Addressing clients' faith-based practices (FBPs) is indispensable in psychotherapy, especially in a religiously diverse country like India. This can be particularly challenging in contexts where psychotherapy is highly stigmatized and FBPs are culturally accepted. A review of the literature highlighted a gap in research on how psychotherapists negotiate FBPs in the Indian context. This pilot qualitative study aims to address this gap by exploring the experiences of Indian psychotherapists in navigating FBPs as mental health service providers. Semi-structured interviews were conducted with 10 Indian psychotherapists. Thematic analysis of the transcribed data generated three major themes and eight subthemes. The findings indicate that FBPs play a nuanced role in clients' mental health care, especially when clinical services like psychotherapy are stigma-laden and difficult to access. However, it is often challenging for psychotherapists to discern the adaptive and maladaptive aspects of FBPs for the client's welfare. Additionally, systemic factors shape clinician interactions with FBPs in psychotherapy practice. This study highlights the dual role of FBPs in supporting and hindering psychotherapy and provides insights into the interplay of culture, faith, and mental health. However, all participants revealed that religious and spiritual competence training programs were unavailable in India. Although psychotherapists learn these skills through experience, their ability to effectively engage these competencies is limited by social barriers like stigma. The findings of this study underscore the importance of these competencies and provide insights into contextualizing such training programs.
In a diversity intervention context, the practitioner may have biases and stereotypes related to their own cultural background that will influence their approach. Developing cultural self-awareness could help reduce the manifestation of these biases and stereotypes. However, it is likely to be one of the least researched aspects of intercultural competence. This scoping study was conducted to provide an overview of how cultural self-awareness is addressed across disciplines related to interventions in diverse contexts. The methodology used followed that of the Joanna Briggs Institute. The different steps of the scoping review are the following: keyword selection and translation in the different selected databases; a first sorting of the selected studies according to the defined criteria, based only on the title and the abstract; a second sorting by reading the entire study; data extraction and finally, analysis of the results. In total, 25 studies were included. The results showed that it is indeed possible to develop cultural self-awareness through workshops that promote interaction among participants, whether they are students or professionals already in the workforce. However, this focus of the research is relatively new and underexplored in the literature.
Indigenous youth's strength and resilience play a vital role in their well-being and mental health. Protective factors, closely linked to resilience, spanning individual, family, and community levels reinforce positive mental health outcomes. The purpose of the current scoping review was to summarize the available literature that describes resilience and/or protective factors promoting mental health and well-being among Indigenous youth in Canada. As a secondary objective, this review investigated community involvement reported in the identified sources. JBI scoping review methodology was followed, and the search of PubMed, EMBASE, CINHAL, PsycINFO, ERIC, and Scopus commenced in August 2021, and was updated in February 2023. A targeted Google search was also conducted to identify eligible gray literature. A total of 61 papers were included in the data extraction. The types of sources identified were observational (n = 22), participatory action research (n = 11), mixed/multi-methods (n = 10), qualitative (n = 9), case study (n = 4), quasi-experimental (n = 1), experimental (n = 1), and other designs such as quality improvement and program evaluation (n = 3). In addition, only a handful of included studies reported use of an Indigenous-specific approach, such as Two-Eyed seeing. Protective and resilience factors were identified across various levels such as individual (n = 52), interpersonal (n = 37), and wider environmental beyond social systems (n = 37) levels. Forty studies described community involvement, which included non-specified community members, like friends or citizens (n = 21), youth (n = 19), Indigenous community members such as leaders and workers (n = 14), and Elders (n = 11). These groups were engaged to varying degrees, functioning either as equal collaborators, consultants, or, in some instances, as decision-makers.
