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Book Reviews   |    
Cultural Competence in Forensic Mental Health: A Guide for Psychiatrists, Psychologists, and Attorneys
Reviewed by Liya Xie
Psychiatric Services 2006; doi:
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edited by Wen-Sing Tseng, M.D., Daryl Matthews, M.D., Ph.D., and Todd S. Elwyn, M.D.; New York, Brunner-Routledge, 2004, 322 pages, $49.95

Dr. Xie is assistant professor in the forensic division of the department of psychiatry of the University of Calgary in Canada.

Cultural competence is the application of knowledge, skills, experience, and personal attributes to respond respectfully and effectively to people of all cultures, races, ethnic backgrounds, and religions in a manner that recognizes, affirms, and values the cultural differences and similarities and the worth of individuals, families, and communities and protects and preserves the dignity of each. As immigration has increased, so too has the need for clinicians to be able to adapt to the change. Cultural Competence in Forensic Mental Health: A Guide for Psychiatrists, Psychologists, and Attorneys presents a complete and contemporary overview of cultural issues with cultural perspectives in the practice of forensic clinical work. This book is organized in such a way as to cover various topics widely and comprehensively to serve as an introductory guide to provide culturally relevant and effective forensic mental health services. It is useful to a broad range of disciplines—psychiatry, psychology, nursing, social work, and law.

Culture is an organized system of knowledge and beliefs that guides and motivates behavior and largely determines the course of our lives. The legal system is a part of the larger sociocultural system, and the legal process is significantly influenced by the cultural backgrounds of the parties involved. The book discusses how cultural factors influence legal systems, legal procedures, and the practice of forensic psychiatry. The authors suggest cultural considerations in psychological assessment and forensic evaluation. They examine cultural aspects of various psychiatric disorders, crimes, and behavioral problems in forensic assessment. They recommend how to carry out culturally competent forensic evaluation in various types of criminal cases, civil matters, and family-court issues. The specialized subjects of competency, insanity, risk of violence, disability determination, and child custody are reviewed. Cultural aspects of civil commitment, maintenance of professional boundaries, and ethical issues are discussed. Most interestingly, 28 forensic cases are analyzed to illustrate the importance of cultural competence.

This book has one major error: it fails to fully understand the forensic psychiatry in contemporary Japan and China by stating that "[in] China and Japan, the legal system does not recognize psychological stress at the time of a crime but may recognize diagnosable mental disorders. So long as there is proof that the defendant suffered from a mental disorder, clarification of his or her state of mind during the criminal action may not be required." In fact, "mental forfeiture" is not a name of a psychiatric diagnosis. It is a legal term equivalent to NCR (not criminally responsible on account of a mental disorder), which implies that the defendant was unable to appreciate the nature or quality of his or her act at the time of the offence or to know right from wrong. Certainly, some diagnoses are more likely related to "mental forfeiture" (NCR) than other diagnoses. Given the same diagnosis, however, psychiatrists may arrive at different opinions about the extent of "mental forfeiture."

Cultural competence is a continual process of seeking cultural sensitivity, valuing diversity, and knowing about cultural mores and traditions of the populations being served. We should improve our cultural competence by upgrading our knowledge of various beliefs, attitudes, and values and using these skills to serve our clients more effectively.

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