Chapter 13: Multicultural Issues

Multicultural issues and mental Illness
Asylum Seekers
Fundamental principles
Health care services
Mental health services

Multicultural issues and mental Illness

What is culture?

The term culture includes knowledge, beliefs, history, art, morals, laws, customs, and language belonging to a particular group of people. Culture is acquired or learned by individual members of particular societies. It can determine how a person perceives and interprets the world, and how they interact within it.

Why is culture important in relation to mental health?

Australia is a multicultural society. Of the 1.3 million people living in NSW, 23% were born overseas and 16 per cent were born in a non-English speaking country. There are over 100 languages spoken in NSW and one in six people aged 5 years and over speak a language other than English at home. The Mental Health Act specifies that the "religious, cultural and language needs" of mental health clients be taken into account throughout the different stages of their care, control and treatment, and that they be informed of their legal rights and entitlements in "the language or terms that they are most likely to understand".

Different cultures have different definitions of health care practice, mental health, mental illness and any associated symptoms. As a result, what is considered a mental illness in one culture may not be considered a mental illness in another. Consequently, diagnoses can differ from culture to culture.

Research shows that people from backgrounds other than the dominant culture are less likely to use available mental health services. This indicates that current services are not adequately reaching all members of the Australian community. A  number of recent studies show that NESB consumers  have higher rates of involuntary admission; police involvement, ECT and Community Treatment Orders.  These difficulties can be attributed to a number of factors. Firstly, there are many factors associated with migration and the process of settlement which may contribute to an increased risk of developing a mental health problem. These include:

• A decrease in socio-economic status consequent to migration and settlement, such as prolonged unemployment
• Low levels of English language learning and proficiency
• Separation from social, religious and cultural networks, particularly from family and relatives
• Experience of trauma or prolonged stress prior to migration, especially in the case of survivores of war, torture and other forms of extreme human rights and violations
• Long periods of detention

In addition, people from a multicultural background may encounter many barriers to accessing mental health services. These include:

• Cultural practices and concepts, religious beliefs and language greatly influence the level of access to services and benefits from the mental health system
• People from CALD backgrounds often use mental health services at a later stage in their illness and are therefore often hospitalised an involuntary patients
• CALD patients are more likely to seek assistance from bilingual GPs and may rely heavily on faily members and other traditional methods for support and healing
• Some ethnic communities experience high levels of stigma and shame associated with mental illness and are consequently less likely to access services.
• Social isolation

From the perspective of mental health service providers, some services have difficulties in assisting people from a multicultural backgroud because:

• Many mental health service professionals do not have the culturally specific knowledge and skills to identify psychiatric symptoms accurately in people fom diffierent cultural backgrounds
• There is inadequate information available for consumers and carers about the mix of avialable mental health services such as multidisciplinary care, case managements, community support and rehabilitation services

What is available for people from culturally and linguistically diverse backgrounds in mental health care?

• Awareness of culture and mental health is ever increasing within the non-government sector. Some services provide a comprehensive and integrated mental health service that caters to particular cultural and linguistic needs of certain communities. Others provide advocacy, information and referral for various cultural groups around NSW. Increased resources would allow this sector to further increase public awareness regarding multicultural issues, promote understanding about varying cultural differences and develop appropriate services for all.
• The most recent research is a ‘Framework for the implementation of the National mental Health Plan 2003-2008 in Multicultural Australia’, designed to complement and expand on existing mainstream mental health policy. The report can be downloaded from www.mmha.org.au
• There are also the networks/services listed below.
  

Multicultural Disability Advocacy Association (MDAA)

MDAA aims to promote, protect and secure the rights and interests of people from a non-English speaking background with disability and their families and carers in NSW. The overriding objectives of MDAA are:

• Promoting and safeguarding the rights of people from a non-English speaking background with disability and their family/carers
• Improving the quality of life for people from a non-English speaking background with disability and their family/carers
• Increasing participation by people from a non-English speaking background with disability and their family/carers in community activities

MDAA assists people from non-English speaking backgrounds (NESB) with a disability as well as families and carers in NSW through:

• Promoting and safeguarding their rights
• Improving quality of life
• Increasing participation in community activities
• Ensuring that over 90% of NDAA Committee members are from a NESB with a disability.  The staff at MDAA are also from different cultures and may have a disability.
  

