Background

Although the literature in medical anthropology and transcultural psychiatry has documented how cultural representations shape individual experiences and perceptions of psychosocial distress and its management, less attention has been given to what is actually meant when the concept of culture is used in professional practice, and how this may influence experience of care.

Objective

The objective of this article is to explore what understandings of culture circulate in youth mental health practitioners’ and families’ narratives, and to analyse how different operationalizations of the concept may affect experience of services.

Methods

This article draws upon the qualitative components of a larger mixed-methods research program on collaborative care in youth mental health. Semi-structured interviews were conducted in Montréal (Québec, Canada) with 39 parents, 48 youths and 29 practitioners about their experience of services, and with 26 practitioners about their experience of intercultural training. Data was analyzed using thematic and narrative approaches.

Results

Results show that families and practitioners use a multiplicity of understandings of the concept of culture in their discourses as a narrative strategy to mediate dialogue in clinical encounters, either by engaging in it, avoiding it, or refusing it.

Conclusions

The concept of culture and its use in the clinical realm can be seen a double-edged sword, both as a tool to reify stereotypes and inequalities, and as a means to mobilize representations towards cultural safety and transformative practices. Minority families’ experiences of services may be improved by providing intercultural training and a supportive work environment to clinicians.

中文翻译：

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家庭和从业者在青少年心理健康服务中的文化使用：一把双刃剑

背景

尽管医学人类学和跨文化精神病学的文献记录了文化表征如何塑造个人经历和对心理社会痛苦及其管理的看法，但很少有人关注文化概念在专业实践中的实际含义，以及这如何可能会影响护理体验。

客观的

本文的目的是探讨在青年心理健康从业者和家庭的叙述中传播的对文化的理解，并分析该概念的不同操作如何影响服务体验。

方法

本文借鉴了一项关于青年心理健康协作护理的大型混合方法研究计划的定性组成部分。在蒙特利尔（加拿大魁北克省）对 39 名家长、48 名青少年和 29 名从业者进行了半结构化访谈，了解他们的服务经验，并与 26 名从业者就他们的跨文化培训经验进行了访谈。使用主题和叙述方法分析数据。

结果

结果表明，家庭和从业者在他们的话语中使用对文化概念的多种理解作为一种叙事策略来调解临床遭遇中的对话，或者通过参与、避免或拒绝对话。

结论

文化的概念及其在临床领域的使用可以被视为一把双刃剑，既是一种工具，可以将刻板印象和不平等具体化，也可以作为动员代表走向文化安全和变革实践的手段。通过向临床医生提供跨文化培训和支持性工作环境，可以改善少数民族家庭的服务体验。