Some reflections on cultural and social considerations in mental health nursing

This article critiques the contribution of two main theoretical perspectives on mental health care and ethnicity, with particular reference to Asian women. It considers the work of those who highlight the impact of culture on the health and illness experience (Kleinman 1980, Rack 1982, Fernando 1989) and the work of authors who argue that the impact of broader socio-economic structures must be considered (Donovan 1989, Pearson 1989, Ahmad 1993). It is posited that the emphasis on cultural difference results in crude monolithic generalizations about Asian culture and operates as a smokescreen for the impact of poverty and racism. The backdrop to this article is provided by an assessment of the problematic conceptual framework of Western mental health and the role it plays in perpetuating stereotypes. It is concluded that mental health nurses need a thorough understanding of the complexity of the cultural and social factors that influence health and illness; an understanding which falls somewhere between these two theoretical perspectives. Such an approach needs to be grounded in the experience of mental health clients themselves if it is to be appropriate.