MDAA provides a range of advocacy services and projects for people from a non-English speaking background (NESB) with disability, their families/ carers and service providers in NSW. These services include:

• Advocacy Development - offers community information days, training and information sessions for people from a NESB with disability and their families and carers.
• Advocacy in Action Project - an advocacy development project for people from all backgrounds with disability living in rural and remote NSW.
• Community Voices - uses the skills and expertise of people from a NESB with disability and family members trained to educate and raise awareness about the diversity of the community.
• Individual Advocacy - assists people to stand up for their rights, for example, when people have problems with housing, immigration, school, work and disability services.
• Industry Development - assists disability services across NSW to become more culturally competent and assists ethnic community services to understand and respond better to people with disability.
• Systemic Advocacy - works towards positive change in policies, procedures, practices and service delivery in government and non-government agencies.
  Our current Projects
• Community Links - works with the African, Spanish-speaking and Indian Sub-continent communities to enhance knowledge about disability and increase understanding about disability in these communities.
• Refugees and Disability - a research project to explore the issues and needs of refugees and humanitarian entrants with disability. More information available soon.
• People from a NESB with disability and the criminal justice system - a research project to explore the issues and needs of people from a NESB with cognitive disability who come into contact with the criminal justice system. More information available soon.
  

For more information visit http://www.mdaa.org.au/

Transcultural Mental Health Centre (TMHC)

The TMHC Clinical Services unit meets the needs of people of NESB in NSW with mental health problems.  The unit offers a specialist consultative service that complements the quality of care provided by mainstream agencies.  The aim is to assist mental health and related service providers to work more effectively with NESB consumers and to assist people of NESB to access mainstream services more effectively. Phone consultations with health, welfare and other relevant professionals, carers and consumers to speak with clinical staff may include:

• Advice about the impact of culture and language on mental health
• Information on and referral to community services, ethnic community organisations or bilingual health/mental health professionals
• Consultation on cross-cultural issues
• Consultation on service delivery issues with individuals and groups
• Specialist clinical intervention by bilingual sessional workers

The Clinical Brokerage program provides short-term clinical intervention in response to needs of NESB individuals.  The role of bilingual sessional workers is as follows:

• Psycho social or psychological assessments and clarification of diagnosis
• Assessment of cultural issues
• Assess social, political and religious aspects
• Development of general, medication and rehabilitation care plans
• Psychoeducation for family members and relatives
• Group intervention focused on mental health promotion and prevention.

Asylum Seekers

This section of the Manual replicates in part the Immigration Detention Guidelines published by the Human Rights and Equal Opportunities Commission in March 2000[1].

The guidelines written by HREOCdraw on relevant international minimum standards which detail what is required for humane detention consistent with respect for human dignity as required by the International Covenant on Civil and Political Rights and the Convention on the Rights of the Child. The vulnerability of immigration detainees and the fact that they are not held as suspects or convicted offenders argue strongly for the adoption of international minimum standards for juvenile detainees where these are more favourable than those applicable to adults, including adult prisoners. Since immigration detainees are not held as criminal suspects or because they represent a risk to community safety, the most lenient detention regime is appropriate. The primary concern of immigration detention authorities should be one of care for the well-being of detainees.

The Commission regularly inspects immigration detention centres and evaluates the conditions and treatment of detainees. The adoption and publication of detailed minimum standards will enhance the consistency and transparency of evaluations, as they will be a fuller statement of the views of what human rights law requires. Publication of these Guidelines does not reflect a change in the Commission’s understanding that Australia’s policy of mandatory detention for unauthorised arrivals contravenes international law. Rather, recognising that mandatory detention is current government policy, the conditions of detention must meet international minimum standards.

Fundamental principles

Immigration detention is not a prison or correctional sentence. Immigration detainees are detained pursuant to the Commonwealth Migration Act 1958 and not pursuant to arrest or charge for any criminal offence. Accordingly, the treatment of immigration detainees should be as favourable as possible and in no way less favourable than that of untried or convicted prisoners.

Australia’s immigration detention practice must conform to international law protecting human rights and defining the status of refugees. The relevant international law is set out in the Convention (1951) and Protocol (1967) Relating to the Status of Refugees, the International Covenant on Civil and Political Rights (1966), the International Covenant on Economic, Social and Cultural Rights (1966), the International Convention on the Elimination of All Forms of Racial Discrimination (1969), the Convention on the Elimination of All Forms of Discrimination Against Women (1979), the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (1987) and the Convention on the Rights of the Child (1989).

