Cultural consultation in psychiatric practice.

While Bhui/Sashidharan (2003) raise important questions in the debate on whether there should be separate psychiatric services for ethnic minorities in the UK, a cross-national comparative perspective can shed light on alternative models, which could valuably inform British debate (Kirmayer & Minas, 2000). For example, a substantial research literature has arisen in Australia regarding the importance of providing services to minorities in their own languages (e.g. Ziguras et al, 2003). Similarly, in the USA there is an important literature on the effectiveness of services that ethnically match service users and professionals (e.g. Rosenheck et al, 1995). These issues may be fundamental in any encounter between providers and users and deserve the appropriate attention. The cultural consultation model developed in Canada (Kirmayer et al, 2003) attempts to take into account culturespecific factors to improve diagnostic assessment, treatment planning and case management. The enormous diversity of Canadian society is not captured by the broad ethno-racial categories commonly used in the UK and USA; thus, specialised clinics for each minority group are not feasible. The consultation model does not assume that any clinician can be a ‘fount of all wisdom’, intimately knowing all ethnic, cultural and linguistic groups. The consultation draws on a bank of translators, culture-brokers, anthropologists, religious informants, traditional healers and mental health professionals who can be appropriately assembled to help referring clinicians with assessment and treatment. The aim is to improve the quality of care at all levels of the health care system rather than segregate ethnic-groups. Every consultation is an opportunity for in-service training of referring clinicians, with an emphasis on transfer of knowledge. This increases their cultural competence and facilitates collaborative work with culturespecific resources in both the health care system and the community. Bhui rightly notes that this model, like any other service, will fail without sustained funding. There are also medico-legal issues related to the use of culture-brokers that must be addressed before implementation. However, the model provides an important resource that can promote the appropriate diagnosis and treatment of service-users, while gradually enhancing cultural awareness throughout the health care system.