Health professionals are now more aware of the challenges they face when providing health care to a culturally and racially diverse population [1
]. Despite concern about ethnic disparities of access to culturally appropriate mental health care, and calls for cultural competency training to be mandatory, there is little information about the effectiveness of cultural competency training in mental health settings [2
]. It is well established that in order to provide culturally competent care, knowledge of cultural beliefs, values and practices is necessary otherwise health practitioners can easily fall prey to errors of diagnosis, inappropriate management and poor compliance [5
]. Training curricula for medical, nursing and social work students now generally include lectures and course work on cultural competency in health care provision. Post-graduate training is also being revised (for example in the UK the Royal College of Psychiatrists) to incorporate cultural influences on mental health care. Despite this progress, a recent tragedy in the UK expedited the acceptance of policies to promote cultural competency training. A psychiatric inpatient was medicated under compulsory legislation and died while being restrained following a period during which he was subjected to racial abuse from another patient. The subsequent inquiry concluded that better training was necessary for the management of imminent violence and for staff to develop cultural competence in care provision [3
Although such recommendations are laudable, there appear to be several problems with such an approach. There is considerable confusion about what constitutes cultural competence. For example, it may be narrowly interpreted to mean better knowledge of the cultural beliefs and practices of a specific cultural group, with little attention to how culture modifies illness perceptions, illness behaviour, and acceptability of specific interventions. Cultural competency is somehow expected to emerge if the racial and ethnic mix of the workforce is representative of the local population. Not surprisingly, working practices following standardised professional trainings remain similar among staff from different ethnic groups because of the common pattern of training. Indeed, a patient and a health professional, ostensibly belonging to the same ethnic group because of shared country of origin, may actually differ in terms of social class, religious practices, languages, and cultural beliefs about illness and recovery. Despite a growing body of health and educational policies that prioritise cultural competency in health care provision, there is surprisingly little agreement on the meaning of cultural competence training or knowledge about its effectiveness.
In this review we seek to: define the meaning of cultural competence in mental health settings, describe models of cultural competence which have been evaluated in mental health settings, and assess the evidence for effectiveness by reviewing studies that implemented a model of cultural competence and then evaluated its effectiveness.