Attitudes toward mental health help-seeking are shaped by a complex interplay of environmental, sociocultural, religious, and generational factors. Within Muslim communities, these attitudes are further informed by religious teachings, cultural norms, and intergenerational dynamics. This study explores the disparities in mental health-seeking behavior between first- and second-generation Muslim Americans. The sample consisted of 37 participants, including 16 first-generation immigrants (foreign-born) and 21 second-generation individuals born in the USA to at least one immigrant parent. The study used a combined deductive and inductive thematic approach to the analysis of semi-structured interviews. Interview content codes and themes were developed using a six-phase method for qualitative thematic analysis. Four major themes emerged encompassing distinct subthemes. First, acculturation effects including: (a) mental health awareness, normalization, and knowledge; and (b) the influence of acculturation on attitudes. Second, intentions including: (a) first-generation participants often sought private help-seeking; and (b) openness to public help-seeking and a health-conscious orientation. Third, perceived behavioral control. Fourth, pathways to seeking mental health care including: (a) preference for informal support systems; (b) incorporation of religious aspects; and (c) a preference for Muslim therapists. The first and second themes highlighted notable intergenerational differences, the third theme revealed shared pathways to seeking care between the two groups. Culturally adapted practices to mental health service provision should integrate both traditional and non-traditional cultural awareness while addressing intergenerational gaps to enhance mental health support within these communities.
Scholarship surrounding the Kraepelinian dichotomy of dementia praecox and manic-depressive insanity has overwhelmingly approached Kraepelin's nosology as the product of Kraepelin's clinical method, use of diagnostic cards, and pre-existing disease concepts, rather than his work in experimental psychology. Revisiting the significance of Kraepelin's 1881-1895 concept of intoxication as model psychosis, this article establishes that Kraepelin's earlier psychological experiments with intoxicants were a potential source of latent, synthesizing concepts, informing the organization of clinical data around two discrete forms of psychosis. Tracking Kraepelin's nosological system over the course of the first six editions of his textbook, it examines Kraepelin's classificatory descriptions relative to the content of his experimental studies on the psychometrics of intoxication, in particular the dualities Kraepelin finds in exogenous and endogenous psychoses. More specifically, it addresses the alignment of inhibitory and excitatory effects at the level of sensation and perception found within both Kraepelin's experiments and psychiatric nosology, proposing that manic-depression and dementia praecox conform with excitatory and inhibitory modes of exogenous psychosis.
Over the past three decades, psychological trauma has become a central framework in Indigenous mental-health research, shaping how silence, disclosure, and healing are interpreted. Within this framework, Inuit silence has been framed as a collective pathology-a "culture of silence"-and a risk factor contributing to suicide in the Arctic. In this article, I draw on pandemic-era public communication and professional narratives collected at a large health event in Greenland to critically reflect on cultures of silence and confession. The article demonstrates how crises such as the pandemic bring to the surface tacit or neglected dynamics, and highlights how hegemonic knowledge frameworks, which prioritize disclosure-centred models of care, shape contemporary mental health governance in Greenland. The case study identifies three recurring patterns: (a) disclosure is framed as both a cure and a civic duty; (b) local practices of quiet that sustain dignity and relational safety are overlooked; and (c) institutional logic of disclosure redirects blame and responsibility from structural conditions to individual and collective failures. Drawing on conceptual metaphor theory, anthropological and historical scholarship on silence and violence, and decolonial approaches to knowledge production, the article highlights the risks of disclosure-centred frameworks. It argues that such models may misrecognize culturally grounded practices of quiet as absence or pathology, rather than as meaningful relational forms of coping and care. It suggests the need for approaches that attend to multiple forms of communication and care, and avoid equating well-being with verbal disclosure and silence with deficiency. By reframing silence as a relational and culturally situated practice, the article contributes to ongoing debates in transcultural psychiatry about the limits of universalizing therapeutic models. It also contributes to scholarship on structural violence, Indigenous mental health, and the potential mistranslation of illness and wellness.
Non-ordinary experiences such as hearing voices, losing control over one's body or mediumship/possession, are observed across cultures. However, there is a notable lack of instruments specifically designed to measure these experiences from a subject-centered, culturally sensitive perspective, with existing measures offering limited coverage ofexperiences that may be particularly salient for religious groups cultivating mediumship/possession practices. This study proposes a novel, feature-based, subject-dependent approach to defining and measuring relevant mediumship/possession-like experiences, grounded in cross-culturally recognizable phenomenological features while respecting participants' culturally specific interpretations. Using Brazil as a case study, given its rich mediumship traditions, we developed and validated a new set of items that capture relevant experiences within mediumship/possession through a multi-step process informed by the Inventory of Non-Ordinary Experiences. Study 1 involved a systematic review of dissociation and mediumship research in Brazil to create an item pool. Study 2 refined these items with input from mediumship practitioners and religious leaders. Study 3 validated the items in a Brazilian population sample, and Study 4 estimated the prevalence of these experiences in a representative sample. The study validated 10 key features of mediumship/possession-relevant experiences and found high prevalence rates in Brazil, with some experiences reported by more than 60% of participants. Our findings highlight the importance of feature-based, culturally informed approaches to studying mediumship/possession and offer recommendations for future research into their phenomenology, prevalence, and cultural appraisals.
