This book presents an extensive collection of high-yield case vignettes with recommendations for a comprehensive approach to cultural psychiatry. Culture is defined from an anthropological perspective, with an emphasis on aspects of culture beyond race, ethnicity, and other traditional demographic categories. The goal of this book is to offer clinical applications of cultural psychiatry via examination of special populations, systems, and settings. With ever-changing geopolitical environments, institutional structures, and sociodynamics, attention and consideration of context is paramount. Theoretical models and specific frameworks for evaluating cultural influence on the manifestation, development, and treatment response of mental health illnesses are presented. The chapters are organized to showcase different ways in which culture plays into everyday clinical practice. Emphasis is placed on the full sum of the care delivery transaction within a larger context, including public and community systems of care. Real-world case examples are discussed in each chapter to help contextualize the dynamic nature that culture plays in practice across inpatient and outpatient settings. Each case presents with relevant academic and historical background and practical operational advice for psychiatrists providing care within these respective communities. The authors address diverse clinical cases related to refugee and asylum seekers, military service members, survivors of human trafficking, incarcerated populations, and more. Training recommendations and best practices are outlined including psychopharmacology, psychosocial treatments, and cultural adaptations to evidence based treatments.
Diversity in Action: Case Studies in Cultural Psychiatry is a useful resource for all psychiatrists, psychologists, general practitioners, social workers, nurses, administrators, public policy officials, and all medical professionals working with a culturally diverse subset of patients seeking mental health.
Author(s): Steve H. Koh, Gabriela G. Mejia, Hilary M. Gould
Publisher: Springer
Year: 2021
Language: English
Pages: 260
City: Cham
Contents
Contributors
1: Introduction
Cultural Constructs in the DSM-5
Definition of Culture to Improve Clinical Care
Culture and Mental Health Conceptual Model
Training and Education
Survivors, Special Populations, and Systems and Settings
Clinical Case Vignettes
Conclusion and Future Directions
References
Part I: Survivors
2: Survivors of Torture
Vignette
Introduction
Definitions
Intersection with Healthcare
Screening and Assessment
Treatment
Psychotherapy Treatments
Pharmacologic Treatments
Social and Legal Services
Children and Adolescents
Pregnancy
Conclusion
Summary of High-Yield Points
References
3: Survivors of Human Trafficking
Introduction
Cultural Considerations of Human Trafficking
Criminal Justice System
A Criminal Justice Approach to Trafficking
Community and Police Relations
Immigration Policy
Race
Racial Stereotypes
Media
Mental Health
Access to Services and Legal Outcomes
Adverse Childhood Experiences (ACEs)
Family Structure
Socioeconomic Factors
Gender
Vignette
Psychiatric Assessment and Treatment of Human Trafficking Survivors
Assessment
Treatment Recommendations
Trauma-Informed Care
Culturally Responsive Care
Addressing Clinician Bias
Systemic Changes
Conclusion
Summary of High-Yield Points
References
4: Survivors of Combat Trauma
Introduction
Background
Military Structure and Organization
The Pillars of Military Culture
Combat and Its Effects
Combat Trauma in the Modern Day
Defining the Problem
Factors Impacting Care
Vignette
Case Discussion
Comments and Recommendations
Summary of High-Yield Points
References
Part II: Special Populations
5: Co-occurring Disorders
Introduction
Background
Historical Significance
Alcohol
Opioids
Stimulants
Tobacco
Cultural Considerations
Vignette
Discussion
Culturally Competent Care in Co-occurring Disorders
Social Risk Factors
Isolation
Stigma
Special Populations
Pregnancy, Postpartum, and Motherhood
Physical and Cognitive Disabilities
Incarcerated Populations
Military Service Members and Veterans
Indigenous Populations
Treatment for Co-occurring Disorders
Alcohol
Opioids
Stimulants
Tobacco
Conclusion
Summary of High-Yield Points
References
6: Telepsychiatry to Rural Populations
Vignette 1
Introduction
What Is Culturally Competent Care and How Can TMH Help in Rural Settings?
Approaches to Provide Culturally Competent Care
Vignette 2
Setting Goals with Patients
TMH and Its Use in Cultural Populations
How Do We Provide Culturally Competent Care Via TMH?
Assess Needs for Cultural and Language “Fit” Between Patients and Providers
Attend to Language and Culture over Distance
Training Approaches to Telehealth and Culture
Models of Care: Enhancing Access, Providing Flexibility, and Leveraging Resources
Refugees and Disaster Victims and TMH
What Are the Dos and Don’ts of Addressing Barriers, Problems and Sustainability Issues
Barriers in Patient/Provider Culture and Access to Technology
Physician and Workflow Barriers
Funding and Cost Analysis
Evaluation
TMH Administration and Models of Care
Discussion
Policy/Advocacy
Conclusion
Summary of High-Yield Points
References
Suggested Reading
7: Religion, Spirituality, and Mental Health
Introduction
Background
Vignette 1
Culturally Competent Care
Vignette 2
Training and Education
Disorder Specific Considerations
Substance Use Disorders
Psychotic Disorders
Trauma- and Stress or-Related Disorders
Anxiety Disorders
Mood Disorders
Recommendations
Conclusion
Summary of High-Yield Points
References
8: Biculturalism: The Case of Two North American Neighbors
Introduction
Background
Biculturalism in the Context of Culture
Historical Significance Between the Two Countries
Biculturalism in the Context of Art, Business, Science, and Entertainment
Culturally Competent Care and Biculturalism
Interaction Between Psychiatry and Biculturalism
Vignette 1: Bill
Discussion
Vignette 2: Sebastian
Discussion
Training and Education in Biculturalism
Recommendations
Conclusion
Summary of High-Yield Points
References
Part III: Systems and Settings
9: Correctional Psychiatry
Vignette
Mass Incarceration and Cultural Implications
Introduction
The Problem of Mass Incarceration
Cost of Mass Incarceration
Overrepresentation of People of Color
Overrepresentation of People with Mental Illness
Right to Treatment in Correctional Institutions
Challenges of Practicing in Correctional Settings
Typical Responsibilities
Cultural Differences: Penal System Versus Mental Health System
Ethical Considerations of Professional Practice
Boundary Challenges
Resource Limitations
Security Restrictions
Threats to Confidentiality
Mental Health Stigma
Implicit Racial Bias
Special Considerations When Working with Patients in Correctional Settings
Suicide Risk
Trauma and Victimization
Behavioral Challenges
Solitary Confinement
Background
By the Numbers
Mental Illness and Segregation
Psychological Impact of Segregation
Mental Health Screening and Monitoring in Segregation
Barriers to Treatment in Restricted Housing Units
Movement Away from Segregation
Vignette Discussion
Conclusion
Summary of High-Yield Points
References
10: Shifting Gears: Cultural Assimilation into Primary Care
The Culture of Primary Care
Interprofessional Education and Practice
The Collaborative Care Model
Measurement-Based Care in Primary Care and Collaborative Care
Vignette 1
Traditional Model of Care
Collaborative, Interprofessional Model of Care
Vignette 2
Traditional Model of Care
Transition to Collaborative, Interprofessional Model of Care
Conclusion
Summary of High-Yield Points
References
11: Psychiatric Care in Residential Care Environments
Introduction
Background
Psychiatric Illness in Residential Care Environments
Vignette
Case Discussion and Recommendations for Optimal Treatment
Conclusion and Recommendations
Summary of High Yield Points
References
Index
