Table 1 Narratives of primary reasons for referrals
Perplexing and complex clinical presentations, lack of sufficient knowledge or understanding about the cases | |
· | Diagnostic clarification or confirmation, or request for second opinion |
· | Identification of possible cultural factors influencing an unclear clinical presentation |
· | Exploration and clarification of previous traumatic history, migration history and possible impact on current presentation |
Lack of engagement or progress and failed treatment alliance: | |
· | Exploration of possible cultural barriers to engagement and treatment adherence for non-collaborative patients |
· | Request for mediation between family and services to improve treatment alliance and outcomes |
· | Exploration of cultural factors influencing family dynamics and difference between culturally appropriate family structures and pathological family constellations |
Exploration and resolution of cultural conflicts | |
· | Exploration of conflict between sexual orientation and culture of origin |
· | Exploration of and guidance for resolution of conflict between culture of origin and UK culture |
· | Resolution of intergenerational conflict between immigrant patients and step children |
Racism and discrimination | |
· | Exploration of patients’ experience of racism and discrimination and evaluation of possible impact on current symptoms and presentation |
Defensive practices | |
· | Requests for generic involvement in care planning alongside other agencies for particularly risky cases |
Information requests | |
· | Requests for information on culturally appropriate community links and resources |
· | Requests for information on migration agencies and procedures, or international organisations |