Storytelling is a widely used method in community-based research. We conducted a scoping review to explore restorative storytelling and community theatre as a tool to support mental health literacy and wellness as well as equity among immigrant communities. Our review followed the methodological framework espoused by Arksey and O'Malley and modified by Levac et al. All 13 peer-reviewed studies that met the inclusion criteria were conducted in Canada. Twelve of the included studies employed qualitative methods, with only one using a quantitative approach. The included studies involved diverse immigrants living in communities across Canada. We identified five themes that spoke to the objective of the review: (1) stories of social marginalization and barriers; (2) increased awareness and understanding through stories; (3) storytelling as a space for transformation and healing; (4) connectedness and sharing through stories; and (5) storytelling promoting empowerment and resilience. Language barriers alongside race were identified as major hurdles encountered by some immigrants. Digital storytelling was seen by some immigrants as a process that provided the opportunity to reflect and reminisce on life, which fostered understanding and (re)connection with self and, in so doing, improved emotional wellbeing. Given the increasing mental health disparities in immigrant and racialized communities in Canada, efforts toward improving the mental wellbeing of immigrants through restorative storytelling and community theatre warrant further investigations.
Following the near-total destruction of mental health services during the Khmer Rouge regime (1975-1979), psychiatry in Cambodia underwent a gradual and resource-constrained revival from the early 1990s onward. This article traces the history of psychiatry in Cambodia from its early institutional foundations in the colonial period, through its collapse during the Khmer Rouge genocide, to its re-establishment and progressive institutionalization in the post-conflict era. Drawing on historical archives, policy documents, and published literature, the paper describes three main phases of development: initial reconstruction and training (1992-2000), expansion of services and education (2001-2015), and recent efforts toward institutionalization and specialization (2015-present). Particular attention is given to the interaction between western psychiatric models and Cambodian cultural frameworks of distress rooted in Buddhism, animism, and community-based healing practices. The article highlights the central role of international collaboration, nongovernmental organizations, and emerging local leadership in shaping psychiatric services, while also documenting persistent challenges including workforce shortages, uneven geographic distribution of care, limited inpatient capacity, and enduring stigma. By situating psychiatry within Cambodia's broader sociocultural and historical context, this review contributes to a transcultural understanding of mental health system reconstruction in post-conflict settings. It also underscores the importance of culturally responsive, community-oriented approaches for sustainable development.
This article examines the scope and prevalence of vicarious posttraumatic growth (VPTG) among service providers working with Syrian refugees in Istanbul, Turkey. VPTG is the phenomenon that, under certain conditions, exposure to traumatic material because of work with traumatized individuals can result in positive psychological growth. This growth can include greater appreciation for life, changed priorities, and an enriched spiritual life, among others. We surveyed 104 service providers throughout Istanbul in 2018. A multivariable logistic regression was used to examine how professional trauma exposure (proportion of clients who disclose trauma, secondary traumatic stress [STS]), support systems (perceived social support, perceived organizational support), and professional experience are associated with VPTG. We hypothesized that greater exposure to traumatic material, stronger support systems, and greater professional experience were associated with higher levels of VPTG. We found nearly half (44.66%) of service providers surveyed had moderate-to-high levels of VPTG. Our hypothesis was partially supported. Moderate/high/severe STS [aOR:3.98, (95% CI:1.26, 12.59)], higher social support [aOR:1.05, (95% CI:1.00, 1.10)], and higher organizational support [OR:1.11, (95% CI:1.02, 1.20)] were associated with moderate-to-high VPTG. However, the proportion of clients who disclose trauma and years in profession did not show significant associations. While secondary stress may be a natural biproduct of work with traumatized individuals, providers may also experience growth from those same experiences. Findings from this analysis elucidate pathways whereby organizations may foster VPTG, such as providing a peer support program to facilitate social support and establishing a feedback loop to enhance organizational support.
