The ETHICA-4P in intercultural mental health care for migrants: perspectives from the United Kingdom and Chile

BACKGROUND: Mental health services in destination countries for migration are increasingly required to support service users from diverse cultural backgrounds. Although migrants may experience elevated mental health challenges, existing approaches are often insufficient to meet their needs. There is a need for tools that support practitioners in delivering competent and ethical intercultural care and navigating complex ethical decision-making. OBJECTIVE: To beta-test the ETHICA-4P ethical decision-making toolkit and evaluate its potential to support clinicians in addressing ethical challenges arising in intercultural practice. METHODS: Feedback was collected from stakeholders and practitioners in two destination countries for migration, Chile and the United Kingdom, through focus groups and anonymous surveys. Data were analysed using Reflexive Thematic Analysis to compare participants' perspectives and suggestions regarding the use and further development of the toolkit. RESULTS: Three themes were identified: 'Shared ethical dilemmas', 'Prioritising different levels of analysis according to place-based needs', and 'Practical guide, or tool for reflection?'. Participants reported similar ethical challenges and shared perspectives on the potential use of ETHICA-4P in practice. However, they differed in how intercultural care needs were conceptualised and addressed according to context, with some emphasising systems-level responses and others clinician-level approaches. These differences generated distinct suggestions for improving the toolkit. CONCLUSIONS: The findings provide guidance for the continued development of ETHICA-4P and highlight the importance of flexibility in supporting ethical intercultural practice across diverse service and national contexts.