Cultural Sensitive Care Provision in a Public Child and Adolescent Mental Health Centre: A Case Study from the Toulouse University Hospital Intercultural Consultation

Abstract

Child and adolescent mental health services in Europe are confronted with children with increasingly diverse socio-cultural backgrounds. Clinicians encounter cultural environments of hyperdiversity in terms of languages and countries of origin, growing diversity within groups, and accelerated change with regards to social and administrational situations (Hannah, in: DelVecchio Good et al. (eds) Shattering culture: American medicine responds to cultural diversity, Russel Sage Foundation, New York, 2011). Children and families who live in these complex constellations face multiple vulnerabilizing factors related to overlapping or intersecting social identities (Crenshaw in Univ Chic Leg Forum 140:139–167, 1989). Mobilizing existing resources in terms of social and family support, and encouraging creative strategies of interculturation in therapeutic work (Denoux, in: Blomart and Krewer (eds) Perspectives de l’interculturel, L’Harmattan, Paris, 1994) may be helpful in order to enhance resilience. Drawing from experiences in the context of French transcultural and intercultural psychiatry, and inspired by the Mc Gill Cultural Consultation in Child Psychiatry, we developed an innovative model, the Intercultural Consultation Service (ICS). This consultation proposes short term interventions to children and families with complex migration experiences. It has been implemented into a local public health care structure in Toulouse, the Medical and Psychological Centre la Grave. The innovation includes the creation of a specific setting for short term therapeutic interventions and team training via shared case discussions. Our objectives are (a) to improve outcomes of mental health care for the children through a better understanding of the child’s family context (exploration of family dynamics and their relatedness to complex migration histories), (b) to enhance intercultural competencies in professionals via shared case discussions, and, (c) to improve the therapeutic relationship between children and professionals on the basis of the work with the family and the dialogue with the team. In our paper, we present the rationale and functioning of the ICS and illustrate our work with a case study. The presentation of the case uses the Mc Gill B-version of the Cultural Formulation, combined with a relational and process oriented reflection on the intercultural dynamics that unfold during the encounter with a family.

This is a preview of subscription content, access via your institution.

Notes

  1. 1.

    Even though experiences of flight and armed conflict have specific consequences on mental health, the distinction of refugee and migrant youth is not always very clear—children and families who migrate for economic reasons may be exposed to violence and traumatic experiences before and during the flight, and some migrants fleeing from conflict decide not to apply for asylum.

  2. 2.

    The terminology in France is variable. While the term “transcultural” is mostly used with reference to Georges Devereux in order to stress the possibility to overcome cultural difference and to refer to universal psychic processes, the term “intercultural” is mostly used with reference to the French intercultural psychology with a specific concern for the impact of real, imagined and attributed difference and its transformation in cultural contacts (Cohen-Emerique 2011; Guerraoui and Pirlot 2011).

  3. 3.

    With some meritorious exceptions such as (Jusot et al. 2009).

  4. 4.

    For a detailed description of the French Helth Care System and Barriers to Access for Migrant Minorities, see Dourgnon, Sturm and Rietsch (2017).

  5. 5.

    http://www.unaf.fr/IMG/pdf/charte-signee-scan19-12-2012.pdf.

  6. 6.

    http://www.cofrimi.com/.

  7. 7.

    For a detailed presentation of the cooperation between the DSM-IV taskforce and the group of specialists in cultural anthropology and cultural psychiatry who participated in the preparation of the DSM-IV, see (Littlewood 2001; Mezzich et al. 1999).

  8. 8.

    http://www.mcgill.ca/culturalconsultation/handbook/assessment/cfb/.

References

  1. Abu-Lughod, Lila 1991 Writing Against Culture. In R.G. Fox, (ed.), Recapturing Anthropology: Writing in the Present. Santa Fe: School of American Research: 137–162.

    Google Scholar 

  2. Aggarwal, Neil Krishan 2012 The Psychiatric Cultural Formulation: Applying Medical Anthropology in Clinical Practice. Journal of Psychiatric Practice. 18(2): 73–85.

