structural and systemic barriers to mental health care for

Structural and Systemic Barriers to Mental Health Care for Communities of Colour

-Vashti Campbell-

PRESENTER DISCLOSURE

• Presenter: Vashti Campbell

• Relationships with commercial interests:

Grants/Research Support:

• Faculty of Medicine Dean’s Doctoral Fellowship

• Memorial University School of Graduate Studies F.A. Aldrich Award

Department of Family Medicine Department of Psychiatry

MITIGATING POTENTIAL BIAS

Department of Family Medicine Department of Psychiatry

• Presenter: Vashti Campbell

• Mitigation of conflict: n/a

LEARNING OBJECTIVES

Department of Family Medicine Department of Psychiatry

1) Describe systemic barriers to mental health and wellbeing for racialized and new-comer communities in Canada

1) Identify challenges and opportunities in the operationalization of cultural competence frameworks for clinical practice

1) Develop awareness of the importance of critical self-reflection in transcultural mental health praxis

COMPARING PSYCHIATRIC CARE IN NEWFOUNDLAND

& LABRADOR WITH EMERGING BEST PRACTICES TO

ADDRESS STRUCTURAL AND SYSTEMIC BARRIERS

TO MENTAL HEALTH FOR COMMUNITIES OF COLOUR

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Vashti Campbell, RSW, MSW, BSW PhD student; Division of Community Health and Humanities Faculty of Medicine

• Acknowledgements • Learning Objectives • Research Questions and Methods – In Brief • Key Concepts

» What is meant by “structural and systemic barriers”? » How do health care systems address “cultural difference”?

• Background • Closing Remarks

OUTLINE

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ACKNOWLEDGEMENTS: PEOPLE AND PLACE

NARRATIVES & STORIES:

PATIENTS AND HEALTH CARE PROVIDERS

DATA ANALYSIS:

DEMOGRAPHICS AND DIAGNOSTICS

DISCOURSE ANALYSIS:

DIAGNOSTIC AND STATISTICAL MANUAL

(DSM)

POLICY REVIEW:

HEALTH CARE ORGANIZATIONS

METHODS

DIVISION OF COMMUNITY HEALTH & HUMANITIES

FACULTY OF MEDICINE

WWW.MUN.CA

KEY CONCEPTS: STRUCTURAL AND SYSTEMIC BARRIERS

• RACISM AND HEALTH CARE

• SYSTEMIC OPPRESSION

• MISDIAGNOSIS AND OVER-REPRESENTATION

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KEY CONCEPTS: STRUCTURAL AND SYSTEMIC BARRIERS

• RACISM AND HEALTH CARE

• SYSTEMIC OPPRESSION

• MISDIAGNOSIS AND OVER-REPRESENTATION

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• Peace

• Shelter

• Education

• Food

• Employment & Income

• Working Conditions

• A Stable Ecosystem

• Sustainable Resources

• Social Status

• Social Capital & Supports

• Coping Skills

• Social Justice

• Gender & Sex

• Equity

RACISM AND HEALTH CARE

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Social Determinates of Health

“…the organization and distribution of economic and social resources among the population”

-Bryant, Raphael & Rioux, 2010

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Canadian Association of Nurses for

HIV/AIDS CARE

With

Centre for Aboriginal Health Research

By

Sambradd

KEY CONCEPTS: STRUCTURAL AND SYSTEMIC BARRIERS

• RACISM AND HEALTH CARE

• SYSTEMIC OPPRESSION

• MISDIAGNOSIS AND OVER-REPRESENTATION

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Human Being & Human Experience

Individual Oppression

Institutional Oppression

Systemic Oppression

Hegemonic Ideologies (Doxa)

KEY CONCEPTS: SYSTEMIC OPPRESSION

Habitus

• Internalized structures that determine how we act and react: “second nature”

Doxa

• Sense of reality that is created by our habitus.

• “[the] process through which social and culturally constituted ways of perceiving, evaluating and behaving become accepted and unquestioned, self-evident and taken for granted – i.e. ‘natural’” (Bourdieu, 1977, p. 164)

(Wait a minute… What’s ‘doxa’?)

KEY CONCEPTS: STRUCTURAL AND SYSTEMIC BARRIERS

• RACISM AND HEALTH CARE

• SYSTEMIC OPPRESSION

• MISDIAGNOSIS AND OVER-REPRESENTATION

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0

1

2

3

4

5

6

BRESNEHAN et al., 2007US Cohort

Schwartz et al., 2014Global Meta-analysis

Selten et al., 2001Relative Risk in Netherlands

EURO-AMERICAN-WHITE

BLACK-AFRICAN-AMERICAN

HISPANIC-LATINO-AMERICAN

MOROCCAN/MIDDLE EASTERN

GLOBAL DATA: MISDIAGNOSIS & OVER-REPRESENTATION

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CANADA: “MISDIAGNOSIS & OVER-REPRESENTATION” AT A CULTURAL CONSULTATION SERVICE (Adeponle et al., 2012)

