People have moved from one place to another within the same country or across national borders for millennia. The reasons for such movements have varied, as does the duration for which people migrate. With globalisation and global connections across countries, migration has increased. The process of migration and its impact on the mental health of individuals has been and will remain heterogeneous. The responses of migrants to the process vary, depending upon a number of factors. Individuals may migrate individually, with their families or in groups. They may move to avoid political or religious persecution and seek political asylum in another country (forced migration) or migrate for personal, employment, economic or educational reasons (voluntary migration). Although these two categorisations are often a little more complex than this. Not all migrants will feel negatively affected by migration. People may migrate on a seasonal, recurrent, permanent or temporary basis. It may be within or across generations. Many migrants will never access mental health services, whilst others may use these in varying ways and with diverse requirements or presentations. The experiences and requirements of voluntary and involuntary migrants may differ. Mental health Services may need to ensure that they are accessible and appropriate to all members of society including those who have migrated. This paper makes some suggestions in relation to this.

Careif is an international mental health charity that works towards protecting and promoting mental health and resilience, to eliminate inequalities and strengthen social justice. Our principles include working creatively with humility and dignity, and with balanced partnerships in order to ensure all cultures and societies play their part in our mission of protecting and promoting mental health and wellbeing. We do this by respecting the traditions of all world societies, whilst believing traditions can evolve, for even greater benefit to individuals and society. Careif believes that knowledge should not only be available to those with wealth or those who live in urban and industrialised parts of the world. It considers knowledge sharing to be a basic human right, particularly where this knowledge can change lives and help realise true human potential. Furthermore, there is substantial knowledge to be found in low and middle income countries and within rural and poorer areas of the world and this knowledge is just as valuable to the wellbeing of people in areas which are wealthier. This Position Statement aims to highlight the current position and need for understanding the role of culture, spirituality and religion in the diagnosis and treatment of mental illness. Globalisation has created culturally rich and diverse societies. During the past several decades, there has been a steadily increasing recognition of the importance of cultural influences on life and health. Societies are becoming multi-ethnic and poly-cultural in nature worldwide, where different groups enrich each other's lives with their unique culture/s. Cultural transition and acculturation is often discussed as relevant to migrants and the need to integrate, when in fact it is of relevance to all cultures in an ever-interconnected world. It is indeed necessary to be equipped with knowledge about cultures and their influence on mental health and illness. Until the early 19th century, psychiatry and religion were closely connected. Religious institutions were responsible for the care of the mentally ill. A major change occurred when Charcot and his pupil Freud associated religion with hysteria and neurosis. This created a divide between religion and mental health care, which has continued until recently. Psychiatry has a long tradition of dismissing and attacking religious experience. Religion has often been seen by mental health professionals in Western societies as irrational, outdated, and dependency forming and has sometimes been viewed as resulting in emotional instability.

Careif is an international mental health charity that works towards protecting and promoting mental health and resilience, eliminating inequalities and strengthening social justice. Our principles include working creatively with humility and dignity, and with balanced partnerships in order to ensure all cultures and societies play their part in our mission of protecting and promoting mental health and wellbeing. We do this by respecting the traditions of all world societies, whilst believing traditions can evolve, for even greater benefit to individuals and society. Careif believes that knowledge should not only be available to those with wealth or those who live in urban and industrialised parts of the world. It considers knowledge sharing to be a basic human right, where this knowledge can change lives and help realise true human potential regardless of their geographical location. Furthermore, there is substantial knowledge to be found in the less developed, rural and poorer areas of the world and this is valuable to the wellbeing of people in areas which are wealthier.