    Article  Google Scholar 

  3. American Psychiatric Association 1994 Diagnostic and statistical Manual of Mental Disorders Fourth Edition—DSM-IV. Washington: American Psychiatric Press.

    Google Scholar 

  4. American Psychiatric Association 2014 Diagnostic and statistical Manual of Mental Disorders Fifth Edition - DSM-V. Washington: American Psychiatric Press.

    Google Scholar 

  5. Amselle, Jean-Loup 1990 Logiques métisses: anthropologie de l’identité en Afrique et ailleurs. Paris: Payot.

    Google Scholar 

  6. Anagnostopoulos, Dimitris C., Johannes Hebebrand, Stephan Eliez, Maeve B. Doyle, Henrikje Klasen, Sofie Crommen, Fusun Cetin Cuhadaroğlu, Milica Pejovic-Milovancevic, Oscar Herreros, Ruud Minderaa, Andreas Karwautz, Carl Goran Svedin, Jean Philippe Raynaud 2016 European Society of Child and Adolescent Psychiatry: Position Statement on Mental Health of Child and Adolescent Refugees. European Child & Adolescent Psychiatry 25: 673–676.

    Article  Google Scholar 

  7. Ascoli, Micol, Andrea Palinski, John Arianda Owiti, Bertine De Jongh, and Kamaldeep Bhui 2012 The Culture of Care within Psychiatric Services: Tackling Inequalities and Improving Clinical and Organisational Capabilities. Philosophy Ethics and Humanities in Medicine 7(1).

    Article  Google Scholar 

  8. Baubet, Thierry, and Marie Rose Moro (eds.) 2003 Psychiatrie et migrations. Paris: Editions Masson.

    Google Scholar 

  9. Baubet, Thierry, and Marie Rose Moro (eds.) 2013 Psychopathologie transculturelle. Paris: Elsevier Masson.

    Google Scholar 

  10. Baumann, Gerd 1996 Contesting Culture: Discourses of Identity in Multi-Ethnic London. Cambridge: Cambridge University Press.

    Google Scholar 

  11. Baumann, Gerd 1999 The Multicultural Riddle : Rethinking National, Ethnic, and Religious Identities. London, New York: Routledge.

    Google Scholar 

  12. Béal, Arnaud, and Nicolas Chambon 2015 Le Recours À L’interprète En Santé Mentale : Enjeux et Problèmes. Rhizome 55: 9–18.

    Google Scholar 

  13. Benadiba, Eve 2008 Psychiatrie Transculturelle : Psychiatrie transculturelle : de l’histoire aux dispositifs accueillant enfants et familles d’ici et d’ailleurs. Thèse pour le doctorat en médecine, Paul Sabatier.

  14. Benslamah, Fethi 2004 Qu’est-ce qu’une Clinique de l’exil? Evolution Psychiatrique 42: 347-366.

    Google Scholar 

  15. Bhui, Kamaldeep, John A. Owiti, Andrea Palinski, Micol Ascoli, Bertine De Jongh, Jane Archer, Pat Staples, Nilu Ahmed, and Ali Ajaz. 2015 A Cultural Consultation Service in East London: Experiences and Outcomes from Implementation of an Innovative Service. International Review of Psychiatry 27(1): 11–22.

    Article  Google Scholar 

  16. Bourgois, Philippe, Seth, H. Holmes, Kim Sue, and James Quesada 2016 Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care. Academic Medicine, 12 (PAP). doi:10.1097/ACM.0000000000001294.

  17. Cattacin, Sandro, and Dagmar Domenig 2015 Healthcare and Social-Services Institutions in the Face of Radical Differences. Intersectionalities: A Global Journal of Social Work Analysis, Research, Policy, and Practice 3(1): 24–38.

    Google Scholar 

  18. Cho, Sumi, Kimberlé W. Crenshaw, and Leslie McCall 2013 Toward a Field of Intersectionality Studies: Theory, Applications, and Praxis. Signs. Journal of Women in Culture and Society 38(4): 785–810.

    Article  Google Scholar 

  19. Clanet, Claude 1990 L’interculturel: introduction aux approaches interculturelles en education et en sciences humaines. Toulouse: Presses Universitaires du Mirail.

