What Matters Most is a video project to inspire young people struggling with their mental health early on to voice their views on what’s happening to them and what matters most to them in recovery.
For many of us what matters most is getting better so we can pursue the things that are most meaningful to us. Having a good relationship with our families. A meaningful career. Financial stability. Friends. Girlfriends. Boyfriends. A family of our own. Purpose. And, above all, getting the support we need to get there while feeling respected in who we are, in our identities.
If you are a young person beginning your recovery journey, we hope these real-life stories will inspire you to find your truth and share it.
If you are a provider or someone who cares about a young person who is struggling, we hope these stories will help you build trust and support them to stay engaged in recovery.
Click the link below to watch the videos.
Objectives:
A Guide that focuses on how culture affects the care of individuals experiencing a first episode of psychosis (FEP). It describes key concepts and principles, best practices, and case examples to help individuals with FEP, their supports, and providers work together to implement culturally competent early intervention services, prevent cultural misunderstandings, and enhance recovery outcomes.
The Guide was developed through a participatory process involving a series of workgroup meetings with OnTrackNY providers and focus groups with OnTrackNY participants and their families. Many of the case examples included in the Guide derive from assessments conducted with the DSM-5 Cultural Formulation Interview (CFI), a standardized set of open-ended questions used to identify the role of culture in a person’s and family’s experience of illness and care. The CFI has been incorporated into the OnTrackNY routine evaluation procedures.
Specific objectives:
- Define culture and present key principles of culturally competent care.
- Provide a framework for understanding the bidirectional relationship between symptoms of psychosisand culture to help providers conceptualize these issues within the framework of the OnTrackNYmodel and its various treatment components.
- Illustrate, via case examples, how culture shapes participants’ understandings of their experiencewith FEP and their treatment expectations, affecting the overall care of participants in CoordinatedSpecialty Care programs and their families.
- Outline key principles and best practices for delivering culturally competent care to participants andtheir supports within the OnTrackNY treatment model.
Abstract
A guide designed to accompany and expand on the training video series Windows of Opportunity in Early Psychosis Care: Navigating Cultural Dilemmas. These videos and guide address dilemmas around three common cultural themes:
- Religion and Spirituality
- Family Relationships
- Masculinity and Gender Constructs
The training videos are based on true stories of individuals with a first-episode psychosis (FEP) experience. They were created to offer specific examples of how providers can navigate common cultural dilemmas in early psychosis care, as well as how to embrace these dilemmas as opportunities to engage participants and their families more effectively. The dilemmas and best practices illustrated in these videos build on those described in the guide Delivering Culturally Competent Care in FEP. For more infomation, go to www.ontrackny.org.
OBJECTIVE:
The authors synthesize findings of previous studies implicating migration as a risk factor for the development of schizophrenia and provide a quantitative index of the associated effect size.
METHOD:
MEDLINE was searched for population-based incidence studies concerning migrants in English-language publications appearing between the years 1977 and 2003. Article bibliographies and an Australian database were cross-referenced. Studies were included if incidence reports provided numerators and denominators and if age correction was performed or could be performed by the authors. Relative risks for migrant groups were extracted or calculated for each study. Significant heterogeneity across studies indicated the need for a mixed-effects meta-analytic model.
RESULTS:
The mean weighted relative risk for developing schizophrenia among first-generation migrants (40 effect sizes) was 2.7 (95% confidence interval [CI]=2.3–3.2). A separate analysis performed for second-generation migrants (seven effect sizes) yielded a relative risk of 4.5 (95% CI=1.5–13.1). An analysis performed for studies concerning both first- and second-generation migrants and studies that did not distinguish between generations (50 effect sizes) yielded a relative risk of 2.9 (95% CI=2.5–3.4). Subgroup comparisons yielded significantly greater effect sizes for migrants from developing versus developed countries (relative risk=3.3, 95% CI=2.8–3.9) and for migrants from areas where the majority of the population is black (relative risk=4.8, 95% CI=3.7–6.2) versus white and neither black nor white.
CONCLUSIONS:
A personal or family history of migration is an important risk factor for schizophrenia. The differential risk pattern across subgroups suggests a role for psychosocial adversity in the etiology of schizophrenia.
PURPOSE:The EUropean Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study contains an unparalleled wealth of comprehensive data that allows for testing hypotheses about (1) variations in incidence within and between countries, including by urbanicity and minority ethnic groups; and (2) the role of multiple environmental and genetic risk factors, and their interactions, in the development of psychotic disorders. METHODS:Between 2010 and 2015, we identified 2774 incident cases of psychotic disorders during 12.9 million person-years at risk, across 17 sites in 6 countries (UK, The Netherlands, France, Spain, Italy, and Brazil). Of the 2774 incident cases, 1130 cases were assessed in detail and form the case sample for case-control analyses. Across all sites, 1497 controls were recruited and assessed. We collected data on an extensive range of exposures and outcomes, including demographic, clinical (e.g. premorbid adjustment), social (e.g. childhood and adult adversity, cannabis use, migration, discrimination), cognitive (e.g. IQ, facial affect processing, attributional biases), and biological (DNA via blood sample/cheek swab). We describe the methodology of the study and some descriptive results, including representativeness of the cohort. CONCLUSIONS:This resource constitutes the largest and most extensive incidence and case-control study of psychosis ever conducted.
