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The Bosniak and Albanian minorities in postcommunist Montenegro have supported and been represented by mainstream Montenegrin parties more than by their ethnic parties. This stands in striking contrast to the situation in neighboring Serbia and North Macedonia where the Bosniak and Albanian minorities vote almost exclusively for their ethnic parties. The Montenegrin case stands out as deviant also when one considers a number of extant explanations, all of which would predict a different outcome. Montenegrin Bosniaks and Albanians constitute two native, sizeable and geographically concentrated minority groups inhabiting a country with an institutional framework and several special electoral arrangements favoring minority parties. Drawing on original data on Bosniak and Albanian legislators elected across 12 parliamentary elections in Montenegro (1990–2023), municipality and country-level parliamentary election results and 12 semi-structured elite interviews, I argue that what explains the deviance in the Montenegrin case is the peculiar nature of Montenegrin identity, specifically the fact that it does not pit the majority against minority, but rather it pits the Montenegrin and Serbian components of the Orthodox majority against each other and in such a context the non-Orthodox minorities become critical political allies of the Montenegrin bloc against the Serbian one.
As contentious as the writings of Samual Huntingdon might be, the quote that opens this chapter epitomises the challenges faced in developing twenty-first-century forensic mental health services (FMHS) to be culturally responsive. Indigenous peoples and other ethnic minorities are increasingly recognised as being disproportionately represented in criminal justice, mental health and FMHS settings. The inadequacy of Western paradigms and systems to meet their needs is evident. In Canada, for example, the Supreme Court recently ruled that the Correctional Service breached its statutory duty to an Indigenous prisoner in assessing his risk of recidivism using actuarial risk assessment tools not validated with Indigenous peoples [2].
There are well-known, significant racial disparities in mental healthcare access, experience and outcome. The additional duty of forensic mental health practitioners to be always mindful of public protection means that it is imperative that all steps are taken to reduce the risk that individuals with mental disorder may pose to others, as well as themselves. Forensic mental healthcare focusses on secondary prevention – preventing known patients from relapsing and re-offending – recurrence of violence. The evidence increasingly points to the fact that forensic mental health services are doing this more successfully with some sections of the population we serve than others.
Meeting the needs of people accessing healthcare from ethnic minority (EM) groups is of great importance. An insight into their experience is needed to improve healthcare providers’ ability to align their support with the perspectives and needs of families. This review provides insight into how families from EM backgrounds experience children’s palliative care (CPC) by answering the question, “What are the experiences of EM families of children’s palliative care across developed countries?”
Methods
A systematic search of articles from 6 databases (Scopus, Medline, Web of Science, APA PsycINFO, CINAHL, and Global Health) with no limit to the date of publication. The search was conducted twice, first in June 2022 and again in December 2022. The extracted data were analyzed using thematic synthesis.
Results
Eight studies explored the experiences of families of EM in different high-income countries. Four themes were identified: unmet needs leading to communication gaps, accessibility of hospital services and resources, the attitude of healthcare workers, and the need for survival as an immigrant.
Significance of results
Overall, the study shows EM families rely heavily on healthcare professionals’ cultural competence in delivering palliative care for their children. There is an interplay between EM families’ culture, spiritual ties, communication, and social needs from this review. Understanding how to bridge the communication gap and how families use their culture, faith, and spirituality to manage their pain, and grief and improve their quality of life would be extremely beneficial for healthcare practitioners in increasing their support to EM families accessing CPC.
This article begins with a folk idea, or stereotype, attached to the Hui Muslim minority in China: that of being violent. The analysis focuses on how ideas of ethnicity are contextualized in folk or popular narratives about violence. Specifically, cases presented in this article are narratives where different aspects of violence feature either positively or negatively: as a collective ethnic mark of being unreasonable, as martial spirit, as fighting prowess and so forth. This article argues that differently contextualized ideas of being violent or narratives about violent events enable Hui and non-Hui to not only establish ethnic turfs, but also to co-exist and merge ethnic boundaries, rendering ethnic borders open to redrawing and straddling.
