This position paper has been substantially revised by the Canadian Psychiatric Association (CPA)’s Section on Transcultural Psychiatry and the Standing Committee on Education and approved for republication by the CPA’s Board of Directors on February 8, 2019. The original position paper1 was first approved by the CPA Board on September 28, 2011.

Cultural competence is increasingly recognized as an essential component of effective mental health care delivery to address diversity and equity issues. Drawing from the literature and our experience in providing cultural competence consultation and training, the paper will discuss our perspective on the foundational concepts of cultural competence and how it applies to a health care organization, including its programs and services. Based on a recent consultation project, we present a methodology for assessing cultural competence in health care organizations, involving mixed quantitative and qualitative methods. Key findings and recommendations from the resulting cultural competence plan are discussed, including core principles, change strategies, and an Organizational Cultural Competence Framework, which may be applicable to other health care institutions seeking such changes. This framework, consisting of eight domains, can be used for organizational assessment and cultural competence planning, ultimately aiming at enhancing mental health care service to the diverse patients, families, and communities.

Summary:Purpose: David Taylor and Murray Falconer suggested that some patients may develop a psychotic illness after resection of a ganglioglioma that led to intractable seizures. They implied that the mechanism of this association remained unclear. This concept is currently not universally accepted (M. Trimble, personal communication).Methods: We studied six children or young adults from four centers who developed psychosis after resection of a ganglioglioma or dysembryoplastic neuroepithelioma (DNET).Results: All patients were operated on because of intractable epilepsy. The lesions involved mainly the temporal lobe. Patients had good outcomes for seizure control. In none of the six was potentially psychogenic medication used nor were the psychotic symptoms postictal in nature. The psychosis was schizophreniform with paranoid features and prominent depressiveThe suggestion of an increased occurrence of psychosis with prominent or paranoid depressive features or both after surgical treatment of temporal lobe epilepsy (TLE) due to ganglioglioma originated with David Taylor, Murray Falconer, and their group at the Maudsley Hospital (1-4). This concept has now been challenged by Trimble (personal communication), who is not convinced that the presence of a ganglioglioma predisposes to the development of psychosis after resection. In this analysis, the term schizophreniform is used to indicate a schizophrenia-like psychosis with paranoid and affective features and does not imply duration of symptoms or age of onset, as in the DSM-IV ( 5 ) definition of schizophrenia.Recent experience in the four participating centers suggests that psychosis may occur after resection of a

The series publishes original scholarly books that advance our understanding of international migration and immigrant integration. Written by academic experts and policy specialists, each volume addresses a clearly defined research question or theme, employs critical analysis and develops evidence-based scholarship. The series includes single-or multi-authored monographs, volumes and edited collections.The scope of the series is international migration and integration research. Topics include but are not limited to thematic and current issues and debates; comparative research of a regional, national or international nature; the changing character of urban areas in which migrants or refugees settle; the reciprocal influence of migrants/ refugees and host communities; issues of integration and social inequality as well as policy analysis in migration research.

This study evaluates the incorporation of Multi-Family Psycho-education Group (MFPG) to an Assertive Community Treatment Team developed to serve culturally diverse clients who suffers from severe mental illness. Participants included Chinese and Tamil clients and their family members. Family members’ well-being, perceived burden, and acceptance of clients were assessed before and after the intervention. Focus group interviews with clinicians were conducted to qualitatively examine MFPG. Family members’ acceptance increased after MFPG. Regular attendance was associated with reduction in perceived family burden. Culturally competent delivery of MFPG enhanced family members’ understanding of mental illness and reduced stress levels and negative feelings towards clients.

The authors propose that these changes to the curriculum may lead to enhanced cultural competence and clinical effectiveness in health care.

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The social construction of gender is an important concept for better understanding the determinants of mental health in women and men. Going beyond physical and physiological differences and the traditional biomedical approach, interdisciplinary study of the complex factors related to culture and society, power and politics is necessary to be able to find solutions to situations of disparity in mental health, related to both prevalence of disorders, availability and response to treatment. Gender inequality continues to be a source of suffering for many women around the world, and this can lead to adverse mental health outcomes. This review focuses on developments in the literature on culture, gender and mental health over the past decade, focusing on themes around the social construction of gender, mental health and the media, a look at cultural competence through a gender lens, gender and the body, providing some examples of the intersection between mental health and gender in low-income countries as well as the more developed world, and the impact of migration and resettlement on mental health. At the clinical level, using a bio-psycho-social-spiritual model that can integrate and negotiate between both traditional and biomedical perspectives is necessary, combined with use of a cultural formulation that takes gender identity into account. Research involving both qualitative and quantitative perspectives, and in many cases an ethnographic framework, is essential in tackling these global issues.