Promoting mental health requires cultural sensitivity in mental health services and programs

One out of 35 people in the world is an immigrant, and in virtually every country, different languages, beliefs and cultures coexist.

In this context, promoting mental health requires incorporating cultural sensitivity into mental health services and programs, experts said at a special event held to observe World Mental Health Day 2007.

"Culture and diversity are central to the everyday perceptions, behavior, and interactions of individuals," said Dr. Carissa Etienne, Assistant Director of the Pan American Health Organization (PAHO). "It is no wonder therefore that culture and diversity influence the way that mental illness manifests itself, how individuals and communities perceive and cope with this illness, and how health care providers diagnose, treat, and care for persons with mental illness."

Led by the World Federation for Mental Health and supported by PAHO and other institutions, this year's World Mental Health Day focuses on the growing importance of cultural competency and sensitivity in ensuring effective mental health programs and services around the world.

One in four people suffers from a mental disorder at some time in his or her life, Etienne noted. "They are universal problems that affect people of all societies and countries, women and men of all ages, the rich and particularly the poor, those who live in cities and those who live in rural areas."

Since every individual has the right to his or her own values, culture and beliefs, it is the responsibility of health providers to develop intercultural competencies to be able to provide the appropriate care, said Etienne.

"In the PAHO region, one of the top priorities in this area is technical cooperation with the countries to develop programs aimed at protecting the mental health of indigenous and minority populations, as well as vulnerable groups," said Dr. Jorge Rodr?guez, Chief of PAHO's Mental Health Unit. "Health services that are developed to serve psychosocial needs must be not only accessible but also culturally acceptable."

In addition to the challenge of diversity, Etienne noted that the countries of the Americas face a growing gap between the burden of mental illness and specialized services for the mentally ill. According to the recent PAHO report Health in the Americas 2007, the contribution of psychiatric and neurological conditions to the burden of illness in Latin America and the Caribbean more than doubled between 1990 and 2002, from an estimated 8.8 percent to 22.2 percent. Yet today there are only two psychiatrists per 100,000 population in the Americas, compared with 9.8 per 100,000 in Europe.

According to the same report, an estimated 1 percent of people in the PAHO Region suffer from nonaffective psychoses (including schizophrenia), 4.9 percent suffer major depression, and 5.7 percent suffer from alcohol abuse or dependency. Yet more than one-third of those suffering from nonaffective psychoses, more than half of those suffering from anxiety disorders, and about three-quarters of people dependent on or abusing alcohol do not receive specialized mental health care.

These gaps are due to both shortages of mental health personnel and to cultural factors, particularly the stigma associated with mental illness in many of the Region's cultures.

According to the World Federation for Mental Health, social and cultural influences play a key role in individual mental health, the use of mental health services, and the provision of mental health care.

"A female mental health professional born and trained in India may have moved to the United Kingdom and is seeing a male client born and raised in Ecuador-how do they communicate and how do each view the same mental illness?" the federation asks in a special booklet prepared for World Mental Health Day. "How do we overcome the barriers of language and cultural differences, views of mental illness, gender issues, and different training and teaching methods?"

To confront this challenge, the World Federation, PAHO and other supporters say that mental health services should be developed and strengthened so they can provide the best care possible to individuals from different cultural backgrounds.

In the Americas, these efforts form part of a larger process of reform linked to the 1990 Declaration of Caracas, which committed signatory countries to restructuring psychiatric care as a key component of their public health strategies. The declaration called, among other things, for shifting the focus of mental health services from so-called "mental institutions" to community-based programs and primary health care networks.

Participants in today's observance of World Mental Health Day at PAHO headquarters included Dr. Preston J. Garrison, Secretary-General of the World Federation for Mental Health, and Dr. Eliot Sorel, Professor of Global Health at George Washington University.