The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities

Introduction

Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service.

Results

These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering “culture” in the presentation and expression of mental distress. The narratives reveal an overall “culture of understanding cultural issues” and specific “cultures of care”. These emerged as necessary foci of intervention to improve service user outcomes.

Conclusion

Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery.

     

The Body Doesn't Lie: Five Tales of Superobesity as Somatic Language

The bodies of the five patients described here seemed to signal their ongoing dilemma: they could not fully grow up and therefore resorted to a somatic language that fairly shouted to be recognized. The author presents the case histories from an unusual point of view: She reaches her patients by working with the incomplete body images in both verbal and nonverbal modes. While the patients are on the couch, she uses verbal interpretations. When pre- and nonverbal phenomena raise their heads, she uses dance therapeutic interventions. She describes how and what she does with her patients from the point of view that motility is another way to reach the unconscious. Some of her patients were able to use movement improvisation like free association. Her highly sophisticated conceptualizations about the why and how of superobesity shine a new light on the etiology of this particular syndrome     

Response to DiNunno's “Long-Term Group Psychotherapy for Women Who Are Survivors of Childhood Abuse”

Trauma impels people both to withdraw from close relationships and to seek them desperately. The profound disruption in basic trust, the common feelings of shame, guilt, and inferiority, and the need to avoid reminders of the trauma that might be found in social life, all foster withdrawal from close relationships. But the terror of the traumatic event intensifies the need for protective attachments. The traumatized person therefore frequently alternates between isolation and anxious clinging to others [Herman, 1992, p. 56].     

sleep complaints,behavioral characteristics and vital exhaustion in myocardial infarction cases

Abstract

Prodromal symptoms of vital exhaustion and sleep complaints are increasingly being recognized as important risk indicators for myocardial infarction (MI). In this study, the relationships between vital exhaustion, behavioral characteristics, and MI, and between several sleep complaints and MI were investigated. The subjects were 133 male cases with first MI, 192 male hospital controls, and 133 male neighborhood controls. The instruments used were the Maastricht Questionnaire (vital exhaustion), the Life Styles Questionnaire (sleep complaints, coffee consumption, and current smoking), and the Structured Interview (Type A behavior). All sleep complaints, vital exhaustion, Type A behavior, excessive coffee consumption, and current smoking occurred significantly more often in MI-cases. After controlling for these potential confounders, and age, most sleep complaints retained significant associations with MI, in particular often taking naps during the day and waking up in the morning feeling tired and exhausted.     

Parenting style and adolescent smoking cognitions and behaviour

Parenting style and smoking-related cognitions have both successfully predicted adolescent smoking behaviour. Data were collected among 482 Dutch adolescents to examine whether effects of parenting styles (authoritative, permissive, authoritarian, rejecting, neglecting, measured by underlying dimensions support, strict control, and psychological control) on adolescent lifetime smoking were mediated by cognitions (pro-smoking attitude, social norm, self-efficacy, intention) and to study the role of gender in this process. Support was not significantly associated with smoking behaviour. The inverse relation between strict control and smoking was partly mediated by attitude and intention, both associated with increased smoking. Psychological control related directly to increased lifetime smoking. Combinations of dimensions creating the specific styles were not associated with cognitions or behaviour. Maternal and paternal parenting were equally associated with smoking cognitions and behaviour; nor were effects moderated by adolescent gender. Interventions to prevent adolescent smoking initiation should aim at increasing strict control and reducing psychological control.     

Coping with dental treatment correlates of dispositional and domain specific monitoring and blunting

Abstract

Relations between coping style and several variables on an intermediary level were studied in a group of dentally anxious patients (N = 68) awaiting dental treatment. Monitoring was found to be positively related to the need of information: General dispositional monitoring was the best predictor of the need of information in case of more distant threat, whereas domain specific monitoring was the best predictor in case of imminent threat. Furthermore. dental trait anxiety was strongly related to early anticipatory tension, degree of anticipatory tension at several moments in time, and tension during treatment as perceived by the dentist, thereby overshadowing the weaker effects of coping style. Domain specific blunting was negatively related to desires for informational adaptations in the waiting room, and to question proneness as perceived by the dentist during treatment. It is concluded that, in order to study further effects of coping style, a sample homogeneous with respect to domain specific anxiety is needed.     