The personal recovery approach in mental health draws on people's own experiences to build care policies. Models of personal recovery constructed in recent decades have been based on studies in Anglo-European cultural settings. No study has been conducted in Martinique, where Creole culture is prevalent. Our work aimed to explore the recovery experiences of people with schizophrenia in Martinique. We carried out a qualitative study. Fifteen people participated in a face-to-face interview, with collection of sociodemographic data. Three themes emerged from the analysis: self-work; evolving illness role; and rebuilding identity. Our results described a recovery process in which strong importance is given to social norms, involving difficult adjustments among multiple therapeutic approaches and overcoming psychological trauma. Access to employment, housing, and financial autonomy was related to social recognition. These results suggested the value of different approaches to aid recovery, including: support from relatives, peers, and caregivers; valuing their experiential knowledge; support for psychological trauma; fighting against the stigmatization of schizophrenia in Martinique; social support for work and housing empowerment; and recognition of the complementarity of the biomedical, religious, and traditional health care sectors.
As forced displacement and migration reach unprecedented levels globally, the ways in which parents communicate stories of trauma, displacement, and post-migration adversities to their children offer unique insight into how these experiences affect forcibly displaced families. The present study aimed to explore how mothers communicate with their children about their experiences of trauma, displacement, and mental health whilst seeking International Protection in Ireland. Semi-structured qualitative interviews were conducted with 19 mothers who had children aged between four and 17 years. All mothers were applicants for, or recipients of, International Protection in Ireland. Data were analyzed using thematic analysis. Two superordinate themes were developed from the analysis. 'Guarding communication' occurred when mothers used strategies including avoiding certain topics of conversation, silencing their children, and withholding information from their children. 'Grappling with communication' occurred when mothers sought to be child centred yet doubted themselves and were inconsistent in how they communicated with their children. Mothers do not adopt one strategy for communicating with their children. Rather, communication was fluid and dynamic as mothers oscillated between silence and narration. The findings show how difficult it can be for mothers to tell their narratives to their children, and have implications for the provision of therapeutic support for parents and families. What matters most may be to support mothers' agency in choosing the manner, timing, and content of their communication with their children.
Patients who speak languages other than those spoken by mental health professionals are significantly disadvantaged in mental health care settings. To bridge the communication gap, multilingual health professionals and professional interpreters are target-orientated solutions. This study was conducted to assess the multilingual resources, attitudes and needs of psychotherapist trainees in Germany. A cross-sectional nationwide online survey was conducted on psychotherapists-in-training. The 48-item survey consisted of a self-developed instrument to assess 'Attitudes towards working with an Interpreter in Health Care Services (AIHC-20)' with partly reasonable psychometric properties. Psychotherapists-in-training were reached via 238 institutes for psychotherapy training in Germany. Some 803 psychotherapists-in-training completed the survey, of whom 27% had a migration background and 76% would treat patients in a language other than German. According to the participants, on average, 7.5% of their treated patients had limited German skills. The likeability of treating patients with limited German skills and of working with professional interpreters was positively influenced by a personal migration background, cross-cultural encounters in everyday life and previous work experience. Some 52% of all trainees had experience in working with an interpreter and 72% of them stated a training on 'psychotherapy with an interpreter' to be useful. The linguistic diversity among future psychotherapists is not able to fully cover the patients' actual multilingual needs. Therefore, qualified interpreters need to be integrated into mental health care services. In addition to adequate funding and minimal qualification standards for interpreters, psychotherapists need to be trained to overcome cultural barriers.
Diversity, equity, and inclusion (DEI) are foundational values for cultural psychiatry. The current assault on DEI in the United States and other countries represents a direct challenge to the scientific, ethical, and clinical commitments that have guided progress in mental health over recent decades. This paper examines the history, rationale, and successes of DEI frameworks in health care and psychiatry, discusses legitimate critiques, documents the scope and consequences of the current anti-DEI movement in the United States and other jurisdictions, and draws comparisons with Canadian and United Kingdom contexts. We revisit each component of DEI-diversity, equity, and inclusion-to clarify its scientific grounding and moral significance for mental health. We argue that, rather than dismantling DEI, cultural psychiatry and allied disciplines must respond with renewed commitment to the values of DEI as well as those of dignity, empathy, and integrity, as ways to advance social justice and pluralistic civil society.
