Rethinking cultural competence

In recent years, cultural competence has become a popular term for a variety ofstrategies to address the challenge of cultural diversity in mental health services.This issue of Transcultural Psychiatry presents papers from the McGill AdvancedStudy Institute in Cultural Psychiatry on ‘‘Rethinking Cultural Competencefrom International Perspectives,’’ which was held in Montreal, April 27and 28, 2010. Selected papers from the meeting have been supplemented withother contributions to the journal that fit the theme. Taken together, thesepapers show how conceptual analysis and critique of cultural competence canpoint toward ways to improve the cultural responsiveness, appropriateness andeffectiveness of clinical services, and in doing so contribute to reducinghealth disparities.Cultural diversity poses challenges to mental health services for many reasons.Culture influences the experience, expression, course and outcome of mentalhealth problems, help-seeking and the response to health promotion, preventionor treatment interventions. The clinical encounter is shaped by differencesbetween patient and clinician in social position and power, which are associatedwith differences in cultural knowledge and identity, language, religion and otheraspects of cultural identity. Specific ethnocultural or racialized groups may sufferhealth disparities and social disadvantage as a result of the meanings and mater-ial consequences of their socially constructed identities. In some instances, cul-tural processes may create or constitute unique social and psychological problemsor predicaments that deserve clinical attention. In culturally diverse societies,the dominant culture, which is expressed through social institutions, includingthe health care system, regulates what sorts of problems are recognized and whatkinds of social or cultural differences are viewed as worthy of attention.A large literature shows the importance of social determinants of healthincluding social status, employment, education, wealth and social support