EPA guidance on cultural competence training: a critical update and meta-review

BACKGROUND: Cultural competence training has become increasingly common in psychiatric practice across Europe and worldwide, supported by evidence demonstrating improvements in quality of care, clinical effectiveness, and patient satisfaction. Since the publication of the original EPA guideline in 2015, the field has advanced considerably in its theoretical foundations, evidence base, and institutional support. This updated guideline addresses recent developments and challenges in research, policy, and clinical practice. METHODS: The guideline is based on a systematic meta-review of 15 systematic reviews and evidence-based guidelines on cultural competence training in psychiatric care and mental health. The evidence was synthesized to identify key concepts, educational components, implementation strategies, and current debates. RESULTS: The review comprises four sections. First, it examines core elements of cultural competence training, emphasizing cultural humility, structural competence, and perspectives from the social and cultural sciences. Second, it provides practical recommendations for curriculum design, including the potential role of digital learning tools. Third, it addresses critiques of cultural competence, particularly concerns regarding essentializing and potentially racist interpretations. Finally, it explores strategies for integrating cultural competence training into existing psychiatric services, highlighting both individual and organizational factors that support implementation. CONCLUSION: Cultural competence benefits not only migrant and ethnically diverse populations but all patients and healthcare professionals, including members of majority cultures. Successful implementation requires cultural sensitivity, critical self-reflection, and sustained commitment at individual, organizational, and system levels to achieve meaningful and lasting improvements in psychiatric care.