The Multicultural Mental Health
Project Worker, Patrycja Toczek
Australian Polish Community Services
[email protected]
Aims of the presentation
 To provide information about the
Multicultural Mental Health Project (MMHP)
 To provide an overview of the issues faced by
ethnic communities in particular the
communities selected for the purpose of the
project (Arabic speaking, Cambodian,
Chinese, Macedonian and Polish)
 To facilitate discussion about issues faced by
Culturally and Linguistically Diverse (CALD)
communities in context of mental health
Multicultural Mental Health Project
 The project was funded by the William Buckland
Foundation and Coles Group Community Fund to
promote mental health awareness amongst five ethnic
communities in Victoria:
Polish – Australian Polish Community Services
Arabic – Victorian Arabic Social Services
Cambodian – Cambodian Community Welfare Centre
Chinese – Chinese Health Foundation
Macedonian – Macedonian Community Welfare
Multicultural Mental Health Project Aims
 Research
 Community development
 Resource development
 Capacity building
Mental Health and CALD communities
ABS data (2005) indicates that the number of
people of non English speaking backgrounds
(NESC) diagnosed with mental and behavioral
problems is proportional to those born in
Australia (ABS 2005); however people of CALD
background are often characterized by higher
levels of psychosocial distress (ABS 2005); a
language barrier is often reported to cause
emotional and psychological distress in critical
situations (Sozomenou et al, 2000)
Mental Health and CALD communities:
service utilisation
As noted in the “Access to mental health services in Victoria”
(Stolk et al, 2008):
NESC compromise 20% of the Victorian population whereas
NESC mental health service users compromises 13% of
community clients and 15% of inpatients
A higher percentage of NESC clients than Australian-born
community clients were admitted to acute inpatient units with
a higher percentage of severe mental disorders (e.g.
psychosis, schizophrenia) which resulted in longer admissions
Treated prevalence for the majority of ethnic communities was
significantly lower than for Australian-born population
Issues faced by CALD communities
As noted in VicHealth report (2007) there is evidence from a
number of Australian studies, which suggests that the
culturally and linguistically diverse communities of low-socio
economic backgrounds remain disadvantaged:
in everyday contexts (Dunn, Forrst et al 2004: in VicHealth,
their access to housing (Allbrook 2001; Moriarty, Babacan &
Hollinsworth 2006; DHS 2000: in VicHealth 2007),
health-care (Grove & Zwi 2006 in: Vichealth 2007),
employment (Colic – Peisker & Tilbury 2005 in: Vichealth
2007) and
education (Dunn, Forrset et al 2005 in: Vichealth 2007).
CALD communities are also at a higher risk of developing a
range of health problems (Paradies 2006; Williams et al 2003
in: Vichealth 2007)
Multicultural Mental Health
Project - Methodology
 Stage 1: Needs assessment /Consultations
 Stage 2: Working group preparation to
community sessions
 Stage 3: Partnership Building
 Stage 4: Community education sessions
 Stage 5: Evaluation
Profile of the ethnic communities:
Arabic speaking community
 Arabic speaking community as the most varied community
in Victoria made up of 41,000 people of different ethnic
backgrounds including: Lebanon, Egypt, Iraq, Syria and
some newly emerging African communities (e.g.
Sudanese) of different religious denominations
(predominantly Christian and Muslim)
 Young profile
 MMHP focused on women and young people identified as
most vulnerable populations in the community with high
prevalence of depression, anxiety and post traumatic
stress disorder (PTSD)
Arabic speaking community:
Perception of mental illness
 Mental health as a damaging illness
“Mental health is like cancer, people do not easily discuss the
diagnosis. They fear the stigmatization not only to themselves but to
the other members of their family”
 Mental health as a weakness seen in negative terms and
evidenced through the stigma significantly impacting
upon the whole family
“Some young people won’t even take their medication as needed
because they are afraid of what their peers will think about them. They
don’t want to be labeled as ‘crazy’”.
Arabic speaking community:
Perception of mental illness
Mental health not viewed as a serious problem unless
manifested with physical symptoms
‘Mental health is not really taken seriously in the community. Unless it
is affecting them physically they won’t seek help. Depression is not
seen as a mental health issue, people think that it has no affect on the
person physically therefore it must not be that bad’
Stigmatization of the mental health illness and mental health
“Everyone seems to know each others’ business in the community,
people seem to be more sensitive towards mental health and find it
difficult to even use certain terminology such as the word counseling;
people get defensive”
Profile of the ethnic communities:
Cambodian community in Victoria
 Community of refugees arrived in Australia subsequent to
the Pol Pot regime
 Collective traumatic war time experience resulted in high
prevalence of PTSD in the Cambodian community
 Traditional family composition with children and family
members caring for the elderly
 Disability regarded as shameful and a strong cultural
stigma is attached to mental illness in particular
Cambodian community:
Perception of mental illness
Limited Understanding about mental illness and the concept of
“Not normal thinking or working of the brain in the person.”
