Nisha Dogra

WPA guidance on mental health and mental health care in migrants

The purpose of this guidance is to review currently available evidence on mental health problems in migrants and to present advice to clinicians and policy makers on how to provide migrants with appropriate and accessible mental health services. The three phases of the process of migration and the relevant implications for mental health are outlined, as well as the specific problems of groups such as women, children and adolescents, the elderly, refugees and asylum seekers, and lesbian, gay, bisexual and transgender individuals. The concepts of cultural bereavement, cultural identity and cultural congruity are discussed. The epidemiology of mental disorders in migrants is described. A series of recommendations to policy makers, service providers and clinicians aimed to improve mental health care in migrants are provided, covering the special needs of migrants concerning pharmacotherapies and psychotherapies.

The development and evaluation of a programme to teach cultural diversity to medical undergraduate students.

This paper describes the design (of process and content), implementation and evaluation of a component of the Human Diversity Module developed to teach cultural diversity to undergraduate medical students. The objectives of the teaching were to enable students to gain factual and practical information about other cultures and also for them to examine their own attitudes.

Teaching Cultural Diversity: Current Status in U.K., U.S., and Canadian Medical Schools

In this paper we present the current state of cultural diversity education for undergraduate medical students in three English-speaking countries: the United Kingdom (U.K.), United States (U.S.) and Canada. We review key documents that have shaped cultural diversity education in each country and compare and contrast current issues. It is beyond the scope of this paper to discuss the varied terminology that is immediately evident. Suffice it to say that there are many terms (e.g. cultural awareness, competence, sensitivity, sensibility, diversity and critical cultural diversity) used in different contexts with different meanings. The major issues that all three countries face include a lack of conceptual clarity, and fragmented and variable programs to teach cultural diversity. Faculty and staff support and development, and ambivalence from both staff and students continue to be a challenge. We suggest that greater international collaboration may help provide some solutions.

First-year medical students' attitudes toward diversity and its teaching: an investigation at one U.S. Medical School.

Purpose. To investigate whether medical students conceptualize culture and cultural diversity best within “categorical” or “cultural sensibility” teaching models. Method. In spring 2002, first-year medical students at the University of Illinois Colleges of Medicine at Chicago and Urbana-Champaign completed a previously developed questionnaire. A self-selected subset participated in focus groups. The questionnaire collected data on attitudes toward race, culture, and diversity education and how these concepts relate to medical practice; responses to a case scenario; attitudes toward cultural tolerance; definitions of key terms and sense of cultural belonging; and feedback on the questionnaire. The focus groups discussed the two models for teaching diversity. Results. Questionnaires were returned by 111 of 153 students (72.5%). Generally, the students displayed open attitudes about the balance between cultures of origin and the culture of the wider community in which immigrants may live. However, with very personal issues there was a tendency to stay with the familiar. These students had an impression of ethnic groups as very discrete and well defined. Skin color and issues of race remained a significant barrier to dialogue regarding diversity. Students were overwhelmingly in favor of the cultural sensibility teaching model that emphasizes the fluidity and malleability of culture. Conclusions. The students in this study were not familiar with key terms on culture and race, and struggled with the issues that diversity raises in medical practice. Although students held open attitudes toward equal opportunities and multiculturalism, differences among and within groups indicated that all students would benefit from a curriculum that emphasizes self-reflection and diversity teaching.

Twelve tips for teaching diversity and embedding it in the medical curriculum

Despite growing recognition of the need to increase cultural diversity undergraduate education in the UK, the US and Canada, there is a lack of cohesion in the development and delivery of cultural diversity teaching in medical schools in these three countries. This article highlights 12 tips for developing cultural diversity education in undergraduate medical programmes by integrating it in institutional policies, curriculum content, faculty development and assessment. These tips can be used to help ensure that students gain needed knowledge, skills and attitudes consistent with a view of patients as complex individuals with unique needs.