Coping with adverse drug events in patients with heart failure: Exploring the role of medication beliefs and perceptions

This study describes coping strategies that patients with heart failure (HF) use to manage adverse drug events (ADEs). The included coping strategies were social support seeking, information seeking, non-adherence and taking alleviating medication. The role of beliefs about medication and ADE perceptions in explaining these coping strategies was assessed using the Self-Regulation Model. We performed a cross-sectional study including 250 HF patients who experienced an ADE. Patients completed validated questionnaires assessing their coping strategies, ADE perceptions and medication beliefs. Social support (60%) and information seeking (32%) were the most commonly used strategies to cope with ADEs. Non-adherence was reported by 7% of the patients. Multivariate linear regression analysis showed that demographics, clinical factors and medication beliefs explained only a small amount of the variance in coping strategies, whereas ADE perceptions explained a substantial amount of variance. Path analysis showed that patients’ perceptions about the timeline, consequences and controllability of ADEs by the health care provider were directly related to their coping behaviour. The effect of patients’ medication beliefs on their coping strategies was consistent with mediation through their ADE perceptions. Our results support the value of the Self-Regulation Model in understanding patients’ coping behaviour with regard to ADEs.     

Comparing Five Sets of Five‐Factor Model Personality Disorder Counts in a Heterogeneous Sample of Psychiatric Patients

The research agenda for DSM‐5 emphasizes the implementation of dimensional trait models into the classification of personality disorders (PDs). However, because assessment psychologists may still want to recover the traditional DSM‐IV categories, researchers developed a count technique that uses sums of selected Five‐Factor Model facets to assess the DSM‐IV PDs. The presented study examined the convergent and divergent validity of different linear combinations of trait facets to describe specific DSM‐IV PDs in a heterogeneous clinical sample (N = 155) with sufficient prevalence of all PDs, using semi‐structured interviews to obtain all diagnostic information, and comparing alternative counts from five different sources for each PD. The results show that none of the schizotypal, antisocial, and dependent counts succeeded in combining good convergent with adequate divergent validity. However, the original counts could be optimized for five of the seven remaining PDs by using alternative Five‐Factor Model prototypes. The diagnostic and taxonomic implications of these findings are discussed. Copyright © 2012 John Wiley & Sons, Ltd.     

Convergent,Discriminant, and Incremental Validity of the Pictorial Attitude Implicit Association Test and the Picture Story Exercise as Measures of the Implicit Power Motive

The Pictorial Attitude Implicit Association Test (PA‐IAT) has recently been proposed as new measure of implicit motives. We report a study that provides the first evidence for the convergent validity of the PA‐IAT by showing that the PA‐IAT correlates significantly with a standard measure of implicit motives [i.e. the Picture Story Exercise (PSE)]. Discriminant validity of the PA‐IAT was verified in the sense that the PA‐IAT shared virtually no common variance with explicit motive measures. Our analyses revealed that the PA‐IAT and PSE can best be conceived as related but distinct measures. We further showed that the PA‐IAT had incremental validity in predicting performance on a memory recall task over and above the PSE. In general, our results confirm that the PA‐IAT is a valid measure of implicit motives and can serve as valid alternative to the PSE. Copyright © 2012 John Wiley & Sons, Ltd.     

Rapid naming,not cancellation speed or articulation rate,predicts reading in an orthographically regular language (Italian)

This study examined the influence of rapid automatization naming (RAN) measures on various parameters of reading performance in children who were native speakers of a language with a shallow orthography (Italian). Participants included 281 children enrolled in first-to-sixth grade. They were given a Naming test, in which they had to name rapidly matrices of colors, objects, or digits, a Cancellation test, using the same stimulus materials, and an oral Articulation test. Performance on all tests improved steadily across ages tested. Performance on the Naming test, but not on the Cancellation and Articulation tests, predicted speed and accuracy in reading; none of these measures reliably predicted the reading comprehension measure. Data on a Blending test were also available for a subsample of first- and third-graders. Both RAN and phonological ability contributed independently to the prediction of reading ability (accuracy and speed) in these participants. The results extend observations on RAN to an orthographically shallow language (Italian) and suggest an element of continuity between languages with opaque and transparent orthographies.