“It is a problem of many thoughts in your head. These many thoughts
in your head will cause the lack of sleep, being upset, really sad.”
Mental illness often viewed as a taboo associated with bad spirits, bad
karma, witchcraft or upsetting ancestors
“Cambodians see that problems of the brain like this have to do with
the spirit of the ancestors being upset with someone in the family. The
ancestor makes the person upset. That’s why it comes to your family.”
Mental illness denied and feared due to its attribution to severe
emotional disturbance and possession by malicious spirits
“Many Cambodians believe that the spirit of the land or water has
taken over the person because the spirit is upset.”
“It is a bad Karma of the person who has got this illness.”
Cambodian community:
Perception of mental illness
Attitudes towards mental illness different comparing to other
illnesses such as heart disease, diabetes, asthma etc
“If they go to see the doctor about their illnesses such as heart
disease, diabetes, asthma etc., the doctor will prescribe them the
medications to take and so on. They then follow the doctor’s orders
and their illnesses will be improve and be in control. However, if they
go to see the doctor about their mental illness, the doctor will
prescribe them the medication to take to help them to sleep all the
time. These tablets make the person worse because they don’t do
things at all anymore. This is worse.”
Ambivalent feelings towards sufferers of mental illness and
their families
“You feel ashamed to let anyone know your family has this problem.
Because you worry not only for that person who has the problem,
but it can mean it is not easy for the other siblings or relatives to get
married as well. People would think that if you marry to that person
or that person’s siblings or relatives it is in their breed. So stay away
from that breed.”
Profile of the ethnic communities:
Chinese community
 Large and diversified community
 Impact of traditional Chinese Medicine on the way mental
health is viewed as balance within the body
 The Chinese-born community regards disability as
shameful, and a strong cultural stigma is attached to
mental illness
 Disability is viewed as a punishment for wrongdoing by the
person or the family in a previous life; the families
affected may believe that they are paying a debt that is
 Services sought if issues are regarded as “acute” or “very
Chinese speaking community:
Perception of mental illness
 The link between mental health condition and
 The mentally ill are differentiated in the community
 Lack of knowledge, understanding and awareness
towards mental health issues
Profile of the ethnic communities:
Macedonian community in Victoria
 Macedonian community as ageing community
 Traditional views on the family values and responsibility for
looking after elders
 Seeking services seen as shameful and as a failure to fulfil
ones duty to the family
 Mental illness and disability stigmatised and not openly
discussed within the community
Macedonian community:
Perception of mental illness
 Mental health viewed as a burden and something that
brings shame to the family; individuals are often to
blame for having a mental illness
 Fear of being judged by others in the community which
often leads to denial about the illness
 Stigma attached to the topic of mental health
exacerbated by a lack of education, limited knowledge
and access to information and services
 Varied understanding of the condition in different age
groups and a lack of understanding about mental health
preventative measures
Mental Health and CALD communities
Polish community
Polish community an ageing community with two major waves of
migration occurring after the 2WW (60, 000) and during the Solidarity
Movement in 1980’s (20, 000)
Depression, isolation and schizophrenia are identified as major issues
impinging on the mental and emotional wellbeing of the Polish
Elements of PTSD amongst the ageing – especially those with dementiarelated conditions
Strong stigma attached to mental health exacerbated by fear of what
others will think
Strength, independence and ability to work out one’s own problem
viewed as important values
Family, religion and social networks viewed as strong protective factors
Polish community:
Perception of mental illness
Varied understanding of the mental illness
“People suffering from schizophrenia are sometimes quiet and isolated from
the people. The person thinks that he/she is not liked by the others and is
shutting down from the outside world. Slowly one can turn into a violent
psychotic person e.g. rapist. However, sometimes a person suffering from
mental illness can be very intelligent and has strong preference towards
living in one’s own world”.
Depression described as illness of “dullness and isolation” not viewed
as mental illness and of high prevalence in the community
Mental health as a disability viewed as a weakness
“People seeing a person suffering from a mental illness made
him/her look more retarded than he/she really was”.
Mental Health and CALD communities
Polish community
 Social isolation exacerbating the mental health condition
in the community
Impact of war on individual experiences and life chances
“The 2WW survivors believed that their life would be much
happier and better should they not have gone through the
experience of war. The unfulfilled youth dreams made them
disillusioned about their future choices: “A person remains
silent and angry; constantly seeks someone that would
provide one with answers, provide some support”.
