"Dr. Kwame McKenzie is a psychiatrist and researcher who specializes in redesigning mental health services for visible minority groups. Last year he moved to Toronto from London, England, to join the staff of the Centre for Addiction and Mental Health. This week Margaret Wente asked him to explain why understanding ethno-cultural differences is so important for improving mental health care....
"What are some of the distinct problems experienced by minority groups?
"They vary with the group. People from areas where there has been torture and war are more likely to suffer from post-traumatic stress issues. There's a huge Tamil population in Toronto that has very high rates of PTSD. Among South Asian groups, depression is a problem among older South Asian women, and alcohol misuse - probably caused by depression - is a problem among some South Asian men. People of African and Afro-Caribbean origin will tell you that racism and thwarted aspirations are a terrible problem that leads to depression, suicide and psychosis.
"Are certain groups more at risk of developing mental illness than others?
"Yes. In the U.K., for example, we've found that people of Afro-Caribbean origin are significantly more likely to develop psychosis. But they delay getting services. When they do, they are sicker and more likely to go into the hospital.
"Your key message is that we can't treat people effectively unless we understand cultural differences. Can you give us some examples?
"A good one is depression. Most doctors here in Canada would probably say that the most common symptom of depression is depressed thinking. But the experience of depression in other cultures is very different. People don't say 'I feel depressed.' They say, 'I feel tired. I'm thinking too much. I feel heavy.' They don't have the mind-body-split that we do. Women of South Asian origin are only half as likely to have their depression noticed by their GP. They have all the symptoms, but the GP doesn't understand the cross-cultural presentation of depression.
"Do these differences also have implications for the way we deliver services?
"Yes. The Latino population is a good example. They're very much into credibility, heart and warmth. If you are a Latino looking into services, you want a warm greeting. You don't want a receptionist saying, 'Here's a form to fill in.' Then there's the difference between individualist and collectivist societies. A lot of people don't want individual therapy. They want family therapy. Some people from East Asian societies don't want their son going off into a room and talking to someone by himself...."