The objective of this study was to describe the prevalence and demographic correlates of mental disorders and healthcare-seeking behavior of adolescents in Mozambique. Trained assessors administered sociodemographic questionnaires and the Portuguese Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) to adolescents in two schools in Maputo City, Mozambique to determine mental disorder diagnoses. Associations between sociodemographic factors and mental disorders were assessed with logistic regressions. Among 488 Mozambican students (ages 12 to 19; 66.4% female), the prevalence of mental disorders was 23.0%. Anxiety (17.8%) and depressive disorders (8.6%) were most common. Half of adolescents who were diagnosed with a mental disorder had two or more diagnoses. Females were more likely than males to have a mental disorder (odds ratio (OR) 1.60, 95% confidence intervals (CI) 1.00-2.57), and the likelihood of mental disorder diagnosis increased with age (OR 1.28, 95% CI 1.12-1.47) and grade (OR 1.24, 95% CI 1.07-1.45). Only 2.7% of adolescents with a mental disorder had sought mental health care in the previous year. To our knowledge, this is the among the first studies to use a structured diagnostic interview (MINI-KID) to report the prevalence of mental disorders among Mozambican adolescents. High rates of untreated mental disorders underscore urgent need for increased mental health services. High comorbidity of mental disorders suggests that transdiagnostic interventions may be an effective approach to care. Primary healthcare settings where adolescents routinely receive care may be appropriate for mental health treatment integration.
Several studies in Western countries have found that first- and second-generation immigrants have an increased risk of developing schizophrenia. Mental health literacy can facilitate help-seeking and prevent chronic mental conditions. This study explores cross-generational differences in schizophrenia literacy among immigrants from the former Soviet Union (FSU) in Israel. Data were collected using a cross-sectional online survey of 405 respondents who self-identified as first-generation, 1.5-generation, or second-generation FSU immigrants. Questions about schizophrenia literacy were adapted from the Australian National Survey of Mental Health Literacy and Stigma, tapping into the recognition of schizophrenia, knowledge of potential helpers, first-aid support, and effective interventions for persons with schizophrenia (PwS) as well as attitudes, measured by personal stigma and trust in the healthcare system. The findings revealed that knowledge was associated with trust in the healthcare system across generations. First-generation immigrants were less likely to correctly identify a distress situation as involving schizophrenia and held more stigmatic attitudes toward PwS. Their utilization of mental healthcare services was lower, compared to the younger generations, which they compensated for by turning to traditional treatment and hypnosis. Lower trust in the mental healthcare system was also found among the first-generation immigrants, as compared to the 1.5- and second-generation groups. In conclusion, lower levels of knowledge and more stigmatizing attitudes toward schizophrenia reflect the lingering effects of living in the Soviet Union, placing first-generation immigrants in a vulnerable position. Implications for culturally adapted interventions aimed at increasing schizophrenia literacy and mental health trust among FSU immigrants are proposed.
Indian mental health providers have suggested that the Hindu scripture the Bhagavad Gita ("Gita") could be a source for psychotherapeutic interventions. This raises questions about how mental health practitioners have interpreted relationships between the Gita and psychotherapy, how these interpretations construct selfhood, and how these interpretations of selfhood relate to commentaries from Hindu religious scholars. This paper answers these questions through a critical narrative review of studies on the Gita and psychotherapy, along with textual analyses of authoritative Gita commentaries, analyzed through the pattern theory of the self framework. An April 2025 search for studies that explored psychotherapy and selfhood in the Gita in five databases along with forward citation and backward bibliographic analyses uncovered 17 studies, all suggesting that principles of the Gita could be used within psychotherapy, with eight studies naming cognitive behavioral therapy. Thirteen drew on Hindu concepts of ātman, dharma, and karma to postulate an ideal self to help patients reflect on thoughts, emotions, and behaviors. Authoritative commentaries from Ādi Śaṃkarācārya, Swami Vivekananda, and Swami Chinmayananda show that ātman as the eternal soul, dharma as morally prescribed behaviors, and karma as actions without expectations of results have religious connotations without equivalents in Euro-American forms of psychology. A post-colonial approach to psychiatry can read the Gita alongside its commentators-ancient and modern, religious and non-religious-to uncover ways of conceptualizing selfhood before assuming that religious concepts have direct correspondences with psychotherapy.