    Google Scholar 

  20. Clifford, James, and George E. Marcus 1986 Writing Culture: The Poetics and Politics of Ethnography. Berkeley: University of California Press.

    Google Scholar 

  21. Cohen-Emerique, Margalit 2011 Pour Une Approche Interculturelle En Travail Social. Théories et Pratiques. Rennes: Presses de L’EHESP.

    Google Scholar 

  22. Crenshaw, Kimberlé W. 1989 Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. The University of Chicago Legal Forum 140: 139–167.

    Google Scholar 

  23. DelVecchio Good, Mary-Jo, Sarah S. Willen, Seth Donal Hannah, Ken Vickery, and Lawrence Taeseng Park 2011 Shattering Culture: American Medicine Responds to Cultural Diversity. New York: Russell Sage Foundation.

  24. Denoux, P. 1994 Pour une nouvelle définition de l’interculturation. In: Blomart, J, Krewer, B, editors. Perspectives de l’interculturel. Paris: L’Harmattan. p. 67–81.

    Google Scholar 

  25. Derluyn, Ilse, Eric Broekaert, and Gilberte Schuyten 2008 Emotional and Behavioural Problems in Migrant Adolescents in Belgium. European Child & Adolescent Psychiatry 17(1): 54–62.

    Article  Google Scholar 

  26. Dourgnon, Paul, Gesine Sturm, and Marie-Gabrielle Rietsch 2017 Migration Integration Policy Index, Health Strand. Country Report France. International Organisation for Migration, Regional Office for the European Economic Area, the European Union and Nato, Migration Health Division, Brussels. http://equi-health.eea.iom.int/index.php/migrant-health/milestones-and-deliverables-mh, accessed April 10, 2017.

  27. Douville, Olivier 2014 Les figures de l’Autre. Pour une anthropologie Clinique. Paris: Dunod.

    Google Scholar 

  28. Falicov, Celia J. 2011 Migration and the Family Life Cycle. In B. Carter and M. Mc Goldrick (eds.), The Expanded Family Life Cycle: Individual, Family and Social Perspectives. Boston: Allyn & Bacon: 336–347.

    Google Scholar 

  29. Fassin, Didier 2000 Les politiques de l’ethnopsychiatrie. La psyché africaine, des colonies africaines aux banlieues parisiennes. L’Homme 153 : 231-250.

    Article  Google Scholar 

  30. Fassin, Didier, and Richard Rechtman 2005 An Anthropological Hybrid: The Pragmatic Arrangement of Universalism and Culturalism in French Mental Health. Transcultural Psychiatry 42(3): 347–366.

    Article  Google Scholar 

  31. Garland, Caroline 1998 Understanding Trauma: A Psychoanalytical Approach. London, New York: Karnac Books.

    Google Scholar 

  32. Guerraoui, Zohra 2009 De L’acculturation à l’interculturation: réflexions épistémologiques. L’Autre. Cultures, Cliniques, Sociétés 10(2):195–200.

    Google Scholar 

  33. Guerraoui, Zohra, and Gérard Pirlot (eds.) 2011 Comprendre et Traiter Les Situations Interculturelles. Anvers: De Boeck.

    Google Scholar 

  34. Guzder, Jaswant 2014 Family Systems in Cultural Consultation. In L. Kirmayer, J. Guzder, and C. Rousseau, (eds.), Cultural Consultation. Encountering the Other in Mental Health Care. New York: Springer:136–162.

    Google Scholar 

  35. Guzder, Jaswant, and Cécile Rousseau 2016 Supplementary Module 9: School Aged Children and Adolescents. In R. Lewis-Fernandez, N.K. Aggarwal, L. Hinton, D.E. Hinton, L.J. Kirmayer (eds.), DSM-5 Handbook on the Cultural Formulation Interview. Washington, D.C.: American Psychiatric Publishing: 156-163.

    Google Scholar 

  36. Hannah, Seth Donal 2011 Clinical Care in Environments of Hyperdiversity. In M.J. DelVecchio Good, S.D. Hanna, S. Willen, K. Vickery, and L.T. Parck (eds.), Shattering Culture: American Medicine Responds to Cultural Diversity. New York: Russel Sage Foundation: 35–69.

