Abstract

Indigenous peoples, immigrants and refugees and racialized groups, as well as some long-established ethnic, linguistic, cultural and religious communities, experience inequities in mental health in Canadian society. These inequities result from social structural determinants of health that are embedded in the cultural knowledge, values and attitudes of the specific group as well as those of the larger society. Culture shapes the experience and expression of mental health problems, modes of coping, pathways to care and the effectiveness of treatment and prevention, as well as the processes of resilience and recovery. Systematic attention to culture in the provision of mental health services can improve access, utilization and health outcomes. We review models to address diversity in mental healthcare and identify key areas in which we believe policy innovation is urgently needed:

1. Cultural competence, safety and anti-racism training and accreditation standards for practitioners and for healthcare education, service systems and institutions; 
2. National regulations and quality assurance standards to ensure use of language interpreters; 
3. Development of a cadre of culture brokers to improve clinical communication; and 
4. Integration of attention to culture in service systems design, as well as clinical practice.