Ths is from Psychiatric News, and it relates to the idea that diversity is good, and it must increase. That we must all converge. As these very worthy people tell me how to do my job… I keep on thinking there is no idiocy like academic Yankee idiocy.

You see, I have a bad habit. I listen to the non academics: the tradies, the support staff: and they generally report that the current way of teaching racism and micro aggression makes them more racist. The Cathedral turns this into a new pathology “White fragility”.

I will work to engage with anyone. Including those who I disagree with. Not an issue: I have worked with too many criminals: it is lawyers who keep me away from Forensic Psychiatry.

But this requirement that we join the Borg is leading to resistance. The Minority cannot require that those who are not them become them.

The goal is not simply the achievement of diversity but inclusion, said opening speaker Terry Cross, M.S.W., of the National Indian Child Welfare Association.

“Cultural competence means being able to function in the context of cultural differences,” said Cross. “Inclusion is not just having people show up at the door but about their being able to be who they are.”

The conference was cosponsored by APA, Ohio State University, and General Motors.

Yet how can an organization know where it stands and how well it has progressed toward achieving cultural competence and inclusion?

“You can’t manage what you can’t measure,” said Joshua Schwarz, Ph.D., a retired professor of management at Miami University, Ohio, recalling an adage in the field.

Most attempts to measure cultural competence have been ad hoc, limited to specific occupational categories, poorly validated, or not freely available, said Schwarz.

In response, he and his colleagues developed the Healthcare Provider Cultural Competence Instrument, which incorporates both a general awareness/sensitivity dimension and a more conventional multicultural approach to measurement. It also has cross-occupation validity, a better approach than developing individual training programs for smaller professional populations, he said.

“Have patience,” added Sonja Harris-Haywood, M.D., M.S., senior associate dean in the College of Medicine at the Northeast Ohio Medical University in Cleveland. “Cultural competence assessment and measurement is a journey.”

Harris-Haywood helped develop a set of 67 questions to measure knowledge of cultural competence and its implementation, as well as community engagement.
Photo: Joshua Schwarz, Ph.D.

In medicine, said Schwarz, “the most important aspect of cultural competence is the attitude of practitioners toward patients, particularly patients from different cultures.”

At a minimum, clinicians must be aware of how their own biases influence patients’ experience of the health care encounter, he said. Clinicians must learn the skills needed to draw from patients their own perspectives on illness so they can take part in informed decision making.

Inclusion is difficult today less because of major, blatant forms of discrimination than of less obvious exclusion, said Ranna Parekh, M.D., M.P.H., director of APA’s Division of Diversity and Health Equity.

Parekh noted that Harvard psychiatrist Chester Pierce, M.D., coined the term “microagressions” in 1970 to describe not the major indignities of traditional racism but the “subtle, stunning, often automatic, and nonverbal exchanges” that implicitly degrade members of minority groups and provide advantage to members of the dominant culture. The tension and stress induced by microaggressions can affect physical and mental health as well as job prospects, said Parekh.

Measuring the subtleties of inclusion is more difficult than simply counting heads, noted several speakers.

“Metrics are indispensable to transforming organizations into learning organizations,” said Douglas Haynes, Ph.D., a professor of history and vice provost for academic equity, diversity, and inclusion at the University of California, Irvine (UCI).

“For too long, we didn’t measure diversity and inclusion,” he said. “We have to recognize the uneven landscape of opportunity.”

Besides, the scale is biased.

In the ideal world, we would accept that each nation is good, and let them live where they will. England for the England, Hutuland for the Hutu, and Iceland for the dottirs. We would have workers trained in medicine and nursing from each culture in that culture. We do not live in that world. Our nations have been admixed.

As a medico, you meet the patient half way. But… those who insist of full participation and inclusion harm themselves. They forget that Western medicine is Western, and the scientific method is designed to disallow culture and bias, and find out if something works or not. This is one of those points where quacks hide behind theory, ideology or ethnicity.

TL:DR cultural competence is a crock. Communication is not: communication is part of competence. But letting the entryists in with their narratives of convergence should not happen, and this (along with the appalling job the APA did with DSM5) shows that there is convergence. The rot is also in the royal colleges (which have far more power) but there is less sponsorship, less money, and — since most Aussie and Kiwi psychiatrists interact with Maori and Aborigine and Torres Strait people — there are reality checks.

This is peak entryism. THe APA will reform or fail. My money would be on the second option.