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.

     

Electrophysiological evidence for modulation of lexical processing after repetitive exposure to foreign phonotactic rules

In two experiments we investigate how repeated exposure to native and non-native phonotactic regularities alters the N400, an event-related potential related to lexico-semantic access. Participants underwent a Passive Listening (Experiment 1) or a Categorization Training (Experiment 2) for monosyllabic pseudowords over 3 days. During Passive Listening participants solely listened to the stimuli while for Categorization Training they learned to assign items to two arbitrary categories by feedback. Notably, this task did not rely on phonotactic regularities. Before training, N400 was larger for legal compared to illegal items. Over the 3-day exposure Passive Listening yielded a significant decrease in N400-amplitude for illegal pseudowords, however, this effect was abolished and partially inverted by the Categorization Training. We suggest the decrease in N400-amplitude indicates more efficient discrimination between native and non-native pseudowords since only the former are potential lexical candidates. On the contrary, Categorization Training introduces a ‘protosemantic’ context overriding prelexical selection processes.     

Integrating Dimensional and Discrete Theories of Emotions: A New Set of Anger- and Fear-Eliciting Stimuli for Children

The selection of appropriate stimuli for inducing specific emotional states has become one of the most challenging topics in psychological research. In the literature there is a lack of affective picture database specifically suited to investigate emotional response in children. Here the authors present the methodology that led us to create a new database (called Anger- and Fear-Eliciting Stimuli for Children) of affective stimuli inducing experiences of 3 target emotions (neutral, anger, and fear) to use in experimental session involving children. A total of 84 children were asked to (a) indicate the perceived emotion and its intensity and (b) rate the three affective dimensions of the Self-Assessment Manikin (SAM). Based on concordance between labeled and expected target emotion, the authors decided to select 15 stimuli to be included in Multivariate modeling techniques were applied to evaluate the association between expected target emotion and SAM ratings. The authors found that the hit rate for the neutral pictures was good (greater than 81%), for fear-eliciting pictures it was greater than 64%, and for anger-eliciting pictures it was moderate (between 45% and 56%). The study results reveal also an age effect only in the arousal scale. However, the authors did not find significant gender-related differences in SAM ratings.