Nothing in the present document shall be construed as restricting or derogating from rights contained in any of these international instruments. Persuasive interpretations of these laws are authoritatively set out in non-binding international instruments including, in particular:

• the Declaration on the Rights of Disabled Persons (1975)
• the Standard Minimum Rules for the Treatment of Prisoners (1955)
• the Declaration on the Elimination of All Forms of Intolerance and of Discrimination Based on Religion or Belief (1981)
• the Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment (1988)
• the United Nations Rules for the Protection of Juveniles Deprived of their Liberty (1990) and
• the various guidelines issue by the United Nations High Commissioner for Refugees (UNHCR), including the 1999 Revised Guidelines on Applicable Criteria and Standards relating to the Detention of Asylum Seekers.

Each immigration detainee shall be treated in a humane manner and with respect for the inherent dignity of the human person. Each immigration detainee aged under 18 years shall, in addition, be treated in a manner which takes into account the needs of a person of his or her age.

In the design and delivery of services, facilities, activities and programs, immigration detention authorities should seek: to minimise differences between life in detention and life at liberty and to meet the individual needs of each detainee taking into account his or her history and experiences, age, gender and cultural, religious and linguistic identity.

Immigration detention authorities shall avoid practising discrimination among immigration detainees on any ground such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.

Immigration detainees have the right to be heard in judicial and administrative proceedings affecting them.

Health care services

Each immigration detainee is entitled to medical treatment and care provided in a manner which is culturally appropriate and which respects the inherent dignity of the human person and to a standard which is commensurate with that provided in the general community. Medical and treatment communications should utilise an interpreter unless the detainee freely affirms that he or she is confident and comfortable discussing these matters in English.

The medical personnel of or attached to each immigration detention centre shall comply with applicable standards of ethics for medical practitioners and with applicable international standards.

The health care needs of each new immigration detainee should be assessed by qualified medical personnel as soon as possible after admission. The medical assessment should seek to identify any physical or mental condition requiring medical attention, including the effects of torture and trauma.

Where, upon admission, an immigration detainee is found to suffer from an infectious disease, he or she may be treated to minimise the possibility of contamination before being allowed to enter the normal routine of the detention centre.

Immigration detainees isolated for health reasons enjoy all the rights and privileges accorded to other detainees to the extent that the health of others is not jeopardised. A qualified medical officer should visit regularly to assess the impact of isolation on the detainee’s physical and mental health.

Every instance of isolation for health reasons should be notified to DIMA with supporting medical certification.

Each immigration detainee should be informed in a language he or she can understand of the health issues which may affect him or her and the health care services available to him or her in immigration detention.

Each immigration detainee should be provided, free of charge, with preventive and remedial medical treatment and care including dental, ophthalmological and mental health care and treatment whenever necessary and access to drug and alcohol abuse prevention and rehabilitation programs.

Each immigration detainee should be entitled to obtain a second medical examination or opinion.

The health care needs of each immigration detainee should be regularly monitored. In particular, the medical officer should report to the detention authorities whenever he or she considers that a detainee’s physical or mental health has been or will be injuriously affected by continued detention or by any condition of detention.

Immigration detainees who require specialist treatment should ordinarily be referred or transferred to a general community hospital or specialised institution. A designated relative, community member or appropriate non-government agency should be informed of every transfer.

Mental health services

The mental health treatment and care provided to each immigration detainee should be based on an individually prescribed plan and in accordance with applicable standards of ethics for mental health practitioners and applicable international standards, including those contained in the United Nations Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care.

The mental health treatment and care of immigration detainees should be overseen by mental health professionals. Any determination that an immigration detainee has a mental illness should be made in accordance with internationally accepted medical standards.

Immigration detainees who are found to be severely mentally ill should be transferred to an appropriate facility as soon as possible. A designated relative, community member or appropriate non-government agency should be informed of the transfer.

Survivors of torture and trauma shall have access without delay to assessment and treatment by a qualified professional with expertise in the assessment and treatment of torture and trauma. Where an appropriately qualified professional is not on the staff of the centre, referral should be made to an external specialist agency.

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