Cultural Psychiatric Services: Past, Present and Future

By H. Steven Moffic, M.D.
| October 1, 2003

Dr. Moffic is currently the executive vice chair for managed care of the department of psychiatry and behavioral sciences at the Medical College of Wisconsin. He is also professor with tenure in that department as well as in the department of family and community medicine. Dr. Moffic was elected in 1998 as the president of the American Association for Social Psychiatry.

Given the increasing cultural diversity of the U.S. population, it seems likely that cultural influences will take on even greater importance. The increasing attention to and expectation of cultural competence should help improve psychiatric care to all.

Put simply, the writer George Bernard Shaw provided the core guideline to cultural competence when he said: "Do not do unto others as you would that they should do unto you. Their tastes may not be the same." In a more complex sense, clinicians can become more culturally competent by following the Ten Commandments for Cultural Competence (Table).

These commandments should improve the psychiatric care of all patients. As a field, cultural psychiatry needs to incorporate the cultural variable into our remaining cultural blind spots. These include incorporating cultural values into informed consent (Roberts, 2002), improving substance abuse treatment for ethnic minorities (Wells et al., 2001) and including the cultural variable in pharmacogenomic studies (Licinio, 2000). All treatment guidelines and disease management protocols should explicitly reflect and include the cultural variable.

Like many other things, globalization will likely have an important effect on the future of cultural psychiatry (Kirmayer and Minas, 2000). The global economy, Internet communication and mass population migration can increase cultural sensitivity and knowledge. Clinicians and systems of care in different countries may more readily be able to influence and teach each other. While modern psychopharmacology can be applied in developing countries, more traditional countries can teach us about the therapeutic use of trance and benefits of indigenous plants. Perhaps cultural psychiatry will someday no longer be a separate variable, but routinely incorporated into mainstream society.

Pages: 1 2 3

References
1. Alarcon RD (1998), What cultural psychiatry isn't. Psychline 2(3):27-28.
2. Bae SW, Kung WW (2000), Family intervention for Asian Americans with a schizophrenic patient in the family. Am J Orthopsychiatry 70(4):532-541.
3. Benton GH (1921), "War" neuroses and allied conditions in ex-service men. JAMA 77:360-364.
4. Kirmayer LJ, Minas H (2000), The future of cultural psychiatry: an international perspective. Can J Psychiatry 45(5):438-446.
5. Kleinman AM (1977), Depression, somatization and the "new cross-cultural psychiatry." Soc Sci Med 11(1):3-10.
6. Kornstein SG, Sloan DM, Thase ME (2002), Gender-specific differences in depression and treatment response. Psychopharmacol Bull 36(4 suppl 3):99-112.
7. Lehmann C (2003), Scully urges Black Caucus to back parity, other MH reforms. Psychiatr News 38(5):2-42.
8. Licinio J (2000), Pharmacogenomics and ethnic minorities. Psychiatric Times 17(11):47-52.
9. Lin KM, Poland RE, Nakasaki G, eds. (1993), Psychopharmacology and Psychobiology of Ethnicity. Washington, D.C.: APA Press.
10. LoboPrabhu S, King C, Albucher R, Liberzon I (2000), A cultural sensitivity training workshop for psychiatry residents. Academic Psychiatry 24:77-84.
11. Lu FG (1996), Getting to cultural competence: guidelines and resources. Behav Healthc Tomorrow 5(2):49-51.
12. Mathews CA, Glidden D, Hargreaves WA (2002), The effect on diagnostic rates of assigning patients to ethnically focused inpatient psychiatric units. Psychiatr Serv 53(7):823-829.
13. Moffic HS (2003), 7 ways to improve "cultural competence." Current Psychiatry 2(5):78.
14. Moffic HS (1983), Sociocultural guidelines for clinicians in multicultural settings. Psychiatr Q 55(1):47-54.
15. Moffic HS, Kendrick EA, Reid K, Lomax JW (1988), Cultural psychiatry education during psychiatric residency. J Psychiatr Educ 12(2):90-101.
16. Moffic HS, Kinzie JD (1996), The history and future of cross-cultural psychiatric services. Community Ment Health J 32(6):581-592.
17. Pitts G, Wallace PA (2003), Cultural awareness in the diagnosis of attention deficit/hyperactivity disorder. Primary Psychiatry 10(4):84-88.
18. Roberts LW (2002), Informed consent and the capacity for voluntarism. Am J Psychiatry 159(5):705-712.

FROM PHYSICIANS PRACTICE

Five Steps to Improving Patient Access
Judy Capko, May 21, 2013
Patient access is getting increased attention through reform initiatives. Here are five steps you can take to make sure patients get appropriate access to care in your office.

Growing HIPAA Threat – Ignore Windows XP at Your Own Peril
Marion K. Jenkins, May 21, 2013
Chances are good that you have some major ticking software time bombs lurking in your medical practice's computer environment, namely Windows XP and Server 2003.

Finding Physician Work-Life Balance in the Small Moments
Jennifer Frank, MD, May 21, 2013
At my practice and at home, things are always busy. There's laundry or homework, or a patient with needs.

Three Areas to Reduce Costs at Your Medical Practice
Greg Mertz, May 19, 2013
By taking a hard look at reducing costs for staffing, overhead, and technology at your medical practice, you may see increased physician compensation.

Dos and Don’ts for Starting a Physician Blog
Michael Woo-Ming, MD, May 18, 2013
Starting a physician blog can provide your medical practice with marketing benefits, but it's important to do it right.

Cultural Psychiatric Services: Past, Present and Future

Join the Conversation