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It is very hard and lonely here. I do it all on my own. Sometimes I wonder whether I should take my son home. In my country there would be more people to give us support.

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There is a different system there where there is much more support for people like him. He might even be able to get a job. Here there is only me: I have to do it all. It's very tiring, but I can't ever give up. GPs are often the first and only point of service contact for many consumers from culturally and linguistically diverse backgrounds and their families and carers. This relates partly to the pronounced impact of stigma, but also to other barriers that limit access to mental health services and other community services.

Consequently, for ongoing monitoring and illness management for people who have experienced a mental illness, the GP may play an even more important role in a transcultural context, and this requires additional skills and supports for the GP.

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The cultural competence of service providers, both clinical and non-clinical, is essential to relapse prevention for people from culturally and linguistically diverse backgrounds. Health providers need to be culturally sensitive in their assessment, diagnosis and management of clients.

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While these are areas of continuing need, some relevant resources have been recently developed including a revised, national version of the Cultural Awareness Tool CAT , which is available to facilitate practitioners' understanding of their clients' explanatory model of their presenting problem WA Transcultural Mental Health Centre Working in a transcultural context requires 'awareness, knowledge and skills' Gabb This means, firstly, an explicit awareness of the cultural values involved in the relationship between service provider and client. There is then the need to understand significant events and experiences that impact on wellbeing: a process that is especially relevant for those with experiences of torture, trauma, displacement and loss.

Finally, there are specific skills required for working with people from diverse cultural and linguistic backgrounds, such as working with interpreters and being aware of verbal and non-verbal communication differences. While training in cultural competence is recognised as a necessity in many services, in others, and particularly in some of the support services sectors, there is little provided in the way of such training. Risk and protective factors vary across culture, as well as by age and gender US Department of Health and Human Services Poverty, immigration, violence, racism and discrimination are some of the risk factors that disproportionately affect racial and ethnic minorities, especially refugees.


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Fundamentally, opportunities and access to the basic living requirements that promote wellbeing, such as accommodation, work, education and leisure activities, can be reduced for people from culturally and linguistically diverse backgrounds. Conversely, protective factors such as spirituality, community and family support can be stronger in some communities, and these can be drawn upon to support the wellbeing of people who have experienced mental illness. It is important to encourage community members to talk with each other about their experiences in order to begin to develop shared understandings of the environmental and social factors that comprise the risk and protective factors for mental health within their communities Loughhead , and to determine ways to impact on these to reduce the stressors and improve the supports that will facilitate the wellbeing of people who have experienced mental illness.

Defining relapse Defining relapse prevention Relapse prevention, recovery and rehabilitation Preliminary definitions What is our current state of knowledge? Likelihood of preventing relapse Importance of relapse prevention Current major approaches to relapse prevention and evidence of their effectiveness Awareness of early warning signs Compliance with medication Coping skills training and cognitive behavioural approaches Broad-based psycho-education programs Self-help programs Risk and protective factors What are the basic elements of relapse prevention?

Awareness - acceptance, attitude and recognition Acceptance Recognition of early warning signs Awareness of potential risk and protective factors for relapse Anticipation and planning Alternatives Accommodation Employment Economic wellbeing Education, art and other forms of meaningful activity Harmful alcohol and other drug use Physical health Social relationships Violence Resilience Wider range of treatment options Access and early intervention The role of psychiatric disability support services The role of the acute and specialist mental health system The role of case management The role of primary care including general practice Population groups with special needs Children and adolescents Older adults Aboriginal peoples and Torres Strait Islanders People from culturally and linguistically diverse backgrounds Rural and remote communities Forensic populations What do we need to do to incorporate relapse prevention into continuing care?

Empowering consumers and their families and carers through participation and partnerships Service access and responsiveness Workforce development Information: monitoring, evaluation and research Issues for consideration References Popular Feedback Provide feedback If you would like a response please complete our enquiries form. Comments will be used to improve web content and will not be responded to.

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Beyond Cultural Competence: Critical Consciousness, Social Justice, and Multicultural Education

The culture-specific roles of women and men have the potential to affect the care of pediatric and adolescent patients. In some cultures, for example, women are expected to defer important decisions to and, in some instances, to communicate through the male figure.


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  • The concept of machismo in Hispanic cultures often portrays the masculine figure as a protector, provider, and decision-maker. Whereas the cultural connotation may be one of masculine honor and respect, it can be viewed as disempowering toward women. Men in some cultures, for example, may exert power and control over women.

    If men are viewed as final decision-makers on health matters, this may affect pediatricians' ability to empower female adolescent patients. This culturally bound and potentially disempowering role of women can adversely affect their ability to successfully negotiate condom use with a male sexual partner. Given the cultural variability of the role of the patient's family in medical decision-making as well as healing processes, the pediatrician should respectfully ask questions with the goal of fully understanding these important issues. In some cultures, the family nuclear and extended is the main social unit and family members are actively engaged in all aspects of the care of the patient.

    In dealing with hospitalized patients, for example, pediatricians should anticipate the possibility of a large number of family members during visiting hours and the possibility of exceeding the hospital's allowable visitors' quota. Immigrant families may be divided between the United States and the country of origin, posing an added stressor in family-centered cultures. Are racial disparities in ED analgesia improving? Evidence from a national database. Am J Emerg Med. Understanding cultural difference in caring for dying patients. West J Med.

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    Institute of Medicine. Washington, DC: National Academies Press; —66 This section of an Institute of Medicine publication provides summary of research studies on analgesia in minority populations. You may be trying to access this site from a secured browser on the server.

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    Please turn on JavaScript and try again. Chapter 2: Health Beliefs and Practices.


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    • Koenig and Gates-Williams 2 offer the following helpful guidelines in dealing with these complex situations: Determine who controls access to the body and how the body should be approached after death. Consider the relevance of religious beliefs, particularly about the meaning of death, the existence of an afterlife, and belief in miracles. Assess how hope for a recovery is negotiated within the family and with health care professionals. Assess the degree of fatalism versus an active desire for the control of events into the future.

      Role of Family Given the cultural variability of the role of the patient's family in medical decision-making as well as healing processes, the pediatrician should respectfully ask questions with the goal of fully understanding these important issues.