Pluralism, Multiculturalism and Mental Health

From the 31st May to the 7th June I travelled to Montreal to attend the Advanced Study Institute at Division of Social and Transcultural Psychiatry at McGill University. It was my first visit to Canada. Montreal has a population of 1.6 million people and is the largest city in Quebec, which is Canada’s largest province by area. The fate of Canada as a developing nation was sealed on 13th September 1759 when British troops defeated a colonial French force at the Battle of Plains of Abraham outside Quebec City. This was the defining battle of the Seven Year War that was fought between Britain and France (and various other protagonists) across the globe. From that point on the British consolidated their power base in North America and the vast majority of land that had been ruled by France was ceded to Britain.

Despite the change in sovereignty the French influence in Quebec and Montreal has remained strong in the intervening years. French is the official language of the city. McGill University has consistently been rated as the best university in Canada and one of the finest in North America. It is also the only English speaking University in Montreal. The University was founded in 1821 at the bequest of James McGill. James McGill had been born in Glasgow in 1744 and graduated from the University of Glasgow. He was a successful merchant in the Montreal area up until his death in 1813.

Medical anthropology is an area of particular strength at McGill University. This is exemplified by the Division of Social and Transcultural Psychiatry (http://www.mcgill.ca/tcpsych/), which is directed by Prof Laurence Kirmayer. Every summer the Division organize a comprehensive programme of summer schools. The Advanced Study Institute (ASI) is a highlight of the summer programme. The theme for this year’s ASI was ‘The Politics of Diversity:
Pluralism, Multiculturalism and Mental Health’. There was a fascinating mix of presentations, which focused on a range of themes including:

• How does diversity contribute to mental health and well-being for individuals and communities?
• How is the “other” constructed and what are the consequences of “othering” for recognition or discrimination and suppression of cultural values and practices?
• What are the implications of recent challenges to multiculturalism and attacks on diversity in the public space for the health and well-being of populations?
• How can mental health research, policy and practice address the challenge of social integration in culturally-diverse societies?

http://www.mcgill.ca/tcpsych/sites/mcgill.ca.tcpsych/files/asi_2014_conference_and_workshop_program.pdf

Highlights of the ASI included a lunch-time presentation from Prof Fred Hickling about the award-winning Dream-a-World Cultural Therapy project that uses creative arts to enhance the resilience of children in Jamaica:

http://www.centreforglobalmentalhealth.org/news-events/news/jamaican-dream-world-cultural-therapy-wins-ttwud-mental-health-challenge-award
The ASI was a fantastic opportunity to spend time with, and learn from, researchers and clinicians doing fantastic work in relation to pluralistic approaches to promoting mental health and well-being in different parts of the world. There was much discussion about the Quebec Charter of Values that had caused controversy when a minister from the Parti Québécois (PQ) political party led efforts to introduce legislation to formalize Quebec as a secular state and do away with the notion of ‘reasonable adjustment’ (http://en.wikipedia.org/wiki/Quebec_Charter_of_Values). To many people’s relief the bill died in 2014 when the Quebec Liberal Party won the election.

I very much enjoyed my visit to Montreal and was greatly impressed by the city. Walking up Mount Royal and enjoying the panoramic views that it affords over the city, visiting the old port and enjoying a smoked meat sandwich at Schwartz’s restaurant were definite highlights. Meeting with Prof Kirmayer and his colleague Dr Duncan Pedersen, and discussing areas of mutual interest, was also very enjoyable.

The visit to McGill University also coincided with the publication of an editorial in the British Journal of Psychiatry that I had written in conjunction with Sashi Sashidharan. The editorial critically reflects on the World Health Organization’s (WHO) flagship mhGAP initiative, an initiative which aims to increase mental health provision in LMIC. Key issues explored in the paper include: the limitations of advocating for psychotropic medication as the first line of treatment; the problems around emphasizing ‘evidence-based interventions’ and the lack of emphasis placed on the potential role that social and cultural factors play in mental health problems across the globe. The editorial can be accessed at the following link:

https://www.academia.edu/6970293/White_R.G._and_Sashidharan_S.P._2014_._Towards_a_more_nuanced_Global_Mental_Health._British_Journal_of_Psychiatry_204_415-417

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