural Psychiatry Rethinking ...Advanced Study Institute in Cultural Psychiatry Rethinking Cultural Competence from International Perspectives April 27