5 Organisation and delivery of psychiatric services5.8 Cultural competence and accessibility
5.8 Cultural variation in the presentation of psychiatric disorder
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Written by Resident Doctor Committee · Published
Idioms and explanatory models
An idiom of distress is a shared way of expressing suffering, such as "bad nerves" or "a heavy heart" for anxiety or depression.
Kleinman's explanatory model asks the person's view of the problem, its cause, its effects, its likely severity and course, and what treatment would help.
Cultural concepts of distress place symptoms within their social meaning; ICD-11 includes cultural guidance when distinguishing disorders from expected experiences.
Over- and under-recognition
Over-recognition labels culturally understandable experience as illness, such as hearing a dead relative during bereavement.
Under-recognition dismisses illness as cultural, such as missing eating disorders in Black and South Asian women.
Ethnic inequalities in UK care
People from Black ethnic groups have the highest population rate of detention under the Mental Health Act in England and the UK, while the White group has the largest absolute count but a low rate.
Black groups carry the highest measured burden of serious mental illness and the largest excess of coercive care, including detention, restrictive practice and inequalities in self-harm and suicide.
The 2010 Count Me In census found inpatient admission rates in England and Wales below average for Indian and Chinese groups and above it for Black and White and Black mixed groups.
Exclusion, discrimination and adversity may contribute, and the social defeat hypothesis proposes that they act on dopamine systems.
Unequal access and mistrust mean contact comes late and in crisis, often through the police.
Diagnostic bias contributes but cannot alone explain the higher incidence of diagnosed psychosis in Black Caribbean and Black African people.
Assessment
Use a professional interpreter: relatives may omit sensitive material or make disorganised speech sound coherent, and children should never interpret.
Cultural formulation explores how the person defines the problem, its causes, past help-seeking and preferences, alongside the standard clinical assessment.