Ethnicity and Mental Ethnicity and Mental HHealth: ealth: AA CCultural ultural HHistory istory

of of IInterrelatednessnterrelatedness

Prof. dr. Darja ZaviršekProf. dr. Darja ZaviršekUniversity of Ljubljana University of Ljubljana

Darja.zavirsek@fsd.uni-lj.siDarja.zavirsek@fsd.uni-lj.si

Jerusalem, 18.-21.09. 2008Jerusalem, 18.-21.09. 2008GAMIAN EUROPEGAMIAN EUROPE

Culture, ethnicity and mental crises Culture, ethnicity and mental crises

were never defined in simple were never defined in simple neutral neutral

definitions, budefinitions, but were always t were always loaded loaded

and and depended depended from particularfrom particular

ttemporary politicalemporary political and social contexts and social contexts

aand values across different countriesnd values across different countries. .

HHistoricistoricalal relatedness of ethnicity relatedness of ethnicity and mental health:and mental health:

pathologisationpathologisation of ethnic minorities with of ethnic minorities with the use of medical/psychiatric diagnosis; the use of medical/psychiatric diagnosis;

political impactpolitical impact on the lack of ethnically on the lack of ethnically competent mental health services; competent mental health services;

professional limitationprofessional limitationss for for resource-resource-oriented and empowering oriented and empowering mental health mental health services for people services for people oof ethnic groups. f ethnic groups.

Pathologosation is a process when Pathologosation is a process when ethnic/cultural characteristics of a person/ethnic/cultural characteristics of a person/aa group are seen as natural, inborn marks of group are seen as natural, inborn marks of a person/a groupa person/a group,, and and are described in are described in medical terms medical terms which which help to construct help to construct ethnic minorities as being prone to specific ethnic minorities as being prone to specific bodily and mental illnesses, pathological bodily and mental illnesses, pathological violence, and lesser intelligence which violence, and lesser intelligence which supposedly supposedly cause thecause theirir mental mental inferiority. inferiority.

Pathologisation of ethnicityPathologisation of ethnicity

““Professional” pathologisation of ethnicity during Professional” pathologisation of ethnicity during Nacism: social workers registering the “un-Nacism: social workers registering the “un-healthy” Roma in Germany in the late 1930ies.healthy” Roma in Germany in the late 1930ies.

Mental health diagnosis are often a Mental health diagnosis are often a special medicalised form of social special medicalised form of social exclusion of ethnic minorities exclusion of ethnic minorities which has been well-known since which has been well-known since the 19th Centurythe 19th Century..

Having ethnicityHaving ethnicity

sometimes meansometimes meantt

not having a not having a ccultureulture..

This is today still This is today still

often believed by often believed by

ordinary people, ordinary people,

psychiatrists, psychiatrists,

social workers or social workers or

other health workers. other health workers.

Ethnicity has been Ethnicity has been externalized externalized

as relevant only to the other.as relevant only to the other.

““They” not “We” have ethnicity. They” not “We” have ethnicity.

Roma community “Strojan Family” Roma community “Strojan Family” from Slovenia expelled from their from Slovenia expelled from their settlement in Spring 2007. settlement in Spring 2007.

A child from “Stojan family” living under a tent in 2007.A child from “Stojan family” living under a tent in 2007.

Roma children in Slovenia and across eastern Europe Roma children in Slovenia and across eastern Europe

are 10-times more often than the majority children labeled are 10-times more often than the majority children labeled as mentally disabled and send to special schools. as mentally disabled and send to special schools.

In Eastern Europe like in In Eastern Europe like in many western countries:many western countries:

Ethnic minorities have less access Ethnic minorities have less access to to general mental health services, general mental health services, or they or they have no access and have no access and any any proper treatment at all.proper treatment at all.

Inter-cultural /trans-cultural Inter-cultural /trans-cultural competencies competencies can be defined as the ability can be defined as the ability

to communicate appropriately and to communicate appropriately and successfully with persons:successfully with persons:

whose first language is different from the whose first language is different from the language of the country in which they live language of the country in which they live and/or;and/or;

who have grown up with a different culture who have grown up with a different culture and/or; and/or;

whose social mobility differs from that of whose social mobility differs from that of members of the majority group on account of members of the majority group on account of discrimination (Schultz 2007). discrimination (Schultz 2007).

In addition to that it means In addition to that it means avoiding any kind of avoiding any kind of Othering. Othering.

Focus of the transcultural Focus of the transcultural psychiatry in different countires:psychiatry in different countires:

language; language; acceptance of cultural diversity and a acceptance of cultural diversity and a

cultural and self-reflective perspective; cultural and self-reflective perspective; understanding and addressing the understanding and addressing the

consequences of traumatic life events consequences of traumatic life events before emigration and post-immigration before emigration and post-immigration stress in the host country; stress in the host country;

hearing the voices of immigrants and hearing the voices of immigrants and minorities.minorities.

Ethnic minorities are less likely to Ethnic minorities are less likely to receive needed mental health receive needed mental health services and services and often often receive poorer receive poorer quality of treatment than the quality of treatment than the dominant society, even when dominant society, even when access existsaccess exists..

PProfessionals see ethnic minorities as rofessionals see ethnic minorities as having having more problemsmore problems than the than the majority population, majority population, as being needy, as being needy, as being dependant and as being less as being dependant and as being less capablcapablee of solving the everyday of solving the everyday difficulties: “difficulties: “… … the stranger is always the stranger is always thought to be very much in need of thought to be very much in need of help, even though this person has help, even though this person has many abilities”many abilities” (Dagmar Shultz 200(Dagmar Shultz 20077).).

Strenghts perspective, resilience and Strenghts perspective, resilience and resource-oriented professional practice resource-oriented professional practice

can:can:

encourage self-confidence and the encourage self-confidence and the healing motivation of the patient;healing motivation of the patient;

positively influence the attitude of the positively influence the attitude of the personnel toward patients;personnel toward patients;

challenges challenges the personnels’ self-the personnels’ self-reflection of prejudice and reflection of prejudice and stereotypical views.stereotypical views.

In Eastern EuropeIn Eastern Europe there is an urge there is an urge for: for:

training professional staff in trans-cultural and anti-racist practice;training professional staff in trans-cultural and anti-racist practice; cultural consultancy based on a multicultural multidisciplinary team;cultural consultancy based on a multicultural multidisciplinary team; services-led by professionals from similar ethnic backgrounds to services-led by professionals from similar ethnic backgrounds to

those of clients to help people from a variety of cultural those of clients to help people from a variety of cultural backgrounds;backgrounds;

advocacy to help mental health clients to deal with statutory advocacy to help mental health clients to deal with statutory services;services;

guidance to clients on strategies to deal with everyday racism; guidance to clients on strategies to deal with everyday racism; incorporating resource-oriented/resilience perspective into therapy incorporating resource-oriented/resilience perspective into therapy

and using inter-cultural competencies in therapy; and using inter-cultural competencies in therapy; linking psychological support to housing, economic independen ce, linking psychological support to housing, economic independen ce,

social integration, community development.social integration, community development.