Objective: a four-fold increase in natural disasters over the past three decades (world health organization [ who] 2008) has generated a greater need to guide mental health practitioners who confront the aftermath of natural disasters. this paper aims to review the literature on response to psychological interventions following natural disasters and whether these are culturally competent.Method: Critical review of the current literature. the economic cost and human losses of natural disasters appears to be increasing in many cities across the world (United Nations Office for the Coordination of Humanitarian Affairs, 2010). Cities are also growing in size and the growing population density clearly makes such places vulnerable to more casualties should natural disasters occur unexpectedly. we will provide an international perspective on the effectiveness and the cultural sensitivity of the psychological interventions used for psychotrauma management in natural disaster settings.Results: the international literature shows plenty of data that highlight the extent of the damage as well as the humanitarian efforts that have been instigated to alleviate physical suffering and trauma from a variety of natural disasters. however, there is little in the research and practice evidence of the cultural acceptability or congruence of some of the interventions that are offered.Conclusions: an alternative approach is to encourage resilience and disaster management informed by cultural competence and research that charts and monitors outcomes and interventions to improve the resilience of the local populations who live in areas which are most vulnerable to future natural disasters.

OBJECTIVETo examine whether sedentary behavior, obesity, smoking, and depression are risk factors for persistent fatigue in adolescents.DESIGNLongitudinal population-based survey.SETTINGTwenty-eight randomly selected schools in east London, England, in 2001 and 2003.PARTICIPANTSA total of 1880 adolescents (49% male; 81% nonwhite British) aged 11 to 12 years and 13 to 14 years in 2000.INTERVENTIONConfidential questionnaires completed in class.MAIN OUTCOME MEASURESPersistent fatigue (extreme tiredness twice weekly or more often in the previous month at both surveys), sedentary behavior, physical activity, depressive symptoms, body mass index, and smoking.RESULTSSevere fatigue was reported in 11% of participants aged 11 to 14 years and 17% of participants aged 13 to 16 years. Eighty-four participants (4%) reported persistent fatigue. Across both surveys, only 3 pupils reported chronic fatigue syndrome. In multivariate logistic regression, risk of persistent fatigue was independently associated with being sedentary for more than 4 hours per day (odds ratio = 1.6; 95% confidence interval, 1.1-2.3; P = .01), being physically active (odds ratio = 1.5; 95% confidence interval, 1.1-2.3; P = .004), and depressive symptoms (odds ratio = 2.0; 95% confidence interval, 1.5-2.7; P < .001) in the first survey, after adjustment for age, sex, and socioeconomic status. Obesity and smoking were not associated with fatigue.CONCLUSIONSPersistent fatigue is common. Being highly sedentary or highly active independently increased the risk of persistent fatigue, suggesting that divergence in either direction from healthy levels of activity increases the risk for persistent fatigue. Mental health is important in the etiology of persistent fatigue. To help define effective preventive strategies, further work is needed on the mechanisms by which these factors contribute to fatigue.

AIMS:To examine whether physical health and health-risk behaviours in young people are risk factors for psychological distress and depressive symptoms over a 2-year period.DESIGN/SETTING:A 2-year, prospective epidemiological cohort study in East London.PARTICIPANTS:A total of 1615 adolescents from the Research with East London Adolescents: Community Health Survey (RELACHS)-a representative cohort of young people aged 11-12 and 13-14 years at baseline, followed-up after 2 years.MEASUREMENTS:Psychological distress and depressive symptoms identified by the self-report Strengths and Difficulties Questionnaire and the Short Moods and Feelings Questionnaire at baseline and follow-up. Data on overweight/obesity, general health, long-standing illness, physical activity, smoking, alcohol use and drug use were collected from questionnaires completed by the adolescents at baseline and follow-up.FINDINGS:At follow-up, 10.1% of males and 12.9% of females reported psychological distress; 20% of males and 33.7% of females reported depressive symptoms. Having tried drugs or engaged in two or more health-risk behaviours (smoking, alcohol use or drug use) at baseline predicted psychological distress and depressive symptoms at follow-up. Smoking on its own, long-standing illness, obesity/overweight and activity levels were not associated with later psychological health. Risk of poor psychological health at follow-up was associated strongly with psychological health at baseline.CONCLUSIONS:Psychological health at baseline was the strongest predictor of psychological health at follow-up. Engaging in two or more health-risk behaviours moderately increased the risk of poor psychological health, suggesting that prevention strategies targeting co-occuring substance use may reduce burden of disease.

