Cross-cultural issues in Mental Health: a conversation with a survivor at Making Waves.

Jeremy K.* , a survivor at Making Waves, advocates that mental health care professionals should be open to learn about the cultural background of their patients.

Jeremy is surprised at the lack of ethnic minority psychiatrists, nurses and other health care providers that have an important role in mental health care. When presenting his observations as a consultant to the Implementing Recovery through Organisational Change (ImROC) initiative, Jeremy received a honest reply from one psychiatrist. The clinician said he was treating mainly minority patients, but he didn’t know how an African-Caribbean person is like when he is not unwell.

A number of studies have shown that African-Caribbean people are over-represented in British psychiatric hospitals. Within Black and Minority Ethnic communities, Caribbean people are the most diagnosed with psychosis, revealed a survey commissioned by the Time to Change campaign and published in March last year.

It has been suggested that white psychiatrists might misunderstand the culturally encoded experiences of African and Caribbean people. Stresses associated with racial discrimination may also account for this over diagnosis. Jeremy, who was a self-employed pharmacist when he was sectioned ten years ago, says he was stopped by the police more than once for no apparent reason while driving his BMW.

“Socialize with us, see what makes us laugh, see what makes us cry, what makes us happy or sad.”

Richard Bentall, in his 2003 book “Madness Explained”, suggests that African-Caribbean people express distress in a way that is perceived by northern europeans as aggressive and leads to intervention by psychiatric services. Jeremy says most of it has to do with misinterpretation of cultural cues.

“When we speak, we tend to break eye contact a lot, and people see that as being unwell. It is not. It’s just something we do naturally to decrease the sense of aggression, because we are passionate people when we speak.

“What I would call for in immediate effect is more cultural competence among professionals,” says Jeremy. “Socialize with us, see what makes us laugh, see what makes us cry, what makes us happy or sad.”

On his journey through the mental health care system, very seldom had Jeremy the chance to have his voice heard. He confirms what Richard Bentall writes about psychiatric wards today: psychiatrists see their patients for only a few minutes every week and psychologists prefer to work in outpatient clinics.

How can mental health care services in psychiatric wards become culturally compatible? Jeremy sends an invitation to practitioners: “When it comes to working cross-culturally, get to know your patients, get some practical experience with them. If you know of a ceremony, find yourself down there, or if you get fifteen minutes in the day, listen to KEMET FM for the music we listen to.”

Jeremy hopes that more cultural understanding will help professionals to refrain from pathologising cultural differences.


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