Negotiating Engagement, Worthiness of Care and Cultural Identities Through Intersubjective Recognition: Migrant Patient
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Negotiating Engagement, Worthiness of Care and Cultural Identities Through Intersubjective Recognition: Migrant Patient Perspectives on the Cultural Formulation Interview in Danish Mental Healthcare Laura Glahder Lindberg1,2 • Katrine Schepelern Johansen3 Maria Kristiansen2,4 • Signe Skammeritz1 • Jessica Carlsson1,5
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Accepted: 25 October 2020 Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract This qualitative study presents migrant patient perspectives on using the Cultural Formulation Interview (CFI) in mental health assessments in Denmark. Empirical data consisted of 20 recorded CFI sessions and 16 patient interviews, coded with a constructivist grounded theory approach. Empirical findings prompted us to draw on the theoretical framework of intersubjective recognition in the analytical process. Our analysis showed how patients had multiple previous experiences of misrecognition in life and healthcare. This seemed to restrain their self-esteem and available positions for expressing preferences and reservations during the CFI and led to negotiations of worthiness of care. Despite occasional lack of flow and information in the recorded CFI sessions, patients subsequently recounted how they felt the CFI recognised the complexity and context of their cultural identities and illness narratives. Patients described how the CFI-guided provider approach of curiosity and empowerment carried significant meaning and left them feeling dignified, hopeful and engaged in future care. Intersubjective recognition is fundamental in all human interaction, but we argue that the recognising CFI approach is particularly important in vulnerable and asymmetrical mental health
& Laura Glahder Lindberg [email protected] 1
Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevænget 21, 2750 Ballerup, Denmark
2
Department of Public Health, University of Copenhagen, Copenhagen, Denmark
3
Competence Centre for Dual Diagnosis, Mental Health Centre Sct. Hans, Mental Health Services of the Capital Region of Denmark, Roskilde, Denmark
4
Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
5
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Cult Med Psychiatry
assessment encounters where access to care is determined and when working with migrants or other marginalised groups. Keywords Recognition Mental health Health-related deservingness Migrants Cultural Formulation Interview
Introduction The Cultural Formulation Interview (CFI) is an internationally acclaimed clinical tool to guide a cultural assessment in mental healthcare. It was developed for the 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association 2013a). The core CFI consists of 16 open-ended questions. Taking a person involving approach, the CFI encourages the patient to define their problem and elaborate on explanato
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