Negotiating Engagement, Worthiness of Care and Cultural Identities Through Intersubjective Recognition: Migrant Patient Perspectives on the Cultural Formulation Interview in Danish Mental Healthcare

Abstract

This qualitative study presents migrant patient perspectives on using the Cultural Formulation Interview (CFI) in mental health assessments in Denmark. Empirical data consisted of 20 recorded CFI sessions and 16 patient interviews, coded with a constructivist grounded theory approach. Empirical findings prompted us to draw on the theoretical framework of intersubjective recognition in the analytical process. Our analysis showed how patients had multiple previous experiences of misrecognition in life and healthcare. This seemed to restrain their self-esteem and available positions for expressing preferences and reservations during the CFI and led to negotiations of worthiness of care. Despite occasional lack of flow and information in the recorded CFI sessions, patients subsequently recounted how they felt the CFI recognised the complexity and context of their cultural identities and illness narratives. Patients described how the CFI-guided provider approach of curiosity and empowerment carried significant meaning and left them feeling dignified, hopeful and engaged in future care. Intersubjective recognition is fundamental in all human interaction, but we argue that the recognising CFI approach is particularly important in vulnerable and asymmetrical mental health assessment encounters where access to care is determined and when working with migrants or other marginalised groups.

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Acknowledgements

We are indebted to all participants for sharing personal experiences and letting us record their CFI sessions. We also wish to thank two anonymous reviewers and Niklas Størup Agerup for their constructive suggestions to improve this article.

Funding

The study was funded by TrygFonden (ID 120354), Mental Health Centre Ballerup and Axel Muusfeldt’s Foundation (Grant No.: 3-701). The foundations had no influence on the analysis nor the reporting of findings.

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Correspondence to Laura Glahder Lindberg.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. A protocol for this study was submitted to the Regional Committee on Health Research Ethics in Denmark (Journal no.: H-15011361), which confirmed that the project was not liable for approval since the Danish research ethical system does not require approval of qualitative interview studies.

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Lindberg, L.G., Johansen, K.S., Kristiansen, M. et al. Negotiating Engagement, Worthiness of Care and Cultural Identities Through Intersubjective Recognition: Migrant Patient Perspectives on the Cultural Formulation Interview in Danish Mental Healthcare. Cult Med Psychiatry (2020). https://doi.org/10.1007/s11013-020-09694-2

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Keywords

  • Recognition
  • Mental health
  • Health-related deservingness
  • Migrants
  • Cultural Formulation Interview