Fatigue is a ubiquitous symptom in adolescence. However, little is known about risk factors for persistent fatigue states in adolescents. We examined the hypotheses that being sedentary, exercise, obesity, smoking and depression are risk factors for persistent fatigue in an epidemiological sample of adolescents. RELACHS (Research with East London Adolescents Community Health Survey) is a longitudinal population-based survey of adolescent health in East London, UK. We collected confidential data from adolescents in year 7 (11-12 years) and year 9 (13-14 years) in 28 schools in 2000 (Phase 1) and 2003 (Phase 2). 1880 (49% male; 81% non White British) provided data on fatigue in both Phases. Persistent fatigue was defined as extreme tiredness twice weekly or more often in the previous month in both Phases. We used logistic regression to examine the association of persistent fatigue with sedentary behavior, exercise, depressive symptoms, smoking, BMI, country of birth, longstanding illness in Phase 1. 84 (4.5%; 49 females) had persistent fatigue. Two (0.07%) reported having the Chronic Fatigue Syndrome (CFS) in Phase 1. Persistent fatigue was not associated with ethnicity. The Table shows odds ratios (OR) and 95% confidence intervals (CI) for a multivariable model for the association of persistent fatigue with predictor factors adjusted for all factors shown, and for age, gender and socioeconomic status. Tabled 1Predictors at Phase 1OR (95% CI)pSedentary behaviour>4 hours hours/day2.3 (1.2, 4.5)0.02Physical activityHighly active2.0 (1.2, 3.6)0.01Depressive symptoms2.9 (1.8, 4.7)<0.0001Regular smoking2.4 (0.9, 6.5)0.10ObesityBMI≥98th centile0.5 (0.2, 1.2)0.12Longstanding illness1.7 (1.1, 2.9)0.03Birth outside the UK0.5 (0.2, 1.0)0.05 Open table in a new tab Persistent fatigue is concerningly common in adolescents, although CFS itself is rare. Being either highly sedentary or active each independently increased the risk of persistent fatigue, as did depressive symptoms. These findings suggest that promotion of healthy levels of activity and emotional wellbeing in adolescence may prevent persistent fatigue states.

Background There is considerable evidence that incidence of schizophrenia and other psychoses varies across ethnic groups in the UK, with particularly high rates for people of African-Caribbean origin. Aims The aims of this shady were to estimate in a community-based sample of people from ethnic minorities: 1) the prevalence of psychotic symptoms; and 2) risk factors for reporting psychotic symptoms. Method Face-to-face interviews were carried out with a probabilistic sample of 4281 adults from six ethnic groups living in the UK. Psychotic symptoms were measured using the psychosis screening questionnaire (PSQ). Results There was a twofold higher rate of reporting psychotic symptoms on the PSQ in Black Caribbean people compared with Whites. Adjustment for demographic factors had little effect on this association. Conclusion Prevalence rates of psychotic symptoms were higher in people from ethnic minorities, but were not consistent with the much higher first contact rates for psychotic disorder reported previously, particularly in Black Caribbeans.

PURPOSE:To investigate patterns of vulnerability and protection factors associated with risk behaviors and the co-occurrence of risk behaviors in minority ethnicity early adolescents.METHODS:Analysis of data from the Research with East London Adolescents Community Health Survey (RELACHS), a school-based study of a representative sample of 2789 adolescents age 11-14 in 2001 (sample 73% non-Caucasian, 21% born outside the United Kingdom). Questionnaire data were obtained on sociodemographic variables, ethnicity, smoking, drinking, drug use, psychological well-being, physical health, and social support from family and peers. Models of associations for each behavior and co-occurrence of risk behaviors (defined as engaging in > or = 2 behaviors) were developed by hierarchical stepwise logistic regression.RESULTS:Two hundred ninety-two (10.9%) reported 1 risk behavior, 84 (3.1%) reported 2, and 25 (0.9%) reported 3 behaviors. In multivariate models, psychological morbidity was associated with higher risk of all behaviors and co-occurrence, while higher family support was associated with lower risk in all models. Non-Caucasian ethnicity was associated with lower risk of regular smoking and co-occurrence but not drinking or drugs. Birth outside the United Kingdom was associated with lower risk for individual behaviors but not co-occurrence. Religion and religious observance were associated with lower risk of smoking and drinking but not drug use or co-occurrence. Peer connectedness was associated with drug use, but with increased risk. Socioeconomic status was associated only with smoking.CONCLUSIONS:Patterns of associations of personal, family, and environmental factors appear to differ between smoking, drinking, lifetime drug use, and the co-occurrence of these behaviors. Hypotheses regarding common factors related to health risk behaviors may be misleading in ethnic minorities and immigrants. Co-occurrence may represent a distinct behavioral domain of risk that is partly culturally determined.

