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Fellowship members help highlight cultural psychiatry

Cultural Psychiatry


Associate Writer, Department of Psychiatry

It's a key step in raising awareness of cultural psychiatry.

Dr. Nicole del Castillo works in Child and Adolescent Psychiatry at UI Hospitals and Clinics. Beginning in 2011, she earned the honor of being a member of the Minority Fellowship Program courtesy of the American Psychiatric Association (APA)/Substance Abuse and Mental Health Services Administration (SAMHSA).

Since then, two other UI Psychiatry residents, Drs. Elizabeth Homan and Thomas Salter, have both been named as members of the APA/SAMHSA Minority Fellowship Program, as well. Homan is a resident in Child and Adolescent Psychiatry and Salter is in the combined internal medicine/psychiatry residency program.

It's not every day that you see this number of individuals involved in the APA/SAMHSA Minority Fellowship Program in one place in such a span of time. Marilyn King, Assistant Director of the APA Minority Fellowship Program, says having three fellows from one institution in the fellowship since 2011 is unique.

Dr. del Castillo said there are clear goals associated with the fellowship, including enhancing psychiatry training in cross-cultural issues and increasing the number of psychiatrists and medical students from minority/underrepresented groups. The fellowship also seeks to identify and work toward eliminating barriers to quality mental health care for an increasingly diverse population.  

Cultural psychiatry focus of lecture series

There's no better way to raise awareness about cultural psychiatry than to have some of the nation's foremost speakers on the topic visit UI Hospitals and Clinics, and the minority fellowship has allowed for this to occur.

A number of cultural psychiatry lectures are being hosted at the University of Iowa during the winter months, thanks to del Castillo and fellow planning committee members, Tina M. Campbell, Homan and Salter.

This lecture series at the UI is in place to promote continued cultural psychiatry training. It also advocates for reducing stigma and health disparities related to underserved populations. 

The lectures include one courtesy of Dr. Hendry Ton, associate professor at University of California Davis. Ton is the cofounder and medical director of the Transcultural Wellness Center and also serves as director of education at the UC Davis School of Medicine Center for Reducing Health Disparities. This places Ton at the forefront of the cultural psychiatry discussion in the U.S.

Ton's December 2013 talk at UI Hospitals and Clinics was an engaging experience for those attending the doctor's presentation. A significant portion of what Ton brought to the table during his visit included voicing the importance of including the cultural formulation when interacting with patients.

"The cultural formulation helps providers to understand where their patients are coming from and, in doing so, you can really then start to establish a positive therapeutic relationship," said Ton during his December visit. "A significant part of psychotherapy and many other kinds of visits are founded upon a strong therapeutic relationship and the cultural formulation offers a very systematic way of doing that by considering the cultural factors as opportunities for engagement." 

A more complete approach

So, why is cultural psychiatry important at UI Hospitals and Clinics? 

According to del Castillo, it's a vital part of gaining a more complete picture of patients. Being aware of potential cultural dynamics is essential to how del Castillo approaches treatment with her patients. In becoming more knowledgeable about cultural psychiatry, del Castillo says she's learned about her own cultural identity.  

"Now that I am more aware, I am better able to anticipate potential cultural dynamics between myself and the patients that I have the privilege to work with," says del Castillo. "In addition, as I have learned more about the disparities in psychiatric care, it has become a goal of mine to improve the access of mental health services to underserved populations through efforts such as school mental health clinics." 

Psychiatrists generally conduct a formulation to sum up the biological, psychological and social aspects of a patient that might help better understand their course of illness or the presentation in their illness, del Castillo explained.

Providing the best treatment for patients means acknowledging their culture at UI Hospitals and Clinics. Understanding patients' cultural backgrounds is a part of being able to better treat and care for them, said del Castillo. Dr. del Castillo says culture plays "a crucial role in basically all aspects of mental health and illness.  Therefore, attention towards cultural factors in the evaluation of patients with mental illness results in improved access to care, increased understanding of a patients' illness experience, more accurate diagnosis, and overall better treatment. "

When treating a patient at UI Hospitals and Clinics for mental illness, including the cultural formulation holds a lot of importance for Homan, as well. She said that in psychiatry, getting a full picture of the patient is needed. With that in mind, it only makes sense to think about culture when making an overall formulation for each mental health patient.

"People's cultural background impacts their belief system, their behaviors, the way they make choices," says Homan. It may be possible to prescribe the correct medications or therapy recommendations to a patient while disregarding the cultural formulation. However, physicians may be "completely missing the boat" in creating an alliance with the patient if they choose to ignore cultural aspects, thereby endangering treatment adherence, Homan added.

Iowa's population is certainly diverse enough to use the cultural formulation in assessing mental health patients, according to Homan. She says culture is many different things and reaches far beyond one's ethnicity. It includes elements like age group, geographic location, education level, socioeconomic status and religion.

Fortunately, there are those at UI Hospitals and Clinics' Psychiatry Department who recognize the importance of cultural psychiatry and the cultural formulation when treating patients.

When asked to what degree the cultural formulation is being used in the U.S., Ton said it is being seen more and more, adding that hospitals and health care organizations implementing standards of cultural competence have a greater level of patient satisfaction. Higher ratings regarding patient/doctor communication are also found at these institutions. Patients' willingness to refer a loved one to that hospital improves at those having a standard of cultural competence, added Ton.

Ton praised the cultural psychiatry lecture series at UI Hospitals and Clinics during his visit, calling it "great." This is important because of the rich diversity found locally.

"I think that Iowa City is sort of a center where many different cultures congregate," Ton said in December, adding that the Psychiatry Department at UI has a real opportunity to take the lead in bringing culturally competent perspectives into the area. 

Continued cultural conversation   

Spreading the word about cultural psychiatry doesn't stop with Ton's presentation. 

In January of 2014, the cultural psychiatry lecture series featured a second renowned speaker, Dr. Paramjit Joshi, president of the American Academy of Child and Adolescent Psychiatry. Joshi also serves as endowed professor and chair of Department of Psychiatry & Behavioral Sciences at the Children's National Medical Center in Washington, D.C. at George Washington University School of Medicine. She too is at the forefront of the cultural psychiatry discussion in the U.S. 

By March of 2014, the cultural psychiatry input will continue to flourish at UI Hospitals and Clinics. Dr. Cheryl Boyce with the National Institute on Drug Abuse will speak at the University.  Boyce serves with the National Institutes of Health's Division of Clinical Neuroscience and Behavioral Research acting as chief of the Behavioral and Brain Development Branch, as well as associate director for Child and Adolescent Research. Boyce has a great amount of knowledge in the areas of trauma and violence in children, del Castillo noted.

Beyond the initial benefits of informing people about cultural psychiatry, the lecture series can also serve as a way for idea exchanges to occur between UI Hospitals and Clinics' Psychiatry Department and those areas of employment the speakers call home. Homan pointed out that the series will also display the high-quality Psychiatry Department the University of Iowa has to offer.

"It's really an amazing opportunity for our department," Homan says.