Conversations should take into account the cultural context. When it comes to rules of confidentiality or disclosure, for example, the confidentiality of youth over age 14 is legally protected. However, service providers find it helpful to take into account the “cultural legitimacy of parental authority over adolescents” when communicating with youth clients and their families (Kirmayer et al., 2011, p. E964).

Service providers should be aware of how cultural norms may influence people's concepts of help and support, as clients assign different traditions and assumptions to the roles of family, friends or the community (Substance Abuse & Mental Health Services Administration (SAMHSA), 2014; Simich et al., 2004; Stewart et al., 2008). In many cultures, for example, family members are consulted about health issues.

Clients ultimately decide what information can be disclosed and what level of family involvement they are comfortable with. However, in the early stages of treatment, family members can be helpful, serving as an effective source of help and support by intervening in crises and acting as a case manager and patient advocate. Health service providers should not overlook families as they are a critical part of the complex network of people, organizations and institutions that make up the mental health and addiction system (Kirmayer et al., 2011).

It may be useful to view cultural factors within the context of the larger societal structure in which they exist. The host society's existing practices, policies and opportunities strongly affect newcomer clients' settlement, adaptation and social integration (Kirmayer et al., 2011). Service providers may find it useful to be aware of welcoming links and community resources that can provide psychosocial support and other resources to clients as needed (Kirmayer et al., 2011).

Cultural brokers can be used to enhance the quality of the relationship between clients or service providers to produce better outcomes for clients (Al Masri, 2018).

Cultural factors are not specific to immigrants and refugees, but should also be considered when working with members of ethno-cultural and racialized populations in general. However, it is important to be mindful that there is diversity among every population, and that generalizations about people of the same ethnic background, for example, should be avoided.

In summary, culture has a significant impact on whether newcomer clients receive the treatment and support they need, how they perceive mental health and illness and how they are responded to. It is important for service providers to be aware of the potential influence of clients' cultural background at every point of the provision of treatment. This would prevent culture from being seen as a barrier and, instead, ensure that clients receive appropriate and effective care.

The following articles, books and reports provide strategies or background on how to effectively incorporate cultural factors when offering mental health services to clients:

• Common mental health problems in immigrants and refugees: General approach in primary care (Kirmayer et al., 2011); article in CMAJ.
• Cultural Consultation: Considering the Other in Mental Health Care (Kirmayer et al., 2014); book.
• Supporting the Mental Health of Refugees to Canada; backgrounder report published by the Mental Health Commission of Canada.