Cultural Competence and Mental Health

This assignment explores the concept of cultural competence in mental health services, particularly in relation to indigenous populations such as Maori in New Zealand. It examines the impact of ethnic density on mental health, the importance of mind-body-spirit well-being, and the role of community treatment orders. The assignment also discusses the recovery paradigm in forensic mental health services and the need for culturally safe environments. It provides a comprehensive overview of cultural competence in mental health services, with a focus on promoting recovery and creating inclusive environments.

Running head: CULTURAL SAFETY IN OLDER PEOPLE
CULTURAL SAFETY IN OLDER PEOPLE
Name of the Student
Name of the university
Author’s note

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CULTURAL SAFETY IN OLDER PEOPLE
Table of Contents
Introduction......................................................................................................................................2
Interventions:...................................................................................................................................6
Second assessment:..........................................................................................................................7
Philosophical interventions and educational theories:.....................................................................8
Discussion:.....................................................................................................................................10
References......................................................................................................................................12

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Introduction
The concept of cultural safety had come from the health care experiences of the maori
nurses. The term cultural safety can be can be related to the concept of cultural competence or
culture specific care but is sometimes interpreted as addressing of the ethnic or the cultural needs
of the clients. It is a concept for ensuring people of different cultural background to feel safe in
their experiences. The relevance of the aged care to cultural safety is more relevant to ethnicity.
It is about disability, gender, religion, socio economic sector. Cultural safety becomes critical
while providing care to some aged patients belonging to different community. If the cultural
elements are primarily designed or influenced by religion, then the matter of cultural competence
comes in to play (Slade et al., 2014). The aged population may have several predetermined
notions that can act as barriers from getting the patient centered care. The proportion of the aged
people in New Zealand is growing much more rapidly and the augmentation of the aged
population in Maori and the pacific will become significant in the next 50 years. This assignment
will critically reflect on a care scenario involving an 85 year old maori individual who had faced
a few cultural safety issues while receiving the heath care.
Assessment:
Cultural safety can be defined as the practice principle in any care providing scenario that
respects different cultures and their traditional norms, all the while providing a dignified and
inclusive treatment to the culturally diverse individuals. On a more elaborative note, cultural
safety can be defined as the process that provides the culturally diverse individuals with the
opportunity to understand the worth their culture and tradition and be able to respect their own
culture. It has to be mentioned in this context that the concept of cultural safety is integrally

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associated with the different aspects of health (Mathieson et al., 2012). The aboriginals
especially have a very different idea of health and often the mainstream clinical trajectories
intersperse with the traditional concepts of healing. Hence in this process of the cultural safety of
the different individuals belonging to different cultural backgrounds are violated. In this case
year study that is going to be critically assessed in this assignment the patient had been Suzanne,
a 70 year old woman who had been presented to the health care facility due to suicidal attempt.
The assessment discovered that the patients had been suffering from depression ever since she
lost her husband 5 years ago and attempted to take her own life n the 5th death anniversary of her
husband.
Further assessment discovered that the patient had been living alone in her home with no
one to care for her. She had two daughters; both of them lived away from the city and rarely
could make the time for coming to their hometown and visited her. Hence living alone in the city
affected her psych and the psychological burden of her living alone after the death of her
husband had affected her significantly. Subjective assessment of the patient revealed that she had
been suffering from self harming tendencies for past few months however she never sought out
mental health care neither did she visit any of the community care services. On further inquiry
she was not able to communicate with most of our emergency care team, and had appeared very
agitated and scared. However with the intervention from the aboriginal language experts, it was
discovered that she did not find any flaw in wanting to end her life and she felt she does not
require any mental health care. She further informed us that she had been feeling that the purpose
of her life had been lost for years and she would need to pay for hers sins now and no health care
will be able to impact any effect, her destiny is clear to her.
Critical analysis