    Google Scholar 

  37. Hannerz, Ulf 1992 Cultural Complexity: Studies in the Social Organization of Meaning. New York: Columbia University Press.

    Google Scholar 

  38. Hebebrand, Johannes, Dimitris C. Anagnostopoulos, Stephan Eliez, Henk Linse, Milica Pejovic-Milovancevic, and Henrikje Klasen 2016 A First Assessment of the Needs of Young Refugees Arriving in Europe: What Mental Health Professionals Need to Know. European Child & Adolescent Psychiatry 25: 1–6.

    Article  Google Scholar 

  39. INSEE 2005 Atlas Des Populations Immigrés. Midi-Pyrénées. Etudes. Les dossiers de l’INSEE. Toulouse: Midi-Pyréenees Publications.

    Google Scholar 

  40. INSEE 2012 Recensement de La Population. Institut National de La Statistique et Des Études Économiques. Mesurer Pour Comprendre. http://www.insee.fr/fr/themes/theme.asp?theme=2&sous_theme=5, accessed March 2, 2016.

  41. Jusot, Florence, Jerôme Silva, Paul Dourgnon, and Catherine Sermet 2009 Inégalités de santé liées à l’immigration en France. Revue Économique 60(2): 385-411.

    Article  Google Scholar 

  42. Leanza, Yvan, Alessandra Miklavcic, Isabelle Boivin, and Ellen Rosenberg 2014 Working with Interpreters. In In L. Kirmayer, J. Guzder, and C. Rousseau, (eds.), Cultural Consultation. Encountering the Other in Mental Health Care. New York: Springer: 90–115.

    Google Scholar 

  43. Lebigot, François 2005 Traiter Les Traumatismes Psychiques. Clinique et Prise En Charge. Paris: Dunod.

    Google Scholar 

  44. Lewis-Fernandez, Roberto, Neil Krishan Aggarwal, Sofie Bäärnhielm, Hans Rohlof, Laurence J. Kirmayer, Mitchell G. Weiss, Sushrut Jadhav, Ladson Hinton, Renato D. Alarcón, Dinesh Bhugra, Rob van Dijk, Adil Qureshi, Francisco Collazos, Cécile Rousseau, Luis Caballero, Mar Ramos, Francis Lu, and Simon Groen, 2014 Culture and Psychiatric Evaluation: Operationalizing Cultural Formulation for DSM-5. Psychiatry 77(2): 130–154.

    Article  Google Scholar 

  45. Littlewood, Ronald 2001 Nosologie et Classifications Psychiatriques selon les Cultures: les « syndromes liés à la culture » L’Autre. Cultures, Cliniques, Sociétés 3:441–466.

  46. Measham, Toby, Felicia Heidenreich-Dutray, Cécile Rousseau, and Lucie Nadeau 2014 Cultural consultation in child psychiatry. In L. Kirmayer, J. Guzder, and C. Rousseau, (eds.), Cultural Consultation. Encountering the Other in Mental Health Care. New York: Springer: 71–89.

    Google Scholar 

  47. Mezzich, Juan E., Laurence J. Kirmayer, Arthur Kleinman, Horacio Fabrega, Byron J. Good, Keh-Ming Lin, and Spero Manson. 1999 The Place of Culture in the DSM IV. The journal of nervous and mental disease 187: 457–464.

    Article  Google Scholar 

  48. Moro, Marie Rose 1994 Parents En Exil. Psychopathologie et Migrations. Paris: Presses Universitaires de France.

    Google Scholar 

  49. Moro, Marie Rose 2011 Psychothérapie transculturelle de l’enfant et de l’adolescent. Paris: Dunod.

    Google Scholar 

  50. Moro, Marie Rose 2014 Parenthood in Migration: How to Face Vulnerability. Culture, Medicine and Psychiatry 38(1): 13–27.

    Article  Google Scholar 

  51. Mouchenik, Yoram 2006 Introduction Au Concept de Culture En Anthropologie. In M.R. Moro, Q. de la Noë, and Y. Mouchenik (eds.), Manuel de Psychiatrie Transculturelle. Travail Clinique, Travail Social. Grenoble: La pensée Sauvage: 49–64.

