Physiotherapy in mental health care and society
Dirk Vissers
Physiotherapy and diversity
Introduction
What does diversity in health care include?
- Age, disability, gender, race or ethnic origin, religion or sexual orientation
Diversity
- Any dimension that can be used to differentiate groups and people from one another
- Empowering people: respecting & appreciating what makes them different
o Terms of: age – gender – ethnicity – religion – disability – education – national origin – sexual
orientation
Inclusion
- Organizational effort & practices in which different groups or individuals (different backgrounds)
culturally & socially accepted and welcomed
o Equally treated
- Differences:
o Self-evident (national origin, age, race, …)
o Inherent (educational background, training, personality)
Diversity is the mix and inclusion is getting the mix to work well together
Culture
Culture: “ the ideas, customs, and social behaviour of a particular people or society”
Definitions
- A system of behaviour that helps us act in an accepted or familiar way
Managing cultural differences
An intercultural mediator = a person who enables intercultural communication
- Helps representatives of two different cultural communities communicate and understand each other
Cases: slide 16 – 21
1
,Intercultural competence
Intercultural competence can’t be acquired in a short space of time or in one module
- Not a naturally occurring phenomenon
- = lifelong process
PDF intercultural knowledge and competence value
rubric: Blackboard
Intercultural knowledge and competence value rubric
A. Knowledge
1. Cultural self-awareness
- Benchmark: shows minimal awareness of own
cultural rules and biases
o Even those shared with own cultural
group(s)
o Uncomfortable with identifying possible
cultural differences with others
2. Knowledge of cultural worldview frameworks
- Benchmark: demonstrates surface understanding
of the complexity of elements important to
members of another culture in relation to its
o History – values – politics – communication styles – economy – beliefs and practices
o OR
B. Skills
1. Empathy
- Benchmark: views the experience of others but does so through own cultural worldview
2. Verbal and nonverbal communication
- Benchmark: has a minimal level of understanding of cultural differences in verbal and nonverbal
communication
o Is unable to negotiate a shared understanding
C. Attitude
1. Curiosity
- Benchmark: states minimal interest is leaning more about other cultures
2. Openness
- Benchmark: receptive to interacting with culturally different others
o Has difficulty suspending any judgment in interactions with culturally different others, but is
unaware of own judgment
Cross-cultural communication: dia 30 (read)
Need to be respectful of a patient’s cultural perspective = in all the codes of physiotherapy
Gender
Gender equality
- = sexual equality / equality of the sexes
- State of equal ease of access to resources and opportunities regardless of gender, including economic
participation and decision-making
o And state of valuing different behaviours, aspirations and needs equally
o Regardless of gender
2
,Gender equity
- Different treatment is adopted towards men and women, according to their respective needs
o In order to restore historical and social imbalances
o Which impede the active and equal participation in the development of their society
Gender equality more about equal access and opportunities, balance, no preferences or discrimination
- Everyone the same bike
Gender equity more about fairness and justice, giving the same benefit
- Form of bike adapted to needs
Pathways through which gender norms affect lifelong health
1. Gender-related differences in exposures
- Women and men same job title do different tasks & receive different pay
- Persistent gender segregation in employment
o differential exposure to disease, disability and injury
2. Gendered health behaviours
- Hazardous masculinities
o Not seeking medical care, reckless driving, substance use, aggression, …
- Toxic femininities
o Women’s use of toxic beauty products, facial plastic surgery, less participation in physical
activity, …
3. Gender impacts on accessing health care
- Men, mothers-in-law, or older family members are often gatekeepers for women’s access to health
care, and a husband’s consent for the provision of treatment is often required
- By contrast, women’s increased decision-making autonomy and access to economic resources is
positively associated with their use of health-care services in many sub-Saharan African countries
- Similarly, in Pakistan, a 1% increase in women’s decision-making power was correlated with a nearly
10% increase in their use of maternal health services..
(dictionary is gendered: hysterical as an insult of women derived from the Greek word hystera = uterus)
4. Gender-biased health-
care systems
- Cave: equity over
equality?
3
, Treatment disparity = ongelijkheid behandeling
Gender quotas
- 50% women & 50% men
- Problem or solution?
Gender identity
= how a person feels and who they know them self to be when it comes to their gender
- Some people do not identify with some, or all, of the aspects of gender associated with their
biological sex
- Different gender identities: male, female, transgender, gender neutral, gender gluid, non-binary,
agender
Gender & physiotherapy
Three areas, where it is important to consider gender
1. Gender in clinical practice
- Women: “be careful” being weak and fragile
- Men: “ heavy work leads to pain”
o Even though many of the women studies
also had physically strenuous work tasks
- LGBTIQ+ challenges when attending PT
o Assumptions about sexuality or gender
identity
o Discomfort: physical proximity, touch,
undressing or observations of their body
- Choice of treatment appears to be gendered
o Women: acupuncture & treatment for improved mental function (body awareness)
o Men: more joint mobility treatment
2. Gendered organizational aspects
- Gender regime in health care with overrepresentation of women professionals while the men
professionals have more power
o Organization level & high-status professions within organization
3. Gendered sociocultural norms and ideals
- Women struggling with obesity
o More comfortable and accepted when exercising together with p in same situation
- Body, health and illness can be shaped by societal norms and ideals linked to varying social status
Inequality over different axes
4
Dirk Vissers
Physiotherapy and diversity
Introduction
What does diversity in health care include?