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The culture and the ethnicity of the older population of the Maori community are quite
different for the other older people and generally make them unique in comparison to the other
community. Health care field deals with people belonging from different cultural backgrounds. It
is vital for the differences in culture with respect to elderly population. Difference in culture play
a major role in elderly care, as it is the health care professionals who have to realize the values
and the life style of different people. Knowledge of the various cultural values would make the
caregivers or other health care professionals to deliver the type of care. It is not that cultural
safety should be only be confined to the health care sector but should be taken care of in every
phases of life.
Caring for the elderly people belonging from diversified cultural backgrounds can be
challenging and can be as the behavior of a person is entirely shaped by the ways people interact
with the person of their own culture. Information of what can arise while caring for a culturally
diverse set up may help in increase awareness among the caregivers and helps in managing and
avoiding the misunderstandings that can arise due to some cultural clash. Cultural safety is a
concern for almost all the caregivers as it acts as a tool to learn about the beliefs, tradition and
provide respect to those beliefs and traditions. Clients and the families would work hand in hand
to bring out a clear picture to about the cultural needs of the older people (Durie, 2011).
It has to be mentioned in this context that the Maori understanding of health and life in
general differs drastically from the basic health care understandings, there are various traditional
beliefs and values regarding the health and wellbeing, the impact of spiritual factors also play a
pivotal role in defining the conception and ideas of what constitutes health and wellbeing. In case
of the concepts of mental health, the values and beliefs overlap further. In the traditional
concepts mental health is associated with spirituality and emotional connection, and the

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understanding of mental health is more flawed in the aboriginals. According to the Trauer
(2010), the suicide rate among the Maori women had been increasing rapidly in the past few
decades and one of the greatest reasons behind this massive increase can be the fact that the
mental health literacy is extremely flawed and overlapping with the traditional understanding of
spiritual and emotional wellbeing. Most of the Maori women do not recognize depression as a
mental health issue; rather the depressed state is believed to be the sins of the past life haunting
the present life (Dulin et al., 2012).
Verbalization of the medical concepts may be one of the barriers as different cultures
view diseases or how the human body functions differently. One culture may be fine with
relinquishing the total control to the caregivers, whereas some of the cultures may depend more
on the traditional cultures of healing. Elderly people often hold strong beliefs regarding the
traditional health care beliefs. In most of the cases elderly clients who are not enough educated,
in the absence of any malaise or pain or any other diagnostic symptoms holds no meaning to
them. One of the greatest barriers along with the spiritual and traditional misconception of
mental health and need for mental health care, the communicational barrier acts as the most
important challenge for the under- diagnosis and neglect of the mental health of the Maori
women. The lack of culturally competent communication framework in the health care facility
and the inherent discrimination and stigmatization in the health care staff restricts the Maori
women from seeking out mental health care when they need it. In this case, the patient under
consideration had not been able to identify her deteriorating mental health on her own. The lack
of mental health literacy and the fear of lack of cultural safety restricted her from ever seeking
out mental health care (Das-Munshi et al., 2010). Instead, she felt her increasing self harming

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and suicidal tendencies to be the result of her own sins and opted for ending her life, rather than
seeking out the mental health care she needed and was entitled to.
Interventions:
The primary aim of the interventions should be to develop an integrated approach for the
health and the disability support in compliance with the changing needs of the older people. The
key elements for an integrated approach are the services that should be older client focused; the
model for the wellness is promoted. There should be smooth information sharing between the
services. The Development of the Health of older people strategy is one of the key policies to in
the New Zealand Positive Ageing strategy action plan for 2012 and 2013. The health of older
people strategy focuses on improvement of the health status, promoting the quality of life when
the health cannot be restored, reducing the inequalities and promotion of the participation of the
aged people in social life and taking decisions regarding the health care and the disability support
provision (Wepa, 2012).
In order to maintain the cultural safety in case of the older patients, people needs to there
are certain aspects such as the educational backgrounds, literacy levels, gender income, that
might affect the health status of the elderly clients. In order to be more competent in providing a
culturally safe care to the patient, caregivers should strive to be aware of his/ her own cultural
values and should be able to recognize on how they respond to care. One needs to be aware of
the historic events of a specific ethnographic group for understanding how it might have been
affecting them through stereotyping, discrimination or oppression (Kirmayer, 2012).
It is recommended to speak in calm, slow, polite and simple languages for conveying
information to the elderly people. Listening to the older people actively and gently asking open