    Google Scholar 

  52. Mouchenik, Yoram, Thierry Baubet, and Marie Rose Moro 2012 Manuel des Psychotraumatismes. Cliniques et Recherches Contemporaines. Grenoble: La pensée Sauvage.

    Google Scholar 

  53. Nathan, Tobie 1986 La Folie des Autres. Traité d’Ethnopsychiatrie Clinique. Paris: Dunod.

    Google Scholar 

  54. Nathan, Tobie 1993 L’influence qui guérit. Paris : Odile Jacob.

    Google Scholar 

  55. Petitjean, François 2010 The Sectorization System in France. International Journal of Mental Health 38(4): 25–38.

    Article  Google Scholar 

  56. Rechel, Bernd, Philipa Mladovsky, David Ingleby, Johan P. Mackenbach, and Martin McKee 2013 Migration and Health in an Increasingly Diverse Europe. Lancet 381(9873): 1235–1245.

    Article  Google Scholar 

  57. Rousseau, Cécile 2003 La Médiation: Articulation Des Espaces Thérapeutiques et Politiques. In T. Baubet M.R. Moro (eds.), Psychiatrie et Migrations. Paris: Masson: 195–202.

    Google Scholar 

  58. Rousseau, Cécile, Aline Drapeau, Louise Lacroix, Déogratias Bagilishya, and Nicole Heusch 2005 Evaluation of a Classroom Program of Creative Expression Workshops for Refugee and Immigrant Children. Journal of Child Psychology and Psychiatry 46(2): 180–185.

    Article  Google Scholar 

  59. Sleijpen, Marieke, Hennie Boeije, Rolf Klebera, and Trudy Mooren 2015 Between Power and Powerlessness: A Meta-Ethnography of Sources of Resilience in Young Refugees. Ethnicity and Health 21(2): 158–180.

    Article  Google Scholar 

  60. Sluzki, Carlos E. 2015 The Presence of the Absent. Therapies with Families and Their Ghosts. London, New York: Roudledge.

    Google Scholar 

  61. Sturm, Gesine, Zohra Guerraoui, and Jean-Philippe Raynaud 2016 Approches Transculturelles et Interculturelles Dans La Psychiatrie Française. Encyclopédie Médico-Chiruricale (Psychiatrie) 13(3): 1–7.

    Google Scholar 

  62. Sturm, Gesine, Marie Rose Moro, and Thierry Baubet 2010 Trauma, Culture and Subjectivity: The French Ethno-Psychoanalitic Approach. Traumatology 16(4): 27–38.

    Article  Google Scholar 

  63. Sturm, Gesine, Maya Nadig, and Marie Rose Moro 2011 Current Developments in French Ethnopsychoanalysis. Transcultural Psychiatry 48(3): 205–227.

    Article  Google Scholar 

  64. Unger, Michael 2008 Resilience across Cultures. British Journal of Social Work 38(3): 218–235.

    Google Scholar 

  65. Unger, Michael 2015 Varied Patterns of Family Resilience in Challenging Context. Journal of Marital and Family Therapy 42(1): 19–31.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the team of the CMP for our close and stimulating cooperation, and give a special thanks to all families who shared trust, scepticism and many insights with us. Thank you also to Mme Nasr, Vice President of the DRCI (Head Office of Research and Innovation of the CHU Toulouse), for having kindly informed us about the legal framework concerning the publication of case-studies in France: in application of the loi Jardé, the Institutional Review Board does not need to intervene. We also thank Adil Qureshi and Emily Anne Shults for their careful reading and the inspiring comments.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Gesine Sturm.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sturm, G., Bonnet, S., Coussot, Y. et al. Cultural Sensitive Care Provision in a Public Child and Adolescent Mental Health Centre: A Case Study from the Toulouse University Hospital Intercultural Consultation. Cult Med Psychiatry 41, 630–655 (2017). https://doi.org/10.1007/s11013-017-9538-7

Download citation

Keywords

  • Culturally sensitive child mental health
  • Hyperdiversity
  • Intersectionality
  • Interculturation
  • Cultural formulation