Health services, psychiatry and citizenship in a globalizing world: a perspective from Ireland

Competing models of cultural integration present significant challenges and opportunities in the provision of public services to multi-ethnic, multi-cultural populations. In some countries, the mental health needs of refugees, voluntary migrants and ethnic minority groups are met by dedicated mental health services separate from generic services. For other countries, such developments present challenges in terms of integration objectives and public service provision in accordance with national policy. Nonetheless, given our profound, enduring attachments to culture, it appears reasonable that host societies should, at least in part, co-operate with refugees, voluntary migrants and/or ethnic minority groups in re-shaping elements of public services to optimize their appropriateness to the linguistic and historical traditions of such groups. This is particularly relevant to services that address complex states of psychological distress. In addition, it is apparent that globalization is revising received notions of citizenship and opening up political processes to groups who were previously excluded, including the mentally ill. While it is necessary to avoid excessive shifts away from the rights of the individual towards the rights of culturally defined sub-groups, it is important that public services recognize the myriad challenges and opportunities presented by evolving models of culture and citizenship in a globalizing world.