Transcultural Mental Health Services at the cross roads

Article by Transcultural Mental Health Representatives from the, MHiMA Executive

For the past twenty years, Transcultural Mental Health Services (TMHS) have been at the forefront in frontline mental health services addressing the significant disparities in access and quality of care received by people from culturally and linguistically diverse (CALD) backgrounds in Australia. Via the provision of specialist clinical consultation and assessment services, workforce education and promotion, prevention and early intervention programs, Australia is regarded as a leader in transcultural mental health internationally. 

Collectively Transcultural Mental Health Services have delivered clinical services to well over 50,000 immigrants and refugees nationally and their promotion and prevention programs have delivered culturally tailored services to hundreds of thousands of people in Australia’s multicultural communities. With a recurrent investment of less than $4 million per annum this represents excellent value for money.  

Despite this impressive track record, Transcultural Mental Health Services do face ambiguity around state-wide roles and functions in an ever changing health policy context; and having explicit mandate to operate on a statewide basis would better position such critical services to play their part effectively in future mental health reform. It is in this context that there are practical opportunities in the immediate future which include: 

• Getting clarity around roles, responsibilities and scope of statewide services; and optimising co-investment from Federal and State funding in specialist statewide transcultural mental health services as part of forthcoming the Federation White Paper process;

• Expanding the role of Transcultural Mental Health Services beyond primary and secondary clinical consultation services which are currently state funded so that their remit is broader by being able to explicitly work across the continuum of care particularly in the areas of promotion, prevention and early intervention in the primary healthcare space. There is a real opportunity to enable more efficient and cost effective care frontline care for people of culturally and linguistically diverse backgrounds through Commonwealth investment in the newly reconfigured Primary Health Networks (PHNs). 

The diversity of the Australian population necessitates public policy settings which ensure equity and access in the planning and delivery of health services. The recent review of mental health services and programs by the National Mental Health Commission acknowledged that “‘many people with mental health difficulties face compounding disadvantage with specific recognition of marginalisation of those from diverse cultural backgrounds” [1]. 

The Review’s recommendations in relation to responses for different population groups are welcomed with specific references to the adoption of the ‘Framework for Mental Health in Multicultural Australia: Towards culturally inclusive service delivery’[2] as a tool to help organisations identify what they can do to enhance their cultural responsiveness; the requirement for PHNs to partner with state-wide transcultural mental health services in planning and developing services; and the adoption of  clear and explicit equity-oriented targets for people from CALD backgrounds for inclusion in government funding agreements.  

Transcultural Mental Health Services are well placed to make a valuable contribution to these developments, which if followed through, will potentially change the way people from CALD backgrounds engage with mental health services. From current ad hoc examples of good practice, mainly in the four states where TMHS currently exist, to long term sustained change across the spectrum of services, particularly if equity oriented targets are achieved in funding agreements which will significantly increase the funding base for specialist multicultural mental health services and programs. 

TMHS have been the pre-eminent reference point for resources, training and clinical expertise in culture and mental health. At the population health level, TMHS have also made a valuable contribution. Decades of experience of population health practice have demonstrated that the community’s health is determined by so much more than the quality and availability of health services. For CALD communities the social determinants of health are even more significant with many factors relating to migration and settlement experience resulting in socio-economic disadvantages in areas of employment, language, access to health and social services, racism and discrimination. It is well established that mental disorders, as with most other health conditions, arise from the interplay of biological, psychological and social factors[3]. 

For the past twenty years, TMHS have successfully engaged with the wide range of different ethnocultural groups reflecting the different waves of migration and patterns of resettlement influenced by changing economic and political pressures across the globe. Given the exposure to working transculturally with each wave of new arrivals, TMHSs are afforded invaluable opportunities every day to learn about different cultural idioms of distress and the cultural beliefs and values that may influence the presentation of a mental disorder from one culture to the next. The solid connections forged between TMHS and different community groups facilitate ongoing development of innovative strategies for cultural responsiveness and sensitivity in service delivery. These relationships are integral in the work of TMHS to reduce stigma, increase mental health literacy among ethno-specific communities and maintaining an updated understanding of the mental health needs of these communities. The knowledge gained from these connections are valuable not only for ensuring that any training material developed by TMHS are context relevant, topical and applicable, but also to inform on policy at the state and national level on mental health issues pertaining to ethno-cultural communities. 

Engagement with community stakeholders is pivotal to the business of transcultural mental health. This involves representing the voice of transcultural mental health issues on relevant committees and steering groups to ensure that critical aspects of transcultural mental health are given due consideration prior to initiatives being funded or implemented.   

TMHS are pivotal to mental health service reform as we move forward. In the wake of changing funding models and the ongoing devolution that is being implemented across Australia’s health system, the capacity for TMHS to facilitate the inclusion of those marginalised by language and culture within their statewide jurisdictions must not be compromised. The collective strategic objective of all of Australia’s TMHS to work in unison for collective impact across the nation and at the many levels they do on a daily basis is vital for a mentally healthy multicultural Australia. 

[1] National Mental Health Commission, 2014: The National Review of Mental Health Programmes and Services, Sydney NMHC. Published by NMHC, Sydney
[2] Framework for Mental Health in Multicultural Australia: Towards culturally inclusive service delivery: Mental Health in Multicultural Australia (MHiMA) 2014
[3] Fourth National Mental Health Plan Working Group (2009). Fourth National Mental Health Plan:an agenda for collaborative government action in mental health 2009-2014. Canberra: Australian Government Department of Health and Ageing

__________

Do you have a comment on this story? Join the conversation on Twitter @AUMentalHealth