Access to mental health services for people from culturally and linguistically diverse (CALD) backgrounds remains problematic owing to a variety of factors that contribute to low engagement with mental health services. There is also a need for our mental health systems to be more culturally safe to effectively and equitably support their diverse consumer population. Several initiatives have been explored to increase access to mental health services and improve help-seeking behaviours among CALD populations. One of these measures is the use of bicultural workers (BCWs). This study aims to explore the experiences of bicultural mental health clinicians working in tertiary and community-based mental health services. An exploratory, descriptive qualitative study was undertaken. Data were collected through semi-structured interviews involving n = 18 mental health clinicians in area and community mental health services. Participants were recruited using purposive convenience sampling. Data were analysed using thematic analysis. The findings of this study highlighted three key themes: (a) A shared understanding of the world (subthemes: 'The lived experience of biculturalism', 'Having a different perspective' and 'Building rapport and managing boundaries'); (b) Working with other colleagues; and (c) Establishing a BCW model. Participants discussed their ability to use their biculturalism to understand consumers' perspectives from CALD backgrounds. A shared understanding of the world was also seen as valuable. They reported varied experiences regarding whether their biculturalism was valued within their teams. Many participants felt that establishing a dedicated BCW role model within mental health settings could benefit consumers.
This study argues that psychological distress during the COVID-19 pandemic differed across contexts. While the pandemic's impact was global, its disruptions were experienced and perceived in diverse ways. Yet much of the literature reported a worldwide rise in mental illness, particularly depression and anxiety, reinforcing global mental health discourses of universality while overlooking ongoing debates on local contexts in mental health. Within this narrative, low- and middle-income countries such as Ghana and Nigeria were depicted as especially vulnerable, prompting calls to expand services through task-shifting strategies. Such calls marginalise the lived reality of such populations, leading to interventions that may not meet the needs of society. This study aims to examine how people in Ghana and Nigeria experienced distress and anxiety during the pandemic, considering their sociocultural factors. A multidisciplinary approach was used to collect data, including ethnography, COVID-19 case management notes, clinical records, and media reports. Thematic analysis showed that distress was shaped by international narratives echoing colonial logics, which portrayed African countries as deficient or incapable, and by structural violence arising from public health policies. These findings contribute to critical debates in global mental health, challenging universalist assumptions about the pandemic's mental health impact and questioning the sufficiency of biomedical models within task-shifting strategies. The study highlights the need for context-specific approaches that engage more deeply with the sociocultural, political, and historical factors shaping experiences of distress, and that recognise the diverse ways that mental health is understood and addressed.
Globally, people with serious mental illnesses (SMIs) experience significant challenges with healthcare access. This increases their risk of developing chronic physical illnesses (CPIs) and results in negative health outcomes and shorter life expectancy. The Jamaican public mental health service has undertaken several transformations to increase the accessibility of mental health services and improve outcomes for people with mental illnesses. Despite this, there is an absence of research exploring the prevalence of CPIs among people with SMIs and their experiences accessing healthcare in Jamaica. This study seeks to address the dearth of research by exploring the prevalence of CPIs among people with SMIs, as well as their experiences and their caregivers' experiences of healthcare access. The study utilised a convergent mixed-methods design with a dominant qualitative strand. Surveys were conducted with 306 people with SMIs attending mental health clinics across Jamaica. In-depth interviews were also conducted with 23 people with SMIs and with five of their caregivers. The findings of the study revealed that approximately 29% of people with SMIs also had one or more CPI. Three themes outlined key influences of healthcare access for this patient population: 1) money, family, and social support, 2) emphasis on the medical model, and 3) healthcare culture and expectations. The findings of the study indicate that social and cultural factors underpin the healthcare access experienced by this population and call for multi-sectoral and inter-disciplinary strategies to address the healthcare access needs of people with comorbid SMIs and CPIs.
