The following assessment guidelines and tools aim to assist health professionals to consider culture and language when assessing culturally and linguistically diverse (CALD) patients.

• TMHC Transcultural Assessment Tools
• DSM-5 Cultural Formulation
• Additional Tools
• Further Reading

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Diagnostic and Statistical Manual of Mental Disorders (DSM–5)

The Outline for Cultural Formulation in the DSM–5 provides a framework for assessing information about cultural features of an individual’s mental health problem and how it relates to their social and cultural context and history. The Outline for Cultural Formulation can be found in Section III: Emerging Measures and Modules of the DSM–5.

The Outline for Cultural Formulation requires a systematic assessment of:

• Cultural identity of the individual
• Cultural conceptualisations of distress
• Psychosocial stressors and cultural features of vulnerability and resilience
• Cultural features of the relationship between the individual and clinician
• Overall cultural assessment

The Glossary of Cultural Concepts of Distress can be found in the Appendix of the DSM–5. Cultural concepts of distress refers to ways that cultural groups experience, understand, and communicate suffering, behavioural problems, or troubling thoughts and emotions.

The following DSM–5 Cultural Formulation Tools are available to download free of charge from the American Psychiatric Association website:

• The Cultural Formulation Interview (pdf 394.7KB)a set of 16 questions that clinicians may use to obtain information about the impact of culture on key aspects of an individual’s clinical presentation and care.
• The Cultural Formulation Interview - Informant version (pdf 352.7KB) can be used for interviewing family members or friends of a patient.
• Formulation Interview (pdf 439.4KB) these modules supplement the core Cultural Formulation Interview and can help clinicians conduct a more comprehensive cultural assessment. 

Note: The DSM-5 is available for purchase through the American Psychiatric Association. Click here to visit the American Psychiatric Association DSM-5 Website.

Find the DSM-5 in languages other than English (pdf 163.11KB). 

If you work within NSW Health you can access the full text of the DSM-5 through the Clinical Information Access Portal (CIAP).

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Additional tools

CLEAR Toolkit
The CLEAR toolkit is a clinical decision aid developed to help physicians, nurses and other allied health workers (e.g. midwives, community health workers, etc.) assess different aspects of patient vulnerability in a contextually appropriate and caring way and easily identify key referral resources in their local area. The CLEAR toolkit is accompanied by a trainers manual and is available in more than ten languages.  

Conversation Matters - Supporting CALD Communities to Talk about Suicide
Everymind
These resources highlight some of the factors that health professionals should consider when talking to CALD individuals, families and communities about suicide.

Montreal Cognitive Assessment 
The Montreal Cognitive Assessment is a cognitive screening test designed to assist health professionals to detect mild cognitive impairment.

Orientation to Cultural Responsiveness
Victorian Transcultural Mental Health, 2015
This introductory resource aims to help practitioners to explore creating culturally responsive mental health services.

Rowland Universal Dementia Assessment Scale (RUDAS) 
Alzheimer's Australia, 2004
RUDAS is cognitive screening instrument designed to minimise the effects of cultural learning and language diversity on the assessment of baseline cognitive performance.

WONCA Culturally Sensitive Depression Guideline (pdf 92.1KB)
World Organization of Family Doctors, 2004
These guidelines have been developed to assist clinicians with the diagnosis and treatment of adults with depressive disorder in primary care.

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Further Reading

The following journal articles and monographs discuss various aspects of cross cultural mental health assessment.

Where available we have provided links to the full text or abstract of articles. If items are not freely available online please contact your local library or hospital or university library (where applicable) to obtain the full text.

• Bhui, K., et al. (2007). "Cultural competence in mental health care: a review of model evaluations." BMC Health Services Research 7(1): 15.
• Borden, K. A. (2017). "Contemporary assessment practices Part 1: General and diversity issues." Professional Psychology: Research and Practice 48(2): 71-72.
• Fujii, D. (2017). "Conducting a culturally informed neuropsychological evaluation." (2017) Washington, DC, US: American Psychological Association; US.
• Furler, J. & Kokanovic, R.(2010) "Mental health cultural competence."Australian Family Physician, Vol. 39, No.4, April 2010
• Gardiner, J. & Walker, K. (2010) "Compassionate listening. Managing psychological trauma in refugees" Australian Family Physician Vol. 39, No.4, April 2010
• Geva, E. and J. Weiner (2015). "Psychological assessment of culturally and linguistically diverse children: A practitioner's guide." New York, NY, US: Springer Publishing Co; US.
• Goudsmit, M., et al. (2017). "The Cross-Cultural Dementia Screening (CCD): A new neuropsychological screening instrument for dementia in elderly immigrants." Journal of Clinical and Experimental Neuropsychology 39(2): 163-172.
• Hays, P. A. (2016). Addressing cultural complexities in practice: Assessment, diagnosis, and therapy , 3rd ed  Washington, DC, US: American Psychological Association; US
• Kleinman, A. & Benson, P. (2006) "Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It" PLoS Medicine, October 2006, Vol: 3 (10)
• La Roche, M. J., et al. (2015). "A cultural examination of the DSM-5: Research and clinical implications for cultural minorities." Professional Psychology: Research and Practice 46(3): 183-189.
• Lewis-Fernandez, R., et al. (2017). "Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: Mixed-methods results from the DSM-5 international field trial." The British Journal of Psychiatry 210(4): 290-297.
• Various authors (2016). “Special section on cultural considerations in collaborative and Therapeutic Assessment." Journal of Personality Assessment 98(6)    
• Willis, G. B. (2015). "Research synthesis: The practice of cross-cultural cognitive interviewing." Public Opinion Quarterly 79(Supp 1): 359-395.'

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