De l'innovation au changement - Gouvernement du Québec

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
and, (iii) to provide specialized teams with cultural knowledge and language skills essential to work with patients who require a high level of
expertise to diagnose and treat their problems.
An explicit and long term commitment on the part of regional health and social service authorities and health care institutions to the ideals of
cultural competence in health care and to a meaningful response to improving the quality of services for a culturally diverse population.
A willingness to work closely with representatives of ethnocultural communities and community organizations to identify unmet needs and
potential resources for the delivery of cultural appropriate mental health care.
The process of implementation involves identifying core staff with the requisite skills and obtaining infrastructure support (offices, secretarial
support, telecommunications, computers).
While there are grassroots community initiatives that address the mental health needs of immigrants and refugees, there remains a significant
lack of co-ordination of resources as well as a lack of a coherent structure to manage the needs of an increasingly diverse population. As well,
there are too few clinical consultants available to support primary care and frontline workers in the community.
The ability to fund professionals and non-professionals with cultural expertise (culture brokers) provided by the Health Transitions grant
dramatically increased the capacity of the service to provide appropriate interventions.
6.3 Avantages généralisation The findings from this project are important because (a) they indicate significant unmet need for mental health services for Aboriginal peoples,
immigrants, refugees and asylum seekers and (b) because they suggest some effective means of responding to these needs by developing
additional services, providing ongoing training within clinical institutions, and by training and supporting professionals to make systematic use
of their linguistic and cultural expertise.
The specialized teams in transcultural psychiatry facilitated access to services in several ways: 1) they provided service for under-served
populations who usually do not receive ; 2) for patients already receiving mental health care, they providing links to clinicians, interpreters,
culture-brokers and community organizations with knowledge and expertise in working with specific ethnocultural groups; 3) by providing
access to specialized consultation that increases the knowledge and skill («know how») of clinicians in diverse milieus, the service
immediately improved the quality of care of patients; 4) by creating a place for clinical training of professionals from different disciplines who
can use transcultural perspectives in their subsequent practice milieus the services contribute to the development of new resources.
The development of a specialized resource also brought with it certain problems: 1) the development of a sensitivity to cultural questions leads
to an increase in demands, exceeding the capacity of the team; 2) the subsequent tightening of criteria for admission reduced accessibility to
the services the team while increasing the bureaucratic quality of the process which harms the alliance with a vulnerable population.
There were significant changes in service use, diagnosis and treatment in individual cases that will have dramatic impact both on their long
term wellbeing and functioning and on the ultimate costs of their care to the health and social service systems.
In several cases patients who had not been receiving any effective treatment for their conditions were accurately diagnosed and enrolled in
appropriate treatment. In some cases, this involved children who had been incorrectly diagnosed due to a lack of use of interpreters and
cultural expertise and who had treated for years with inappropriate medications and other interventions.
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