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ended questions to them helps in creating therapeutic interpersonal relationships. Intimidating
behaviors towards the senior clients should be avoided, especially those from the non western
cultures. Again some families are not very supportive in disclosing the complicated condition to
the terminally ill patients; the care givers should be able to check the information with the family
members (Smye, Josewski & Kendall, 2010).
It has to be understood that in this case the patient under the case study had been dealing
with depression and she had not been able to communicate her issues due to the language barrier
and traditional understanding of mental health. Hence, the health care professional providing the
health care to the patient needed to be educated on resilience and patience to calm the agitated
patient and make her comfortable so that she can freely share her problems and issues with the
care provider. Along with that, a cultural liaison officer and language interpreter had been
included to the interdisciplinary care team put together for the patient under consideration.
Lastly, the care professionals with the help of the language interpreter and the cultural liaison
officer were instructed to develop a therapeutic relationship with the patient with casual
engaging conversations so that the patient feels at ease. Followed by which the care professionals
were instructed to coerce the patient to understanding the need for mental health care and
counseling along with the philosophical educational therapists all the while being very careful to
providing ultimate cultural safety to the patient.
Second assessment:
The patient slowly but steadily opened up to the team and with the assistance of the
aboriginal health worker the patient was able to voice her discomfort and issues effectively. The
educational plans were successful and the patient understood the concept of depression and

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impaired mental health and rediscovered the value of her life. The patient understood the impact
of depression on self worth and the will to lie and could easily distinguish between the
overlapping traditional norms and notions and the reality of mental health care needs. The
patient, empowered by the cultural safety and assistance began taking counseling session and
was soon discharged with a community counseling care plan and regular mental health checkups.
Philosophical interventions and educational theories:
Malcolm Knolwes have introduced the term andragogy which can be defined as the art
and the science of assisting the adults to learn. It has already been mentioned that adults are
independent and are self directing; they have accumulated a great deal of experience which can
be considered as a rich source of learning. They can value the learning that integrates with the
demand of their everyday life. The principles of Andragogy would help to establish an effective
learning climate, where the learners can feel safe and comfortable while expressing themselves.
According to Knowles, Holton III and Swanson (2014) the principles would help to trigger
internal motivations. It helps the learners, which in this case are the adults that help to identify
the resources, which would help them to formulate their own learning objectives. Authors have
expressed concern that there is a need of theoretical framework in order to foster education for
cultural safety among the health care professionals. According to McEldowney and Connor
(2011), the health care professionals should be able to recognize racism in their society.
It has to be understood in this context that the understanding of andragogy depends on the
adult learning, and the theory of andragogy and adult learning provides an easy framework of 5
principles. On a more elaborative note, there are 5 particular principles, self concept, adult
learning experience, readiness to learn, orientation to learning, motivation to learn. Now each of

