The importance of making sure that multicultural dimensions are supported in the Office for Mental H
Thank you, Madam Speaker. I am delighted to bring this matter of public importance in my name to the Assembly today.
Australia is one of the most culturally diverse nations in the world, exceeding New Zealand, Canada, the United States and the United Kingdom in the proportion of residents born overseas. The nation’s capital reflects and in some measures even exceeds this national diversity. According to the latest census figures, fully 32 per cent of the ACT’s residents were born overseas, with another 15 per cent having at least one parent who was born overseas. A non-English language is spoken in nearly 24 per cent of Canberra’s households.
In short, the term ‘culturally and linguistically diverse’, often abbreviated as CALD, certainly applies to our community. This is a term widely used in Australian government policy and service initiatives and specifically refers to people born overseas, people with limited English proficiency, children of people born overseas, refugees and asylum seekers. Research clearly indicates that these communities often face ‘unique cultural and linguistic barriers that may impede their access to services, including health services, resulting in poorer outcomes’.
Lower utilisation of health services by multicultural communities in Australia is especially pronounced when it comes to mental health services. Thankfully, data suggest that the prevalence of mental health issues in CALD communities is no greater than in the population at large, and in fact, ‘the self-reported prevalence of mental illness is slightly lower for people born overseas … than for people born in Australia’.
But Australians from culturally and linguistically diverse backgrounds do face specific challenges. As a rule, both migrants and refugees choose to travel to a new land because they are hoping to forge new lives, away from often very difficult circumstances. Many refugees and other migrants have ‘experienced and witnessed high levels of traumatic events and violence, including war, persecution, sexual assault, the death and disappearance of loved one and survival in a range of dangerous circumstances’. Beyond this, research suggests that the often difficult process of settlement itself may contribute to the incidence of mental illness. ‘This is often linked to the stressful process of acculturation, language and social difficulties, and struggles in finding employment’.
For all of these reasons, it is essential that multicultural dimensions be included in the design and provision of mental health services. At the very minimum, this means that translation be readily available to clients from linguistically diverse backgrounds. Unfortunately, ‘the existence of interpreter services is often unknown to CALD communities or severely under-resourced’.
Appropriate translation is important because concepts associated with mental health often don’t exist in certain languages and cultural backgrounds. For example, Psychiatric nurse Sione Vaka has noted that ‘there is no direct translation in some Pacific languages’ for the word depression. And as Fatima Mohamed of the Somali Welfare and Cultural Association has pointed out, the phrase ‘mental health’ does not even occur in Somali. ‘In Somalia, you’re either crazy or you’re OK’, she added. ‘Even if they’re sick, they won’t tell you what’s wrong. They keep it in until it’s really bad’.
This last statement helps to illustrate another obstacle, Madam Speaker. Whilst stigmas surrounding mental illness are common across society, these stigmas are often more pronounced in CALD communities and need to be specifically targeted in order to help those from multicultural backgrounds understand that it’s OK to seek help when they need it. At the same time, it is also essential that the help provided is culturally competent, and this goes far beyond just a token access to interpreters. It must incorporate an overarching awareness and recognition of Australia’s cultural and linguistic diversity. Depression, for instance, often presents in different ways in different cultures.
One recommendation is for mental health practitioners to amplify ‘cultural concordance’ between themselves and their CALD patients. For example, psychiatrist Siale Foliaki has referred to his ability as a practitioner with a multicultural background to practise, in his own words, ‘from a place of intimacy’, where he can be ‘enmeshed in [a] client’s world’. For this reason, it is important to see ‘increased recruitment and employment of bicultural and bilingual workers to help overcome language and cultural barriers in accessing mental health services’.
But a perfect match in a truly diverse community is not always an option. Another productive way forward is when mental health practitioners are able to ‘leverage their [own] ethnicity, religion, experience practising overseas, speaking languages other than English and/or existing cultural knowledge and experience to effectively communicate with their … patients’. This means that many professionals who come from a non-dominant culture or have picked up experience where they were part of a non-dominant culture often find it easier to relate to patients from a variety of culturally and linguistically diverse backgrounds, even when those backgrounds differ.
As one doctor reported, and I quote, ‘Having lived myself in another situation where you don’t understand the language, you don’t understand the culture and everything, I guess it makes me a bit more patient and also makes me try and understand where they are coming from so that I can better communicate with them’.
For this reason, policy in New South Wales states that ‘Diversity in the local population needs to be reflected in the skill base and composition of the mental health workforce’. This is why Mr Vaka, the psychiatric nurse mentioned earlier, actively works to recruit people from CALD backgrounds into nursing.
Supporting such initiatives should be a robust program of ‘training in and evaluation of cultural competency across all levels of mental health service provision’. Where such competency does not already exist, it must be carefully nurtured in the professional workforce, with visionary and understanding leaders who both see the importance of this and are willing and committed to making it happen.
Madam Speaker, much has already been made in this chamber about the long delays that have hindered the promised implementation of an ACT office for mental health. These delays are to be regretted, but I would suggest that they also provide the Minister for Mental Health an opportunity to make sure that important multicultural dimensions are not overlooked in the creation of this office.
In light of the fact that the Adult Mental Health Unit at Canberra Hospital is currently experiencing what has been described by the union as a ‘crippling shortage’ of permanent psychiatrists and that, as a consequence, ‘ACT Health is continuing to undertake a national and international recruitment activity to fill vacant positions’, I specifically recommend to Mr Rattenbury that professionals with demonstrable cultural competence be specifically targeted as part of this recruitment drive and that cultural sensitivity be embedded in everything this office does. Madam Speaker, I look forward to hearing more on this topic from the minister.