Objective: The aim of the study was to assess the impact of systematic use of the DSM-IV-TR cultural formulation on diagnoses of psychotic disor- ders among patients of ethnic minority and immigrant backgrounds re- ferred to a cultural consultation service (CCS) in Canada.
Methods: The study entailed a review of medical records and case conference tran- scripts of 323 patients seen in a ten-year period at the CCS to determine factors associated with change in the diagnosis of psychotic disorders by the CCS. Logistic regression analysis was used to identify variables asso- ciated with changes in diagnosis.
Results: A total of 34 (49%) of the 70 cas- es with an intake (referral) diagnosis of a psychotic disorder were rediag- nosed as nonpsychotic disorders, whereas only 12 (5%) of the 253 cases with an intake diagnosis of a nonpsychotic disorder were rediagnosed as a psychotic disorder (p<.001). Major depression, posttraumatic stress dis- order (PTSD), adjustment disorder, and bipolar affective disorder were the common disorders diagnosed with use of the cultural formulation. Rediagnosis of a psychotic disorder as a nonpsychotic disorder was sig- nificantly associated with being a recent arrival in Canada (odds ratio [OR]=6.05, 95% confidence interval [CI]=1.56–23.46, p=.009), being non- black (OR=3.72, CI=1.03–13.41, p=.045), and being referred to the CCS by nonmedical routes (such as social work or occupational therapy) (OR=3.23, CI=1.03–10.13, p=.044).
Conclusions: Misdiagnosis of psychot- ic disorders occurred with patients of all ethnocultural backgrounds. PTSD and adjustment disorder were misidentified as psychosis among immigrants and refugees from South Asia. Studies are needed that com- pare clinical outcomes of use of cultural consultation with outcomes from use of other cultural competence models. (Psychiatric Services 63:147–153, 2012; doi: 10.1176/appi.ps.201100280)
We targeted a rural population near Bangalore, India to enhance knowledge about mental illness. We devised a script for a street play that would enhance knowledge, and shift attitudes and beliefs about mental illness. After identification of the villages in the catchment area, a professional theatre group conducted pilot shows and the script was modified in its design and content. Schizophrenia was the chosen illness. In a manner familiar to them, the theatre group who specialized in street plays staged them in various villages in the chosen catchment area. We received a positive response from the village folk that turned out in large numbers. We were able to co-ordinate, devise and conduct street plays on mental illness in a rural set-up in Bangalore, in a feasible manner, which was keeping in consonance with the local sociocultural background.
We examined how the process of cultural formulation contributes to diagnostic assessment of patients with psychotic disorders at a specialized Cultural Consultation Service (CCS). Specifically, we investigated the reasoning process used to resolve uncertainty of psychotic disorder diagnosis in African immigrant patients referred to the CCS for assessment of possible psychotic disorder. Qualitative thematic analysis of 23 clinical case conference transcripts was used to identify clinicians’ reasoning styles. Use of the CF appears to facilitate the emergence of a rule-governed reasoning process that involved three steps: (i) problematize the diagnosis of the intake ‘psychosis’ symptoms or behavior; (ii) elaborate explanations as to why the symptoms or behavior may or may not be psychosis; and (iii) confirm the diagnosis of psychosis or re-interpret as non-psychosis. Prototypes and exemplars drawn from previous experience in intercultural work featured prominently in clinicians’ reasoning. Prototypes were crucial in diagnostic decision-making and appear to be important sources of both clinician expertise and bias, and may need to be targeted specifically in cultural competence training.
Objective: Identification of need for specialist assessment and the use of relevant cultural information to inform mental health assessment and care are two key factors in improving Aboriginal and Torres Strait Islander access to and experience of mental health care. This paper describes the Here and Now Aboriginal Assessment tool (HANAA) and the Cultural Information Gathering Tool (CIGT), two instruments developed to be used respectively by non-mental health clinicians and Aboriginal and Torres Strait Islander mental health workers.
Method: Following widespread consultations and feedback, two independent groups of mental health clinicians based in Western Australia and Queensland were involved in developing the HANAA and CIGT.
Results: Both the HANAA and CIGT fill unmet needs in terms of instruments that can be used by non-specialists working with Aboriginal and Torres Strait Islander people.
Conclusions: Preliminary use of the HANAA and CIGT suggests that they are well received, easy to deploy and effective instruments that promote cultural security and communication with Aboriginal and Torres Strait Islander people.
Background: In order to facilitate case identification of incident (untreated and recent onset) cases of psychosis and controls in three sites in India, Nigeria and Trinidad, we sought to understand how psychoses (or madness) were conceptualized locally. The evidence we gathered also contributes to a long history of research on concepts of madness in diverse settings.
Methods: We conducted focus group discussions and individual interviews to collect information about how informants in each site make sense of and respond to madness. A coding framework was developed and analyses of transcripts from the FGDs and interviews were conducted.
Results: Analyses suggest the following: a) disturbed behaviors are the primary sign of madness; b) madness is attributed to a wide range of causes; and, c) responses to madness are dictated by cultural and pragmatic factors. These findings are congruent with similar research that has been conducted over the past 50 years.
Conclusions: The INTREPID research suggests that concepts about madness share similar features across diverse settings: a) terms for madness are often derived from a common understanding that involves disruptions in mental processes and capacities; b) madness is recognized mostly by disruptive behaviours or marked declines in functioning; c) causal attributions are varied; and, d) help-seeking is a complex process.