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the different principles relates effectively with the patient educational scenario involving any
culturally diverse patient. Cultural safety is the first and foremost important aspect of the entire
care scenario involving any culturally diverse patients, even in the sector for patient education
(Aliakbari et al., 2015). The first principle in this case relates to the self concept where the ideas
and principles of the patients is analyzed and respected all the while being modified from being
dependent on cultural norms and ideas to being focused on reality and practicality. In the very
next principle the patient is encouraged based on her new found insights to further develop the
learning experience of the patients. Now this principle depends on the following three principles,
readiness to learn, orientation to learn and motivation to learn. In patient education scenario, the
above mentioned three principles depends entirely on the level of understanding that the patients
has attained in the first step and effectively the educator has achieved to instill practical
knowledge and understanding in the patient. Hence the learning experience of the patient will
depend on how far the methods of motivational persuasion of the educator have helped to burst
the psychotic bubble of traditional concepts and superstition. Although the key to optimal
utilization of the learning experience is to provide optimal cultural safety to the patient, if the
cultural identity of the patient is not threatened in any manner the culturally diverse individuals
will be inevitably be more willing to participate in the educational process (Knowles, Holton III
& Swanson, 2014).
The next adult learning theory that can be applied to the concept of philosophical
intervention for mental patients, especially for the culturally diverse patients is the constructivist
theory of learning. This adult learning theory is based on the combination of theory of
behaviorism and information processing in adults. This learning theory has been based on the
learners realizing the realities and practical beliefs of the world and how the adults can attain that

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reality based knowledge all the while being independent on the preconceived notions of the
mind. In this theory, the objective world view of the learner is not considered as the ultimate
truth, rather the learner is encouraged t compare and contrast their personal objective reality with
the reality of the world based on practicality and reasoning (Brandon & All, 2010). This
particular ideology helps the learner to understand the basic flaws of their own preconceived
notions when compared to the stark reality of the happenings of life with respect to the science
behind it. According to the authors, this theory is the most effective and applicable theory when
changing the behaviors and thoughts based on cultural norms and understanding. It has to be
understood that the cultural safety is the most important aspect when caring for the aboriginals.
Even in case of the patient education for bursting the cultural and traditional myths for the
patient must not follow a procedure that will involve any aspect that will hurt the cultural and
traditional understanding of the patients. This theory provides a framework to change behaviors
and understanding by providing a comparison between the falsified objective reality of the
learner and then comparing it with the reasonability and practicality. It has the minimal chance of
hurting or violating the cultural safety of the aboriginal patients and hence this theory of
education can easily be utilized in the process of philosophical intervention for culturally diverse
patients (Brandon & All, 2010).
Discussion:
Hence, patient education plays a pivotal role in changing the worldview and perceptions
of the aboriginal patients. In this case, the Maori patient Suzanne was only on verge of ending
her own life because she had no better understanding of what mental illness constitutes and how
she can get help to improve her mental health. As a result, instead o seeking out mental health
care, the traditional superstitious norms and the fear of discrimination and rejection help her

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captive with her disabled mental health and drove her towards taking her own life. In such cases
reaching out to these unfortunate backward women is very important. The lack of health literacy
does not only lead to un-diagnosis of a variety of mental health disorders of the Maori
individuals, but also leads to misdiagnosis and exacerbation of various other health conditions
(Knowles, Holton III & Swanson, 2014).
Hence, the importance of health education and philosophical interventions are more
crucial in the aboriginal or ethnic care scenario. It has to be mentioned that the promotional
education campaigns can only be effective if the cultural safety is maintained at all costs, for the
traditional communities, their cultural identity and traditional roots are intricately associated with
their dignity and existence (Henschke, 2011). Hence, the health promotional campaigning will
only be helpful if their cultural identity is respected while their views and concepts on heath are
being altered. The educational theories mentioned can help in maintaining cultural safety while
helping the patients realize the practicality and reasonability of mental illness and sickness in
general.

