De l'innovation au changement - Gouvernement du Québec

5. BILAN DE L’EXPÉRIMENTATION
Projet 19
Development and Evaluation of Cultural Consultation Service in Mental Health, région de Montréal
Développement et évaluation d'un service de consultation culturelle en santé mentale
The cultural consultant was sometimes placed in a difficult position, called upon to balance the demands of developing an alliance with the
patient based on cultural understanding while still negotiating the rules, norms and standards of traditional psychiatric care. The demands of
these two positions were sometimes in complete opposition.
Despite the increased use of professional interpreters in the hospitals, difficulties and resistance to their use was still noted particularly in the
case of hospitals that still tend to rely on staff members to act as interpreters.
Service II : A prospective evaluation of new cases, with longitudinal follow-up. Given the limited duration of the FASS project, the collection of
data for this last component is not complete and will be the subject of later publications.
Some of the obstacles to implementation of the program reflected ambivalence in the broader medical sector (including their respective
hospitals), which at once welcomed the effort to promote transcultural mental health services but simultaneously found it difficult to understand
or appreciate the clinical exigencies or therapeutic models used.
There was pressure to replace the consultation-liaison model with an outpatient treatment team approach to provide additional services that
would simply take some of the load off conventional serves. There was also pressure to respond to emergencies (imminent deportation) or
provide quick consultations when time was needed to bring together the requisite expertise.
Finding resources (consultants, cultural brokers, interpreters, clinicians) of particular cultural backgrounds was sometimes difficult, especially
when the local immigrant community in question was small.
One barrier to addressing these structural problems is the prevalent ethnocentrism of health care providers and planners. For example, many
hospitals under-utilize existing interpreter resources because practitioners are satisfied with a minimal level of communication with their
patients, or find it too difficult logistically to obtain the requisite help.
Concerns voiced by clinicians who had not used the service included the impression that such consultations would increase their workload,
were too lengthy, take too long to arrange, and therefore not respond to the need for rapid problem-resolution necessitated by acute
psychiatric treatment.
Funding remained a particularly salient problem. In the Medicare system funding for psychiatrists can be readily arranged but support for other
professionals (i.e. psychologist, nurse-practitioner, social worker, etc.) needed for an interdisciplinary team is less available. The most
pressing needs are for a fulltime clinical coordinator to provide telephone consultation and triage, and funds to compensate the cultural
consultants and culture-brokers drawn from the ethnocultural communities.
Health Impacts & Cost Effectiveness : Due to the extremely heterogeneous nature of the cases, the relatively brief intervention, and the lack
of direct patient contact in many cases, it was not feasible to measure or reasonable to expect direct health impacts on the patients seen by
the service.
5.1 Résultats Service I : Over the 12-month period of formal data collection, the CCS service received 102 requests for consultation.
The most common reasons for consultation were for help with clarifying a diagnosis or the meaning of specific symptoms or behaviours (58%),
treatment planning (45%), and for information or a link to organizations and resources related to a specific ethnocultural group or issue (e.g.
refugee status (25%).
About half of all requests to the CCS could be resolved with telephone contact and informal exchange of information or linking to specific
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