That differences in health outcomes exist between groups is unsurprising and, in some cases, seems subject to ‘natural law’. Such ‘common sense’, arguably unavoidable differences are termed ‘health disparities’ – a term usually understood to be value-neutral. By contrast, more complex differences in health outcomes which seem to derive from differences in opportunities or systemic bias are deemed ‘unfair’ and are referred to as ‘health inequalities’ or ‘health inequities’.
This chapter delves further into how we describe health inequalities and different measures and data that illustrate these differences. Causes and mechanisms of inequality are explored, followed by examples of inequality across groups with certain population characteristics, including ethnicity; gender, sexual orientation and gender identity; disability; and socially excluded groups. Finally, approaches and strategies for reducing health inequalities are presented, with potential actions described at the micro-, meso- and macro-levels.
In Europe, migrants and ethnic minority groups are at greater risk for mental disorders compared to the general population. However, little is known about which interventions improve their mental health and well-being and about their underlying mechanisms that reduce existing mental health inequities. To fill this gap, the aim of this scoping review was to synthesise the available evidence on health promotion, prevention, and non-medical treatment interventions targeting migrants and ethnic minority populations. By mapping and synthesising the findings, including facilitators and barriers for intervention uptake, this scoping review provides valuable insights for developing future interventions. We used the PICo strategy and PRISMA guidelines to select peer-reviewed articles assessing studies on interventions. In total, we included 27 studies and synthesised the results based on the type of intervention, intervention mechanisms and outcomes, and barriers and facilitators to intervention uptake. We found that the selected studies implemented tailored interventions to reach these specific populations who are at risk due to structural inequities such as discrimination and racism, stigma associated with mental health, language barriers, and problems in accessing health care. The majority of interventions showed a positive effect on participants’ mental health, indicating the importance of using a tailored approach. We identified three main successful mechanisms for intervention development and implementation: a sound theory-base, systematic adaption to make interventions culturally sensitive and participatory approaches. Moreover, this review indicates the need to holistically address social determinants of health through intersectoral programming to promote and improve mental health among migrants and ethnic minority populations. We identified current shortcomings and knowledge gaps within this field: rigorous intervention studies were scarce, there was a large diversity regarding migrant population groups and few studies evaluated the interventions’ (cost-)effectiveness.
Community treatment order (CTO) use in Australia and New Zealand ranges from less than 40 per 100 000 population in Western Australia and Canterbury to over 100 per 100 000 in Victoria, South Australia and Waitemata. Recent publications on CTO use now permit a meta-regression to investigate whether differences in CTO use by jurisdiction affect either the possible predictors or outcomes of CTOs.
Aims
To assess whether factors associated with CTO placement or subsequent outcomes vary by rates of use.
Method
A systematic search of PubMed/Medline, Embase, CINAHL, the Cochrane Central Register of Controlled Trials and PsycINFO for any Australian or New Zealand study comparing CTO cases with controls receiving voluntary psychiatric treatment. This study was prospectively registered with PROSPERO (protocol registration number: CRD42022351500).
Results
There were 35 articles from 16 studies identified in the search, plus unpublished data from a further study. Of these, 29 publications were included in meta-analyses. Two were from New Zealand. People who were male, single and not engaged in work, study or home duties were significantly more likely to be on CTOs. In addition, those from migrant backgrounds were 47% more likely to be on an order. On meta-regression, cases in jurisdictions with higher CTO rates had higher proportions of females or individuals with diagnoses other than non-affective psychoses. High-use jurisdictions were also less likely to show reductions in readmission rates or bed-days.
Conclusions
There are marked differences in the possible predictors and outcomes of CTO placement between high- and low-use jurisdictions in Australia and New Zealand. These findings may have implications elsewhere and indicate that better-targeted CTO placement might improve outcomes.