- Age, disability, gender, race or ethnic origin, religion or sexual orientation
Diversity
- Any dimension that can be used to differentiate groups and people from one another
- Empowering people: respecting & appreciating what makes them different
o Terms of: age – gender – ethnicity – religion – disability – education – national origin – sexual
orientation
Inclusion
- Organizational effort & practices in which different groups or individuals (different backgrounds)
culturally & socially accepted and welcomed
o Equally treated
- Differences:
o Self-evident (national origin, age, race, …)
o Inherent (educational background, training, personality)
Diversity is the mix and inclusion is getting the mix to work well together
Culture
Culture: “ the ideas, customs, and social behaviour of a particular people or society”
Definitions
- A system of behaviour that helps us act in an accepted or familiar way
Managing cultural differences
An intercultural mediator = a person who enables intercultural communication
- Helps representatives of two different cultural communities communicate and understand each other
Cases: slide 16 – 21
1
,Intercultural competence
Intercultural competence can’t be acquired in a short space of time or in one module
- Not a naturally occurring phenomenon
- = lifelong process
PDF intercultural knowledge and competence value
rubric: Blackboard
Intercultural knowledge and competence value rubric
A. Knowledge
1. Cultural self-awareness
- Benchmark: shows minimal awareness of own
cultural rules and biases
o Even those shared with own cultural
group(s)
o Uncomfortable with identifying possible
cultural differences with others
2. Knowledge of cultural worldview frameworks
- Benchmark: demonstrates surface understanding
of the complexity of elements important to
members of another culture in relation to its
o History – values – politics – communication styles – economy – beliefs and practices
o OR
B. Skills
1. Empathy
- Benchmark: views the experience of others but does so through own cultural worldview
2. Verbal and nonverbal communication
- Benchmark: has a minimal level of understanding of cultural differences in verbal and nonverbal
communication
o Is unable to negotiate a shared understanding
C. Attitude
1. Curiosity
- Benchmark: states minimal interest is leaning more about other cultures
2. Openness
- Benchmark: receptive to interacting with culturally different others
o Has difficulty suspending any judgment in interactions with culturally different others, but is
unaware of own judgment
Cross-cultural communication: dia 30 (read)
Need to be respectful of a patient’s cultural perspective = in all the codes of physiotherapy
Gender
Gender equality
- = sexual equality / equality of the sexes
- State of equal ease of access to resources and opportunities regardless of gender, including economic
participation and decision-making
o And state of valuing different behaviours, aspirations and needs equally
o Regardless of gender
2
,Gender equity
- Different treatment is adopted towards men and women, according to their respective needs
o In order to restore historical and social imbalances
o Which impede the active and equal participation in the development of their society
Gender equality more about equal access and opportunities, balance, no preferences or discrimination
- Everyone the same bike
Gender equity more about fairness and justice, giving the same benefit
- Form of bike adapted to needs
Pathways through which gender norms affect lifelong health
1. Gender-related differences in exposures
- Women and men same job title do different tasks & receive different pay
- Persistent gender segregation in employment
o differential exposure to disease, disability and injury
2. Gendered health behaviours
- Hazardous masculinities
o Not seeking medical care, reckless driving, substance use, aggression, …
- Toxic femininities
o Women’s use of toxic beauty products, facial plastic surgery, less participation in physical
activity, …
3. Gender impacts on accessing health care
- Men, mothers-in-law, or older family members are often gatekeepers for women’s access to health
care, and a husband’s consent for the provision of treatment is often required
- By contrast, women’s increased decision-making autonomy and access to economic resources is
positively associated with their use of health-care services in many sub-Saharan African countries
- Similarly, in Pakistan, a 1% increase in women’s decision-making power was correlated with a nearly
10% increase in their use of maternal health services..
(dictionary is gendered: hysterical as an insult of women derived from the Greek word hystera = uterus)
4. Gender-biased health-
care systems
- Cave: equity over
equality?
3
, Treatment disparity = ongelijkheid behandeling
Gender quotas
- 50% women & 50% men
- Problem or solution?
Gender identity
= how a person feels and who they know them self to be when it comes to their gender
- Some people do not identify with some, or all, of the aspects of gender associated with their
biological sex
- Different gender identities: male, female, transgender, gender neutral, gender gluid, non-binary,
agender
Gender & physiotherapy
Three areas, where it is important to consider gender
1. Gender in clinical practice
- Women: “be careful” being weak and fragile
- Men: “ heavy work leads to pain”
o Even though many of the women studies
also had physically strenuous work tasks
- LGBTIQ+ challenges when attending PT
o Assumptions about sexuality or gender
identity
o Discomfort: physical proximity, touch,
undressing or observations of their body
- Choice of treatment appears to be gendered
o Women: acupuncture & treatment for improved mental function (body awareness)
o Men: more joint mobility treatment
2. Gendered organizational aspects
- Gender regime in health care with overrepresentation of women professionals while the men
professionals have more power
o Organization level & high-status professions within organization
3. Gendered sociocultural norms and ideals
- Women struggling with obesity
o More comfortable and accepted when exercising together with p in same situation
- Body, health and illness can be shaped by societal norms and ideals linked to varying social status
Inequality over different axes
4