Characteristics of children and adolescents presenting to accident and emergency departments with deliberate self harm

Objectives—The aim of this study was to provide a description of the characteristics of children and adolescents presenting to the accident and emergency (A&E) department with deliberate self harm. Method—Descriptive analysis of data collected by reviewing the notes of all children and adolescents aged 16 years and under, presenting during the period of study (1 January to 31 December) with a history of deliberate self harm. Results—A total of 100 children (18 boys, 82 girls) were responsible for 117 episodes of deliberate self harm. Nine repeaters were responsible for 22% of the attendances; 38% had made use of emergency ambulance service and 6% were referred by their general practitioner (GP). Sixty nine per cent were accompanied by immediate family and 21% children presented alone. Seventy four per cent presented within three hours of the attempt and 37% presented between 6 pm and midnight; 77% presented during weekdays and 30% of attempts had occurred during spring. Ninety two per cent had used a pharmaceutical drug. Sixty five per cent had made the attempt at home and 12% in a public place. Twenty five per cent had prior or current contact with the child psychiatric services and a similar proportion had prior or current contact with social services. Conclusions—Few of the children and adolescents presenting with deliberate self harm to the A&E department have been referred by their GP. They frequently present alone or are accompanied by people who are not family members making assessment and treatment difficult. Many already have other services involved in their care and thus the gathering and dissemination of information can become quite lengthy. The time of presentation is usually out of hours, further complicating this process. A small number of young people present with repeated self harm, who are known to be most vulnerable for completing suicide.

A survey of the teaching and assessment of undergraduate psychiatry in the medical schools of the United Kingdom and Ireland

Background: Individual medical schools currently decide on the content and delivery of their undergraduate psychiatry curriculum, so there is probably significant variation in the students’ experience of the speciality during the medical course and in the extent to which they develop the appropriate skills and knowledge base. Aim: To ascertain how the teaching of undergraduate psychiatry differs across UK and Irish medical schools. Methods: The educational lead for psychiatry at each medical school in the United Kingdom and Ireland completed a questionnaire providing factual information on the teaching structure, contents and assessment methods in their current psychiatry curriculum. Results: Some aspects of the curriculum were consistent across the medical schools with other areas showing great variability. The course content was broadly similar but the assessment, length of experience and course structure differed. Conclusion: There are significant differences in how psychiatry is taught to undergraduate students in the United Kingdom and Ireland and although all the curricula are evaluated by the General Medical Council, further study is required to see if this has any effect on the levels of competency achieved.

What do children and young people want from mental health services

Purpose of review The purpose of this paper is to review the literature reporting on children and young peoples views on child and adolescent mental health services. Recent findings The review demonstrates that there is limited research exploring the views of children and young people regarding mental health services. Despite its limitations, the research available shows that young people, their parents and healthcare providers often have different expectations of services. Young people want accessible services staffed by those they are able to trust and who demonstrate an ability to listen; above all, young people want to be involved in the decisions made about them. Summary To date, children and young people have not been actively engaged or involved in service development. This is an evolving field and we need to ensure that existing evidence is taken into account as well as investigating further the views of young people. Child and adolescent mental health services need to consider how we serve young people, particularly children, whose perspectives may differ from those of their parents.

Children's specific fears

BACKGROUND Most children experience some degree of fear during their development. Specific fears are considered as an appropriate response provided that they are proportionate to the intensity of the perceived threat. Our aim is to present the prevalence of specific fears among children in the Great Britain, their socio-demographic correlates, in particular their association with ethnicity. METHODS Data on the childs experience of specific fears were obtained from parents of a national representative sample of 5- to 16-year-olds using the Development and Well-Being Assessment. Biographic, socio-demographic and socioeconomic characteristics of the child and the family were included in the questionnaire. RESULTS About one-third of children were assessed by their parents as having at least one of 12 specific fears. The most commonly reported fears were animals (11.6%), blood/injections (10.8%) and the dark (6.3%). Just less than 1% of all children were assessed according to International Classification of Diseases research diagnostic criteria as having a specific phobia. Biographic, socio-demographic and socioeconomic factors were independently associated with a greater likelihood of a child having particular fears. The most marked associations were fears of the dark, loud noises, imagined supernatural beings in younger children and fear of animals among girls and all non-white groups. CONCLUSIONS Although fears are only labelled as phobias when they impair functioning and interfere with life, they can cause personal distress to children and also can interfere with their daily activities. Childrens fears differ in nature across different ethnic groups. Culturally mediated beliefs, values and traditions may play a role in their expression.

Making videos for medical undergraduate teaching in child psychiatry: the development, use and perceived effectiveness of structured videotapes of clinical material for use by medical students in child psychiatry

The rationale for using videotapes in medical student teaching is presented with some examples of their use. The process of producing videotapes for use in the undergraduate child psychiatry course at the University of Leicester Medical School is then described, based on eight videos made so far. This includes planning, patient recruitment, and the technical issues associated with video production. The use of the videotapes is then contextualized. Feedback from medical students on the usefulness and quality of the videos is presented. There is finally a brief discussion of some of the issues that arise for both patients and clinicians when videos are made and used for medical student teaching.