Mary Tilki

Cultural competence in action for CAMHS: development of a cultural competence assessment tool and training programme

This article details the development of a tool to measure the cultural competence of individuals working within the Children and Adolescent Mental Health Services (CAMHS). The CAMHS Cultural Competence in Action Tool – known as the CAMHS ‘CCATool’ – was one of the components of a national project which aimed at promoting cultural competence within CAMHS. The other component was a two day training programme. Both components were based on the Papadopoulos, Tilki and Taylor model of cultural competence development. The article also outlines the educational principles and learning strategies used in the training.

The social contexts of drinking among Irish men in London.

The article reports the alcohol-related findings of a qualitative study that examined health beliefs and behaviours among Irish people in London. The findings elicited though key informant and lay focus groups and semi-structured interviews, illuminated the social and socioeconomic background to excessive alcohol use among middle-aged Irish men who left Ireland in the 1960s and 1970s. The findings describe the economic role of the pub and alcohol for men in the construction industry as well protecting them from homesickness, isolation and alienation in an unwelcoming and hostile environment. They illustrate the use of alcohol later in life to cope with physical and psychological pain, social stress and the symptoms of mental illness. The use of alcohol as a culturally sanctioned coping strategy is considered, exploring the ambivalent culture of alcohol in Ireland and in particular the tolerance of excessive consumption among men. The article explores the possibility that tolerant attitudes to alcohol in Ireland persist on migration to Britain and are then confounded by a culture of binge drinking among young people in general. The conclusion argues for further research and for culturally sensitive healthcare and health promotion strategies that take account of cultural and structural factors impacting on young Irish men in Britain. Current NHS policies on equality, alcohol and suicide offer timely opportunities to address alcohol misuse in order to improve physical and mental health and reduce the incidence of suicide among Irish men in Britain.

Older Irish People with Dementia in England

Abstract The Irish community is the oldest minority ethnic community in Britain. Despite an older age profile than general or minority ethnic populations, as well as excesses of mental and physical ill-health and socio-economic disadvantage, the age, poor health and social profile of the community is largely ignored by policy makers and providers. Several of these factors predispose the Irish community in England to a higher incidence of dementia. Unlike other minority ethnic groups with growing numbers of people with dementia, the incidence of dementia is already high. Older Irish people are often reluctant to access mainstream services because they fail to recognise their distinct cultural needs and experiences. Irish third sector organisations provide a range of culturally specific services to older people and their carers and increasingly to those with dementia. This article uses data from a mapping exercise which identifies non-governmental services for Irish people with dementia and their carers, explaining what cultural sensitivity means for them. Changes in the UK government and the ‘Big Society’ agenda pose a threat to dementia services. However prioritising the National Dementia Strategy and revising the National Carers Strategy within this agenda could expand the role of the Irish third sector in England and improve the lives of Irish people with dementia and their carers.

Strategies to surmount the potential barriers to providing anti-discriminatory care in Irish healthcare settings

Abstract Aim: This article aims to explore some of the potential Irish specific barriers to providing anti-discriminatory care to non-Irish nationals in health and social care settings and considers strategies to overcome them. Background: There has been a rapid and unprecedented increase in the ethnic and cultural diversity of the population in Ireland over the past 10 years. This brings with it both opportunities and challenges. The challenges that are particularly poignant include Irish nationals adapting to a multicultural society and integrating migrants into mainstream society. Historically, Ireland’s relative homogeneity as a nation has been reflected in their health services, suggesting the need for an approach that addresses the more diverse needs of their growing multicultural population. Conclusion: Increasing awareness in the Irish health care setting of the complexity of working transculturally is important to interrogate the concept of privilege and the presence of racist practices. Unless practitioners are consciously aware of the personal, social and professional values that inform their attitudes and practices, their ability to be culturally competent will be at best superficial. The need to challenge attitudes, deep rooted social behaviour and misinformation which underline racial hostility is essential. Attention should focus on creating an environment of trust where critical reflection occurs, blame is avoided, risk managed and new ideas developed, tested and evaluated.

Resigned Indifference: The importance of Cultural Competent Education

This paper presents the findings of a PhD study, which explored how nurses’ deal with their main concern when caring for patients from diverse cultural and ethnic backgrounds. Utilising theoretical sampling and the principles of a grounded theory approach, focus groups (n-10) and individual face-to-face interviews (n-30) were conducted with student and qualified nurses, in one region of Ireland. As data were collected, it was simultaneously analysed using constant comparative analysis during open, selective and theoretical coding. Uncertainty was the consistent main concern that emerged for participants in this study. Feelings of ambiguity of how to act were further influenced by a lack of knowledge, an awareness of potential ethnocentric beliefs and the culture of the organisation in which participants learn and work in. Resigned indifference explains how participants in this study dealt with their uncertainty when caring for patients from diverse cultures. It explains how participants adopted a range of disengagement strategies. Instead of doing what they sometimes knew to be right, participants adopted a range of disengagement strategies which were underpinned by a resigned indifference. The culture within the organisation allowed the disengagement strategies and indifference to also go un-noticed. As a result culturally insensitive care went unchallenged, often un-noticed and subsequently unchanged. The discomfort associated with providing culturally insensitive care was eased with shifting the blame to professional preparation or organisational constraints. As a consequence culturally insensitive care is sustained and perpetuated. This paper highlights the need for imaginative learning and teaching approaches that will replace uncertainty with curiosity and resilience, apathy with courage and commitment both at individual and organisational levels.