The article analyses how population genetics has impacted on nationalist discourses across the Taiwan Straits and affected the relationship between Taiwan and China since the 1990s. In Taiwan this cutting-edge science has helped to construct a native-based and Taiwan-centred national identity through promoting indigenous peoples’ rights, rejecting a blood-based, cross-Straits nationalism, and founding a pan-Pacific indigenous peoples’ community through genetic links and cultural affinity. In China, after subverting the nationalist myth of Peking Man (a Homo erectus group believed to be the common ancestor of the Chinese) by analysing genetic data, the same group of Chinese genetic scientists have constructed another nationalist myth of a genetically homogenous nationhood. Such a discourse not only valorizes Chinese nationalism through claiming a DNA-based Chineseness across ethnic distinctions but also asserts genetic links between China and Taiwan, therefore providing a ‘scientific’ basis for China’s nationalism in the new century.
Ethnic minorities in countries such as the UK are at increased risk of dementia or minor cognitive impairment. Despite this, cognitive tests used to provide a timely diagnosis for these conditions demonstrate performance bias in these groups, because of cultural context. They require adaptation that accounts for language and culture beyond translation. The Montreal Cognitive Assessment (MoCA) is one such test that has been adapted for multiple cultures.
Aims
We followed previously used methodology for culturally adapting cognitive tests to develop guidelines for translating and culturally adapting the MoCA.
Method
We conducted a scoping review of publications on different versions of the MoCA. We extracted their translation and cultural adaptation procedures. We also distributed questionnaires to adaptors of the MoCA for data on the procedures they undertook to culturally adapt their respective versions.
Results
Our scoping review found 52 publications and highlighted seven steps for translating the MoCA. We received 17 responses from adaptors on their cultural adaptation procedures, with rationale justifying them. We combined data from the scoping review and the adaptors’ feedback to form the guidelines that state how each question of the MoCA has been previously adapted for different cultural contexts and the reasoning behind it.
Conclusions
This paper details our development of cultural adaptation guidelines for the MoCA that future adaptors can use to adapt the MoCA for their own languages or cultures. It also replicates methods previously used and demonstrates how these methods can be used for the cultural adaptation of other cognitive tests.
The aim of our study was to determine the distribution of hepatitis B virus (HBV) genotypes and subgenotypes in ethnic minorities in Yunnan province to provide evidence supporting the theoretical basis for hepatitis B prevention and control. We obtained serum samples and demographic data from 765 individuals reported by Yunnan province who had either acute or chronic HBV infection and were from one of 20 ethnic minority populations: Achang, Bai, Brown, Tibetan, Dai, Deang, Dulong, Hani, Hui, Jingpo, Lahu, Yi, Lisu Miao, Naxi, Nu, Pumi, Wa, Yao, or Zhuang people. We sequenced the HBV DNA and determined the genotypes and subgenotypes of the isolated HBVs. We mapped the genotype and subgenotype distribution by ethnic minority population and conducted descriptive analyses. There were four genotypes among the 20 ethnic groups: genotype B (21.3% of samples), C (76.6%), D (1.8%) and I (0.3%). The most common subgenotype was C1. There were no genotype differences by gender (P = 0.954) or age (P = 0.274), but there were differences by region (P < 0.001). There were differences in genotype distribution (P < 0.001) and subgenotype distribution (P = 0.011) by ethnic group. Genotype D was most prominent in Tibet and most HBV isolates were C/D recombinant viruses. The only two genotype I virus isolates were in Zhuang people. Susceptibility and geographic patterns may influence HBV prevalence in different ethnic populations, but additional research is needed for such a determination.
The chapter claims that Political Liberalism (PL) is unsuitable to the Israeli situation. PL envisions a liberal constitutional structure that protects the rights of free and equal citizens and serves as an ideational basis for a reasonable overlapping consensus. My internal critique of PL is that its loose definition of reasonable comprehensive doctrines, together with the ideas of overlapping consensus, impartiality and public reason, curtail PL’s ability to maintain a liberal constitutional structure that adequately protects rights. Essentially, PL’s reliance on the willingness of illiberal groups to embrace it renders it ineffective where such groups wield a more than negligible political power. Israel is such a setting. A second reason for PL’s unsuitability for Israel is that Israel’s constitutional structure includes fundamental deviations from liberal constitutional principles, both in the area of religion–state relations and in the area of ethnic (Jewish–Arab) relations. Consequently, application of PL in Israel must be preceded by a fundamental change in Israel’s constitutional structure. Otherwise the application of a form of PL adjusted to its current constitutional structure would result in the continued violation of the rights of ethnic and religious minorities and of women, and lead to the instability of Israeli democracy.
