Improving feeling of control and trust in interpreter-mediated mental health consultations.

Language barriers are among the most critical factors in health care disparities. Low language proficiency is consistently associated with a high prevalence and severity of mental health disorder symptoms. Despite the advantages of working with an interpreter, most practitioners report difficulties, especially with trust and the feeling of control. The main objective of this exploratory qualitative intervention research is to examine the impact of training when working with interpreters and their inclusion in follow-ups. This impact is evaluated in the changes in feelings of control and trust for the practitioners who received the training, for the trained interpreters included in follow-ups and for the patients of these follow-ups. Semistructured interviews were conducted with individuals involved in five follow-ups at four public mental health clinics in Paris, France. The project had two phases: before (N = 18) and a few months after (N = 12) the training. Interviews were transcribed and thematically analyzed. Before the training, practitioners perceived the potential for collaboration with interpreters and the complexity of triadic consultations. Interpreters expressed irritation and disappointment at the lack of recognition, and patients seemed confident because they had already built a relationship with practitioners. After the training and inclusion of interpreters, trust is better established between interpreters and practitioners, which has substantial effects. All the protagonists state that trust positively impacts the relationship with patients and the therapeutic process. Although some practitioners still doubt the sessions' control, the intervention helps them to gain knowledge and critically examines their clinical modus operandi. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

[Migration, health and healthcare access]. / Migration, santé et accès aux soins.

When addressing "migrants'" health and healthcare access, it is imperative to clarify which categories this term refers to. Indeed, the various statuses it comprises impact reception conditions, as well as individuals' state of health and healthcare access. While in France healthcare access is universal, recent studies document how migrants' legal and human trajectories become increasingly precarious, thus impeding healthcare access and negatively impacting their health -for the most vulnerable groups in particular, such as asylum seekers and refugees.

Cultural Consultation in Context: A Comparison of the Framing of Identity During Intake at Services in Montreal, London, and Paris.

Cultural diversity poses a challenge to mental Health care systems in many settings. Specialized cultural consultation services have been developed in a number of countries as a way to supplement existing services. The objective of this paper is to compare and contrast cultural consultation services in Montreal, London, and Paris to determine how culture and society have shaped the evolution of these services to meet local sensitivities and imperatives. Historical contexts of the sites, their descriptions and origins, how they categorize cultural, ethnic, and linguistic diversity, and their intake procedures are compared and contrasted according to a standardized template of themes. Data came from site visits and participant observation at each site. For historical, political, and cultural reasons, categorization of diversity and intake procedures differ markedly by site: Montreal focuses on language categories and language proficiency; London enumerates ethnic diversity according to officially mandated categories; and Paris does not gather ethnic data on its patients in any form. The process of cultural consultation, specifically its triage and intake procedures, is profoundly influenced by local histories and social norms that are maintained by professional cultures of psychiatry in each setting. To properly place their patients in context, cultural psychiatrists must not only aim to understand the culture of the other, but also must consider the culture of the mainstream society and how it shapes the delivery of services.

Disease, risk, and contagion: French colonial and postcolonial constructions of "African" bodies.

In this article, we explore how sub-Saharan African immigrant populations in France have been constructed as risk groups by media sources, in political rhetoric, and among medical professionals, drawing on constructs dating to the colonial period. We also examine how political and economic issues have been mirrored and advanced in media visibility and ask why particular populations and the diseases associated with them in the popular imagination have received more attention at certain historical moments. In the contemporary period we analyze how the bodies of West African women and men have become powerful metaphors in the politics of discrimination prevalent in France, in spite of Republican precepts that theoretically disavow cultural and social difference.

Intangible obstacles: health implications of stigmatization, structural violence, and fear among undocumented immigrants in France.

This study identifies undocumented immigrants' obstacles to realizing their health care rights in France. The ethnographic fieldwork informing this study was carried out in Paris from March 2007 to July 2008. Research findings are based on (1) participant observation carried out in two grassroots health associations catering to undocumented immigrants in Paris (one providing legal and medical aid to undocumented immigrants from sub-Saharan Africa, and another focused specifically on assisting undocumented individuals seeking a visa for medical reasons, as well as women victims of domestic violence); (2) a review of legislative debates on the issue of healthcare access for undocumented immigrants in France, and (3) recently published reports on healthcare access for the undocumented in Europe. The paper analyzes how interaction among intangible factors - namely social stigmatization, precarious living conditions, and the climate of fear and suspicion generated by increasingly restrictive immigration policies - hinders undocumented immigrants' access to health care rights and, furthermore, minimizes immigrants' sense of entitlement to such rights in this European context. Intangible factors such as fear and suspicion have powerful "subjectivation" effects, which influence how both undocumented immigrants and their interlocutors (i.e., healthcare providers) think about "deservingness." Medical anthropology is in a unique position to demonstrate and theorize these factors and effects, which inform contemporary debates about migration and "health ethics."

The construction of "cultural difference" and its therapeutic significance in immigrant mental health services in France.

Since the early 1970s, the French public health system has been accorded considerable responsibility for immigrants identified by the educational, judicial or social service authorities as psychologically distressed or socially disruptive. In this paper we discuss three models of healing embedded in constructs of "cultural difference" and addressed at specialized mental health-care centers catering to immigrants in Paris: "cultural mediation," transcultural psychiatry/ethnopsychiatry and clinical medical anthropology. Based on observations and interviews at three specialized mental health centers in Paris, we explore how these clinical approaches address migrant wellbeing and seek to resolve crises in migrant families, especially those of West African origin. We suggest that the prevalent approaches to therapy creatively blend concepts and practices of anthropology, psychiatry and psychology but, at the same time, confront challenges inherent in the use of a generic "African" healing modality. Cases studies demonstrate that in order for such interventions to be perceived as effective by patients, "cultural difference" must be acknowledged but also situated in broader social, political and economic contexts.