For decades there have been calls for psychiatric services to be more culturally competent. Frustration with a perceived slow pace of change has led to the development of separate services. For instance, in the USA, San Francisco General Hospital has psychiatric wards with different ‘ethnic focuses' – East Asian Americans, African Americans and Hispanic Americans are admitted to different wards. In the UK, the National Health Service has developed culturally specific services as well as funding voluntary sector services that target specific cultural or ethnic minority groups. Are such developments the correct way forward? Do they produce lasting change or just let general services off the hook? Can they work in major cities like London, Paris or New York where over a hundred languages are spoken?

Careif is an international mental health charity that works towards protecting and promoting mental health and resilience, to eliminate inequalities and strengthen social justice. Our principles include working creatively with humility and dignity, and with balanced partnerships in order to ensure all cultures and societies play their part in our mission of protecting and promoting mental health and wellbeing. We do this by respecting the traditions of all world societies, whilst believing traditions can evolve, for even greater benefit to individuals and society. Careif believes that knowledge should not only be available to those with wealth or those who live in urban and industrialised parts of the world. It considers knowledge sharing to be a basic human right, particularly where this knowledge can change lives and help realise true human potential. Furthermore, there is substantial knowledge to be found in low and middle income countries and within rural and poorer areas of the world and this knowledge is just as valuable to the wellbeing of people in areas which are wealthier. This Position Statement aims to highlight the current position and need for understanding the role of culture, spirituality and religion in the diagnosis and treatment of mental illness. Globalisation has created culturally rich and diverse societies. During the past several decades, there has been a steadily increasing recognition of the importance of cultural influences on life and health. Societies are becoming multi-ethnic and poly-cultural in nature worldwide, where different groups enrich each other's lives with their unique culture/s. Cultural transition and acculturation is often discussed as relevant to migrants and the need to integrate, when in fact it is of relevance to all cultures in an ever-interconnected world. It is indeed necessary to be equipped with knowledge about cultures and their influence on mental health and illness. Until the early 19th century, psychiatry and religion were closely connected. Religious institutions were responsible for the care of the mentally ill. A major change occurred when Charcot and his pupil Freud associated religion with hysteria and neurosis. This created a divide between religion and mental health care, which has continued until recently. Psychiatry has a long tradition of dismissing and attacking religious experience. Religion has often been seen by mental health professionals in Western societies as irrational, outdated, and dependency forming and has sometimes been viewed as resulting in emotional instability.

Careif is an international mental health charity that works towards protecting and promoting mental health, wellbeing, resilience and resourcefulness with a special focus towards eliminating inequalities and strengthening social justice. Our principles include working creatively with humility, dignity and balanced partnerships in order to ensure that all cultures and societies play their part in our mission of protecting and promoting mental health and wellbeing. We do this by respecting the traditions of all world societies, whilst believing that culture and traditions can evolve for even greater benefit to individuals and society. Globalisation has created culturally rich and diverse societies. During the past several decades, there has been a steadily increasing recognition of the importance of societal and cultural influences on life and health. Societies are becoming multi-ethnic and poly-cultural in nature worldwide, where different groups enrich each other's lives with their unique culture/s. Cultural transition and acculturation is often discussed as relevant to migrants and mentions the need to integrate, when in fact it is of relevance to all cultures in an ever interconnecting world. It is indeed necessary to be equipped with knowledge about cultures and their influence on mental health and illness. Culturally informed mental health care is rapidly moving from an attitudinal orientation to an evidence-based approach, therefore understanding culture and mental health care becomes greater than a health care issue.