This chapter focuses on populations that did not participate in the uprising. It uses quantitative event data to identify sites and local communities that stayed out of contention or entered it significantly later than others with similar characteristics. One of the clearest trends in the data is that non-Sunni communities participated little in the uprising. The chapter highlights the role of mechanisms of “in-group policing” enabled by group-level institutions and networks in generating this quiescence. It then examines mechanisms impelling nonparticipation among segments of the ethnic majority population; the event data indicate that many Sunni Arab localities saw strikingly little contentious activity in the early weeks and months of the uprising. These populations include local communities structured around extended family and tribal networks and individuals linked to the state through its corporatist economic development strategies. Finally, the chapter examines countermobilization, including counterdemonstrations, “popular committees” formed to defend neighborhoods from shadowy enemies, and pro-regime paramilitaries known colloquially as shabbiha.
We study the link between residential segregation and fertility for the socially excluded and marginalized Roma ethnic minority. Using original survey data we collected in Serbia, we investigate whether fertility differs between ethnically homogeneous and mixed neighborhoods. Our results show that Roma in less-segregated areas tend to have significantly fewer children (around 0.8). Most of the difference arises from Roma in less-segregated areas waiting substantially more after having a boy than their counterparts in more-segregated areas. We exploit variation in the share of Serbian sounding first names to provide evidence that a mechanism at play is a shift in preferences toward lower fertility and sons rather than daughters induced by a higher exposure to the Serbian majority culture.
This article provides clinical guidelines for basic knowledge and skills essential for successful work with clients who have obsessive-compulsive disorder (OCD) across ethnic, racial and religious differences. We emphasise multiculturalist and anti-racist approaches and the role of culture in shaping the presentation of OCD in clients. Several competencies are discussed to help clinicians differentiate between behaviour that is consistent with group norms versus behaviour that is excessive and psychopathological in nature. Symptom presentation, mental health literacy and explanatory models may differ across cultural groups. The article also highlights the possibility of violating client beliefs and values during cognitive behavioural therapy (CBT), and subsequently offers strategies to mitigate such problems, such as consulting community members, clergy, religious scholars and other authoritative sources. Finally, there is a discussion of how clinicians can help clients from diverse populations overcome a variety of obstacles and challenges faced in the therapeutic context, including stigma and cultural mistrust.
Key learning aims
(1) To gain knowledge needed for working with clients with OCD across race, ethnicity and culture.
(2) To understand how race, ethnicity and culture affect the assessment and treatment of OCD.
(3) To increase awareness of critical skills needed to implement CBT effectively for OCD in ethnoracially diverse clients.
(4) To acknowledge potential barriers experienced by minoritized clients and assist in creating accessible spaces for services.
The notion of language rights has proven to be highly controversial. It has typically been invoked in calls for the state to protect and recognize the heritage languages of minority communities. Implicit in such calls is a reliance on traditional understandings of what it means to be a member of a language community, to be a speaker of that community’s affiliated language, and to be a citizen of the state within which the community is embedded. But the conceptions of citizenship as well as those of community and language are changing – often in response to global shifts in mobility and migration. And these changes exacerbate rather than mitigate the problematic nature of language rights. In this chapter, I review various studies of citizenship, mobility, migration and language rights. Among the points that I make are the following: A fuller appreciation of implications of these changes needs to take into account the impact of neoliberalist ideologies. Recent developments such as the gig economy and virtual migration also need to be factored in. Underlying all these is the idea of personhood and how it variously informs the understanding of what it means to be a migrant, a citizen and a speaker of a language. I then flesh out the theoretical and policy implications of these studies, arguing that there is need to move beyond language rights if the migrant-citizen-language nexus is to be properly understood and fruitfully addressed.