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70

24

31

3

12

36

1613

1

6

0

10

20

30

40

50

60

70

80

Psycho cDisorderLabel(N)

Blackpa ents(n) Asianpa ents(n) Whitepa ents(n) "Other"pa ents(n)

AtIntake A erResasessment

CURRENT CANADIAN RESEARCH

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Cultural competence does little to address relations of power in transcultural,

institutionalized and structural interactions. (Pon, 2009; Sakamoto, 2007)

CULTURAL COMPETENCE

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4) Institutionalize Cultural Knowledge

5) Develop Programs and Services that Reflect an Understanding of Diversity Between and Within Cultures

(Gallegos et al., 2008, p. 54)

1) Value Diversity

2) Have the Capacity of Cultural Self-Assessment

3) Be Conscious of the Dynamics Inherent When Cultures Interact

Transcultural Frameworks

•Approach in health care that respects that cultural differences exist, and can affect experiences, worldview, and behaviour

CULTURAL SENSITIVITY

• Outcome based on respectful engagement; addresses power imbalances inherent in the health care system

CULTURAL SAFETY

• Process of self-reflection; acknowledging oneself as a learner

CULTURAL HUMILITY

• Tool within the DSM-5; operationalizes a more thorough evaluation of the social and cultural context in which illness is experienced

CULTURAL FORMULATION INTERVIEW*

Implications for Collaborative Care

• CONTINUE TO BUILD ON EXISTING STRENGTHS

• FOSTER SELF-REFLEXIVITY

• DEVELOP CAPACITY AND KNOWLEDGE RELATED TO COLONIALISM

Slide 17.

1. Bresnahan, M., Begg, M. D., Brown, A., Schaefer, C., Sohler, N., Insel, B., . . . Susser, E. (2007). Race

and risk of schizophrenia in a US birth cohort: Another example of health disparity? International Journal

of Epidemiology, 36(4), 751-758.

2. Schwartz, R. C., & Blankenship, D. M. (2014). Racial disparities in psychotic disorder diagnosis: A review

of empirical literature. World Journal of Psychiatry, 4(4), 133-140.

3. Selten, JP., Veen, N., Feller, W., Blom, J.D., Kahn, R., … Van Der Graaf, Y. (2001). Incidence of psychotic

disorders in immigrant groups to The Netherlands. The British Journal of Psychiatry, 178(4), 367-372.

Slide 18.

1. Adeponle, A.B., Thombs, B.D., Groleau, D., Jarvis, E., Kirmayer, L.J. (2012). Using the cultural

formulation to resolve uncertainty in diagnoses of psychosis among ethnoculturally diverse patients.

Psychiatric Services, 63(2), 147-153.

ABOUT THIS PRESENTATION

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1. Allan, B., & Smylie, J. (2015). First peoples, second class treatment: The role of racism in the health and well-being of

indigenous peoples in Canada. Toronto, ON: The Wellesley Institute. Retrieved September 2, 2016 from http://www.wellesleyinstitute.com/wp-content/uploads/2015/02/Summary-First-Peoples-Second-Class-Treatment-Final.pdf

2. Bourdieu, P. (1977). Outline of a Theory of Practice. (R. Nice,. Trans.) Cambridge, UK: Cambridge University Press. (Original work published 1972).

3. Bryant, T., Taphael, D., & Rioux, M. (2010). Staying alive: Critical perspectives on health, illness, and health care.

Canadian Scholars’ Press Inc. Toronto ON, Canada. p.146. 4. Gallegos, J.S., Tindall, C., & Gallegos, S.A. (2008). The need for advancement in the conceptualization of cultural

competence. .Advances in Social Work, 9(1), 51-62). 5. Mental Health Commission of Canada. (2009). Improving mental health services for immigrant, refugee, ethno-cultural

and racialized groups: Issues and options for service improvement. Ottawa, ON: McKenzie, K. 6. Nestel, S. (2012). Colour coded health care: The impact of race and racism on Canadians' health. Toronto, ON: The

Wellesley Institute. Retrieved September 2, 2016 from http://www.wellesleyinstitute.com/wp-content/uploads/2012/02/Colour-Coded-Health-Care-Sheryl-Nestel.pdf

7. Patychuk, D. (2011). Health equity and racialized groups: A literature review. Toronto, ON: Health Equity Council and Health Nexus.

8. Pon, G. (2009). Cultural competency as new racism: An ontology of forgetting. Journal of Progressive Human Services, 20(1), 59-71.

9. Sakamoto, I. (2007). An anti-oppressive approach to cultural competence. Canadian Social Work Review, 24(1), 105-114. 10. Seeman, M.V. (2010). Psychosis in the immigrant Caribbean population. International Journal of Social Psychiatry, 57(5),

462-470. 11. Summerfield, D. (2007). Major depression' in Ethiopia: Validity is the problem. The British Journal of Psychiatry: The

Journal of Mental Science, 190,

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