Topic: Mental health

SWSPHN recently asked our commissioned mental health and Alcohol and Other Drug (AOD) service providers about their experiences engaging with and supporting culturally and linguistically diverse communities. We hope these shared collective experiences will support other services to develop their own strategies for engaging these communities.

For support and guidance on how to work effectively with multicultural communities, consider implementing the Embrace Multicultural Framework in your organisation. The free framework, developed by Mental Health Australia, has a range of resources which support organisations and individual practitioners to evaluate and enhance their cultural responsiveness. It is mapped against national standards to help organisations meet their existing requirements.

What do we mean by culturally and linguistically diverse (CALD)?

The Ethnic Communities Council of Victoria defines ‘culturally and linguistically diverse’ as a broad term used to describe people and communities which have diversity in language, ethnic backgrounds, nationalities, traditional and societal structures, and religions.

The 2016 Census found 43.3 per cent of South Western Sydney’s population was born overseas, higher than the state average. It showed 46.3 per cent speak a language other than English at home and 9.9 per cent speak English ‘not well or not at all’. These communities often have lower levels of health literacy, and lower levels of access or later access to mental health services, than people born in Australia who speak English at home. Therefore, it is important to develop targeted approaches to engage and support people from culturally or linguistically diverse backgrounds.

What approaches or strategies have been used to engage culturally diverse communities and clients?

From service promotion and outreach activities, through to referral and service provision, organisations work to ensure services are accessible, appropriate and meet the range of needs of diverse communities.

“[The] clinician/service viewed her cultural identity with curiosity and asked relevant questions with no judgement.”

Translated resources and promotional materials allow people to understand what support is available and make an informed decision about the care they receive. In addition, flexible referral pathways provide several avenues for people to be referred into a service, including self-referral/referral from carers, GPs including those who work with people from non-English speaking backgrounds, schools, youth services and other clinical and non-clinical support services (e.g. migrant and settlement services).

At referral, the person is offered access to an interpreter if needed. They may also be offered longer appointments to account for cultural and language barriers which need to be addressed during the appointment. Initial screening and assessment also provides insight into a person’s culture and its influence on identity, their understanding of mental illness, psychosocial stress, vulnerability and resilience. A variety of data is collected to understand need and respond accordingly, including preferred language, country of birth, parent/s’ country of birth and ethnic identity.

Some services are offered by bilingual clinicians with the cultural and language competence to work with people from culturally diverse backgrounds, and/or peer workers or peer trainers may be involved in the person’s care. One service even provides childcare to ensure parents can access therapies and engage with the service without worrying about who will care for their children.

Where appropriate, services involve family and extended family, recognising the intergenerational nature of care-giving and creating connection by increasing understanding and empathy towards the person’s experience of mental health issues.

“We felt respected and welcomed. You provided a warm and welcoming environment.” – carer of young person

To ensure a culturally competent workforce, case reviews/supervision may also be provided to support clinicians and case workers to work effectively with culturally diverse clients. Training provided may include trauma-informed care, person-centred care, recovery and strengths models, inter-cultural communication, graded language and reflective practice. Such training aims to develop an understanding of how mental health is understood in a person’s culture of origin to ensure a culturally responsive service is delivered.

What local organisations do services work with to engage culturally diverse communities?

A number of these services have established collaborative relationships with local organisations which support culturally diverse communities, including:

• STARTTS
• Transcultural Mental Health
• Western Sydney Migrant Resource Centre
• Settlement Services International (SSI)
• CORE Community Services
• Woodville Alliance
• Multicultural Disability Advocacy Association
• Muslim Women’s Association
• Lebanese Muslim Association
• Lebanese Women’s Association
• NAVITAS
• Flourish Australia
• Focus Connect
• Educaid Liverpool

In addition, there are committees like the Multicultural Network and Liverpool Migrant and Refugee Network where services can connect with each other, share their experiences, workshop common issues and promote their services.

What barriers influence help seeking and service delivery?

The stigmatisation of mental illness is the greatest barrier to people seeking help. This is seen to be most significant in smaller communities. In one example, a service was told not to discuss suicide as it would influence others to suicide. They also found young people had problems with parents not believing in mental health issues or not wanting to discuss the topic, even after a suicide attempt.

“[The client] reported feeling comfortable in how the clinician did not make assumptions and approached his views from a learner-observer perspective.”

Other barriers are in relation to language and communication. For example, although interpreters are used when delivering services, interpreters are not available when booking appointments which is a barrier to initial engagement.

To encourage people to seek help and ensure they are able to access services once they decide to seek support, these barriers need to be addressed within the service system and in the community.

How is the lived experience of those from a culturally diverse background engaged with and promoted?

Engaging with people who have lived experience is vital to service development, implementation and evaluation, and empowers others to access services. It also builds the capacity of service providers to support people from culturally diverse backgrounds. During service design, some organisations consult with consumers and carers from culturally diverse communities to co-design approaches. Culturally diverse people may also participate in advisory committees, steering committees and other governance committees.

“I certainly learnt a lot and will cascade the information to my tutors who work with new migrants and refugees one on one. There are many salient points that can assist people with settlement and coping in their everyday life as they face many challenges.”

Some services employ people from culturally diverse backgrounds who have a lived experience of mental illness, or as a carer, in peer work or peer trainer roles. A mental health peer worker is someone employed on the basis of their personal lived experience of mental illness and recovery, or supporting someone with a mental illness. Growing a culturally diverse peer workforce can ensure culturally diverse communities have access to support which is tailored to their unique cultural and religious needs. Tackling the Challenge: Talking Men’s Health project in South Western Sydney is an example of how people with a lived experience from a culturally diverse background can help breakdown stigma and myths about mental illness which is often a major barrier to people from culturally diverse communities seeking help. The project brought together men from different cultural backgrounds to share their stories of resilience through challenges such as migration, unemployment, mental illness and discrimination.

SWSPHN would like to thank our commissioned programs which contributed case studies; including You in Mind (One Door Mental Health and VT Psychological Services), Star4Kids (Proactive Psychology), headspace Bankstown (Flourish), SWS Recovery College (Macarthur Disability Services),  Lifeline Crisis Support Suicide Aftercare Program (Lifeline Macarthur) and HeadFyrst/Fyrst/Yarnlink (Salvation Army Youthlink).