While Multicultural Counseling Training (MCT) and Intercultural Training (ICT) represent two prominent, culture-focused specialties that concern with cultural, intercultural, and human diversity issues, there have been surprisingly little to no intersections or interactions between the two disciplines up to this point. To bridge this gap, the current chapter offers a comprehensive and synergetic review of MCT and its relevance and implication for ICT. Accordingly, the present chapter systematically surveys and analyzes: (1) MCT’s historical roots and development; (2) its parallels and similarities to ICT; (3) the definition of multicultural counseling practice and training; (4) the advent of professional standards for MCT; (5) MCT’s operationalization and measurement of cultural competence; (6) its training models, methods, and techniques; and (7) the prevailing and emerging themes and issues of MCT. In this review, striking parallels and intriguing divergences between MCT and ICT are identified, juxtaposed, and examined, from their respective historical, sociopolitical, intellectual, and methodological traditions and contexts. Critical thoughts and recommended directions to encourage a greater intellectual cross-fertilization and interdisciplinary collaboration between the two specialty areas are considered and presented. As follows, this integrative review represents among the first systematic attempts to facilitate the linkage and the synthesis between these two eminent, allied disciplines.
Recent reports indicate that the quality of care provided to immigrant and ethnic minority patients is not at the same level as that provided to majority group patients. Although the European Board of Medical Specialists recognizes awareness of cultural issues as a core component of the psychiatry specialization, few medical schools provide training in cultural issues. Cultural competence represents a comprehensive response to the mental health care needs of immigrant and ethnic minority patients. Cultural competence training involves the development of knowledge, skills, and attitudes that can improve the effectiveness of psychiatric treatment. Cognitive cultural competence involves awareness of the various ways in which culture, immigration status, and race impact psychosocial development, psychopathology, and therapeutic transactions. Technical cultural competence involves the application of cognitive cultural competence, and requires proficiency in intercultural communication, the capacity to develop a therapeutic relationship with a culturally different patient, and the ability to adapt diagnosis and treatment in response to cultural difference. Perhaps the greatest challenge in cultural competence training involves the development of attitudinal competence inasmuch as it requires exploration of cultural and racial preconceptions. Although research is in its infancy, there are increasing indications that cultural competence can improve key aspects of the psychiatric treatment of immigrant and minority group patients.
This chapter focuses on identifying and reviewing current clinical recommendations for the following special populations of children and adolescents: rural populations, ethnic minority populations, sexual and gender minorities, and youth in the juvenile justice system. Each of the common barriers to treatment with these populations is identified, as well as clinical recommendations for working effectively with children and adolescents with these identities or contextual factors. Ethical concerns associated with working effectively with each population are indicated, with resources to help clinicians engage these patients in a skilled and affirmative manner. Supplementary sources of information are also identified to help encourage clinicians’ continued exploration into current clinical guidelines for working with children and adolescents within these special populations.
A higher incidence of psychotic disorders has been consistently reported among black and other minority ethnic groups, particularly in northern Europe. It is unclear whether these rates have changed over time.
Methods
We identified all individuals with a first episode psychosis who presented to adult mental health services between 1 May 2010 and 30 April 2012 and who were resident in London boroughs of Lambeth and Southwark. We estimated age-and-gender standardised incidence rates overall and by ethnic group, then compared our findings to those reported in the Aetiology and Ethnicity of Schizophrenia and Other Psychoses (ÆSOP) study that we carried out in the same catchment area around 10 years earlier.
Results
From 9109 clinical records we identified 558 patients with first episode psychosis. Compared with ÆSOP, the overall incidence rates of psychotic disorder in southeast London have increased from 49.4 (95% confidence interval (CI) 43.6–55.3) to 63.1 (95% CI 57.3–69.0) per 100 000 person-years at risk. However, the overall incidence rate ratios (IRR) were reduced in some ethnic groups: for example, IRR (95% CI) for the black Caribbean group reduced from 6.7 (5.4–8.3) to 2.8 (2.1–3.6) and the ‘mixed’ group from 2.7 (1.8–4.2) to 1.4 (0.9–2.1). In the black African group, there was a negligible difference from 4.1 (3.2–5.3) to 3.5 (2.8–4.5).
Conclusions
We found that incidence rates of psychosis have increased over time, and the IRR varied by the ethnic group. Future studies are needed to investigate more changes over time and determinants of change.