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Culture shapes the experience and expression of emotional distress and social problems in myriad ways (1,2). To accurately diagnose and treat patients from diverse backgrounds, therefore, it is essential to consider the cultural meaning of symptoms and explore the social context of distress (3–6). Various models have been developed to meet this clinical challenge. These range from ethnospecific mental health services or clinics (7–9) to the use of specially trained mental health translators and culture brokers and the training of clinicians in generic approaches to cultural competence (10,11). Despite the apparent utility of many of these approaches, there have to date been few studies that examine their effectiveness (12). In a climate of constrained resources for health care and steadily increasing cultural diversity, the development and evaluation of models of care has become an urgent priority. In many settings, the high degree of population diversity precludes the development of ethnospecific services. Hence, the emphasis is on general strategies combined with resources mobilized for a specific patient. At the same time, there has been a broad movement toward refining the delivery of mental health care in primary care settings (13–16). These considerations suggest the potential value of the consultation-liaison model as a mechanism to address the impact of cultural diversity on mental health problems. In 1999, with a grant from Health Canada’s Health Transitions Fund, we undertook to develop and evaluate a specialized cultural consultation service (CCS) in mental health for the Montreal region. The CCS, based at Sir Mortimer B Davis —Jewish General Hospital, used a consultation-liaison model and emphasized integrating medical anthropology perspectives with conventional psychiatric, cognitive-behavioural, and family systems perspectives. Although this was a specialized service, it aimed to work within the broader structure of the health care system and to collaborate with existing services in mental health, psychiatry, and primary care. This objective reflects the values of Canadian multiculturalism, which aims to recognize and respond to cultural diversity within mainstream institutions (17–19). In this paper, we summarize some of the lessons learned from our initial evaluation of the CCS. The Practice of Cultural ConsultationCultural consultations took 1 of 3 forms: 1. A consultant with relevant cultural expertise directly assessed the patient, preferably with the participation of the referring person. A complete assessment usually involved 1 to 3 meetings with the patient, a brief written report and phone call or case conference to transmit immediate recommendations, and subsequent preparation of a more detailed consultation report. 2. The cultural consultant discussed the case with the referring clinician without seeing the patient directly. In some instances, clinicians presented the case and their questions and concerns during a clinical conference, at which time the CCS team members and invited consultants discussed the issues and made recommendations. 3. CCS consultants met with a referring community organization, without directly seeing community members. Typically, during a clinical conference, community organization representatives presented recurring problems, questions, and concerns they encountered while serving a specific cultural community. The CCS team members and invited consultants then discussed the issues and made recommendations. Three case vignettes will give an impression of the type of issues dealt with in cultural consultation (Note 1).
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