title: The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities.
abstract: BACKGROUND
  Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service.
  
  
  RESULTS
  These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering "culture" in the presentation and expression of mental distress. The narratives reveal an overall "culture of understanding cultural issues" and specific "cultures of care". These emerged as necessary foci of intervention to improve service user outcomes.
  
  
  CONCLUSIONS
  Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery.
authors.affiliation: Queen Mary, University of London, London, UK.
authors.forename: Micol
authors.initials: M
authors.lastname: Ascoli
authors.forename: Andrea
authors.initials: A
authors.lastname: Palinski
authors.forename: John Arianda
authors.initials: JA
authors.lastname: Owiti
authors.forename: Bertine
authors.initials: B
authors.lastname: De Jongh
authors.forename: Kamaldeep S
authors.initials: KS
authors.lastname: Bhui
mesh_terms: D000884:Anthropology, Cultural; D018864:Cultural Diversity; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000208:ethnology* / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D009740:Nursing Staff; D015279:Organizational Culture; D011618:Psychotic Disorders / Q000208:ethnology; D063505:Racism; D006113:United Kingdom; D000078329:Workforce