Negotiating differences of culture and language in the hospital setting

Background. - Diversity has become the norm in major urban centers around the world. Differences of language and culture strain the capacity of mental health systems to provide appropriate diagnostic assessment and treatment planning, especially in critical settings like the emergency department and inpatient services. Objective. - To demonstrate how the Cultural Consultation (CC) model overcomes obstacles to effective cross-cultural psychiatric care in the hospital setting. Method. - The author reviews the process of Cultural Consultation developed by the Cultural Consultation Service (CCS) at McGill University in Montreal, Quebec, Canada. He uses clinical vignettes to illustrate how to work with ethnically diverse patients and their families. He compares and contrasts models of cross-cultural care and discusses strategies to remove potential barriers from the clinic. Results. - Several challenges complicate cross-cultural psychiatry in hospitals: (1) setting-specific issues, such as time pressure, less than ideal interview space, lack of professional language interpreters, and severe symptomatology of patients; and (2) systemic social factors that limit the open discussion of issues most relevant to many immigrants and refugees: matters of religion, racism, intolerance, and adjustment to life in the host society. Conclusions. - Setting specific and systemic social factors may combine to create a conspiracy of silence in which patients and caregivers from diverse backgrounds avoid discussing fundamental mental health concerns. Cultural Consultation offers a means to negotiate differences of language and culture while respecting the clinical imperatives of the hospital setting. (c) 2017 Elsevier Masson SAS. All rights reserved.