Responding to Client

1
Responding to Clients Mental Health Issues

• Soma Ganesan MD FRCP
• Clinical Professor of Psychiatry UBC
• Medical Director of Psychiatry VGH/UBCH
• Medical Director Vancouver Community Mental
  Health Services
• Physician Leader RVH

2
Service Barriers

• Frequent misdiagnosis
• Inappropriate use of interpreters and
  paraprofessionals
• Culturally inappropriate treatment methods
• NOT AVAILABLE
• NOT ACCESSIBLE
• NOT ACCEPTABLE

3
Cross Cultural Formulation

• Pre-Post migration factors which increase risk
• Impact of socio-political cultural factors on
  diagnosis
• How culture affects perceptions of the cause of
  illness
• Socio-cultural factors affecting the development
  onset

• Effects of culture on help-seeking patterns,
  treatment response to care
• Service needs of high-risk groups such as
  torture victims, the elderly, children,
  adolescents women
• Differentiating between immigrants refugees
  their respective problems

4
Periods of Elevated Risk

• First period
• 3 to 18 months after arrival
• Second period
• 3 to 5 years after migration

5
Relationship Between Complaint Positive Findings
Complaints Positive Findings
Neurological 86 22
Cardiopulmonary 74 14
Gastrointestinal 68 28
Urology 34 4
Sex Organ 54 16
Musculoskeletal 92 92
6
Questions to Elicit Clients Explanatory Model

• What do you think has caused the problem?
• Why do you think it started when it did?
• What do you think your illness (or injury) does
  to you? How does it work?
• How severe is your illness? Will it have a long
  or short course?
• What kind of treatment do you think you should
  receive?
• What are the most important results you hope to
  receive from this treatment?
• What are the chief problems your illness has
  caused for you?
• What do you fear most about your illness?

7
Tips for Negotiating an Agreement Between
Explanatory Models

• Approach this negotiation with an open mind, with
  an expectation of mutual learning
• Explore their understanding of the problem
• Explain your background and your understanding
• Utilize the metaphors of distress that they have
  used
• Acknowledge their model as an important source of
  understanding
• Work to identify areas of agreement, and to
  stress the strengths in the clients situation
• Where discrepancies remain, discuss these

8
Important Factors in Planning Collaborative
Primary/Mental Health Services for Ethnocultural
Population

• Appropriate interpretation services
• Ongoing training for organizations and front-line
  staff
• Role of community for Immigrant settlement
  services
• Development of cultural competency training
  curriculum in professional training programs at
  academic centers
• Inclusion of Immigrant agencies in Federal,
  Provincial and Municipal as partners in service
  delivery system
• Explore role of diversity coordinator in
  community health centers
• No cook book model
• bottom up research and collaborative research
  should be encouraged

9
Key Lessons From The Literature

• Primary needs first (food, clothing, shelter,
  job) met prior to meeting Mental Health needs
• Safety and Trust
• Cultural competence of service providers
• Role of interpreters
• Lack of awareness of services by consumers and
  service providers
• Role of informal Mental Health system
• Population at risk elderly, youth, single
  parent, victim of torture