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References
Aliakbari, F., Parvin, N., Heidari, M., & Haghani, F. (2015). Learning theories application in
nursing education. Journal of education and health promotion, 4.
Arieli, D., Friedman, V. J., & Hirschfeld, M. J. (2012). Challenges on the path to cultural safety
in nursing education. International Nursing Review, 59(2), 187-193.
Bécares, L., Cormack, D., & Harris, R. (2013). Ethnic density and area deprivation:
Neighbourhood effects on Māori health and racial discrimination in Aotearoa/New
Zealand. Social Science & Medicine, 88, 76-82.
Brandon, A. F., & All, A. C. (2010). Constructivism theory analysis and application to
curricula. Nursing Education Perspectives, 31(2), 89-92.
Brannelly, T., Boulton, A., & te Hiini, A. (2013). A relationship between the ethics of care and
Māori worldview—the place of relationality and care in Maori mental health service
provision. Ethics and Social Welfare, 7(4), 410-422.
Brougham, D., & Haar, J. M. (2013). Collectivism, cultural identity and employee mental health:
A study of New Zealand Māori. Social Indicators Research, 114(3), 1143-1160.
Das-Munshi, J., Becares, L., Dewey, M. E., Stansfeld, S. A., & Prince, M. J. (2010).
Understanding the effect of ethnic density on mental health: multi-level investigation of
survey data from England. BMJ, 341, c5367.

13
CULTURAL SAFETY IN OLDER PEOPLE
Dulin, P. L., Gavala, J., Stephens, C., Kostick, M., & McDonald, J. (2012). Volunteering predicts
happiness among older Māori and non-Māori in the New Zealand health, work, and
retirement longitudinal study. Aging & Mental Health, 16(5), 617-624.
Durie, M. (2011). Indigenizing mental health services: New Zealand experience. Transcultural
Psychiatry, 48(1-2), 24-36.
Durie, M. (2013). Puahou: A five part plan for improving Maori mental health. He Pukenga
Korero, 3(2).
Henschke, J. A. (2011). Considerations regarding the future of andragogy. Adult Learning, 22(1),
34-37.
Kirmayer, L. J. (2012). Rethinking cultural competence.
Knowles, M. S., Holton III, E. F., & Swanson, R. A. (2014). The adult learner: The definitive
classic in adult education and human resource development. Routledge.
Mark, G. T., & Lyons, A. C. (2010). Maori healers' views on wellbeing: The importance of
mind, body, spirit, family and land. Social Science & Medicine, 70(11), 1756-1764.
Mathieson, F., Mihaere, K., Collings, S., Dowell, A., & Stanley, J. (2012). Maori cultural
adaptation of a brief mental health intervention in primary care. Journal of primary
health care, 4(3), 231-238.
McEldowney, R., & Connor, M. J. (2011). Cultural safety as an ethic of care: A praxiological
process. Journal of Transcultural Nursing, 22(4), 342-349.

14
CULTURAL SAFETY IN OLDER PEOPLE
Newnham, E. A., & Page, A. C. (2010). Bridging the gap between best evidence and best
practice in mental health. Clinical psychology review, 30(1), 127-142.
Newton-Howes, G., Lacey, C. J., & Banks, D. (2014). Community treatment orders: the
experiences of Non-Maori and Maori within mainstream and Maori mental health
services. Social psychiatry and psychiatric epidemiology, 49(2), 267-273.
Simpson, A. I., & Penney, S. R. (2011). The recovery paradigm in forensic mental health
services. Criminal Behaviour and Mental Health, 21(5), 299-306.
Slade, M., Amering, M., Farkas, M., Hamilton, B., O'Hagan, M., Panther, G., ... & Whitley, R.
(2014). Uses and abuses of recovery: implementing recovery‐oriented practices in mental
health systems. World Psychiatry, 13(1), 12-20.
Smye, V., Josewski, V., & Kendall, E. (2010). Cultural safety: An overview. First Nations, Inuit
and Métis Advisory Committee, 1, 28.
Trauer, T. (Ed.). (2010). Outcome measurement in mental health: theory and practice.
Cambridge University Press.
Wepa, D. (Ed.). (2015). Cultural safety in Aotearoa New Zealand. Cambridge University Press.
Wilson, D., & Baker, M. (2012). Bridging two worlds: Māori mental health nursing. Qualitative
health research, 22(8), 1073-1082.