Contributing factors: carers’ stress, alcohol, death of a close
I suffered from an anxiety attack. It was terrible and I felt like dying. It happened
all of sudden one night. I felt something was strangling me and I thought I was
not going to survive. I developed a feeling of panic and fear, which continued for
a while. Despite the fact that I was involved in the life of my community and
have many friends I felt that I had nobody to share these feelings with. I felt
lonely and isolated. My life was worthless and meaningless.
At the end these depressive thoughts turned into experiences of breathlessness
and I started experiencing breathing difficulties, which turned into high blood
pressure. I ended up in a hospital. It was explained to me there that there was a
link between the panic attacks and the high blood pressure, which provided me
with a greater understanding of what was really happening in my life.
On discharge from the hospital, I was not referred to any mental health
specialist. It took me a while to find a mental health professional, who spoke my
language. Although I have been living in Australia for over 20 years my English
knowledge is limited and I feel much more at ease communicating in my native
tongue. It made the task of finding mental health professionals more difficult as
there are not many of them around.
I was lucky; a friend of mine helped me to find a psychologist who spoke my
language and who she had utilized in the past. The psychologist provided bulk
billing services and agreed to see me for six sessions. Despite the long distance
to travel, which meant long hours using public transport, the sessions brought
great improvement to my general wellbeing.
Mental Health and CALD communities:
common themes:
 Limited understanding of the concept of mental health
 Mental health viewed as a weakness
 Attitudes towards mental illness different compared to
other illnesses such as heart disease, diabetes, asthma
 Negative feelings of shame and embarrassment
experienced by people suffering from mental health
conditions and their carers
 Stigmatization of the mental health illness and mental
health professionals
Popular CALD attitudes towards mental
 Reluctance to identify mental health issues for what they
are often results in denial
 Reluctance to seek assistance
 Exacerbated isolation
 Carers failing to seek support and assistance
 Lack of awareness about available service system
Barriers to services
 Stigma attached to the topic of mental health or differing
explanatory model of mental illness
 Lack of education, limited knowledge and access to
information and services
 Lack of understanding of the mental health system
 Language barrier
 Lack of culturally and linguistically suitable services and
Sources of support
Individual resources
Family members/relatives
Religious representatives/prayer
Social groups
Active way of living
Ethno-specific services
Perception of mental health
services & mental health
“These mental health services do not understand how to treat us
Cambodians. Like they not understand our traditional beliefs.”
“I know one family, the wife of my nephew. She was not well mentally.
She received treatment from mental services here but not help her. So
they took her to Cambodia to see if they can find traditional
Cambodian healer. She is still there and it helps her.”
“We know someone ill like this and when they get to hospital and see
doctors they got better but never the same as before. Like it changed
the person, they look not well, not talk to you fully. They are 50% not
100% any more. Hard for the family.”
“As noted by a Polish speaking counselor participating in one of the
sessions, there is a strong belief in the Polish community that
psychologists manipulate people’s brain and leave them changed for
life to the degree when they are not able to make their own
independent decisions. As a result, people leave counseling sessions
transformed into almost involuntarily patients. Psychologists are
therefore not viewed as practitioners promoting wellbeing but rather as
charlatans, of which people should be aware”.
Multicultural Mental Health
Project -Discussion
- raised community awareness about available services with a focus on
health promotion and early intervention utilizing formats appropriate to
- development of culturally and linguistically appropriate interventions
in collaboration with mainstream service providers
- enhanced the model of positive health and primary interventions by
addressing those at increased risk incl. survivors of trauma and torture,
young people, carers
Potential outcomes:
- increased access to the service system prior to crisis intervention
- increased usage of funded counselling services to diminish the risk of
conditions worsening
- increased support and understanding within communities, thus
reducing isolation and stresses related to mental health issues
- increased prevention of the onset of serious mental health issues
through increased awareness of risk factors and preventative measures
Multicultural Mental Health Project
- Limitations
 Lack of accurate epidemiological data reflecting the
prevalence of mental health conditions in CALD
 Limited time and resources
 Lack of ongoing funding
 Limited evaluation of the project due to a number of
factors, including: participants’ reluctance to provide
written feedback as a result of stigma, limited level of
education and issues of confidentiality
Multicultural Mental Health
Project – Recommendations
 More focus on prevention and early intervention in
culturally and linguistically appropriate format
 Provision of ongoing long-term funding to ethnic
 More collaborative approach to mental health promotion
between main stream and ethno-specific sector
 More targeted approach by government and funding
bodies in responding to mental illness
 More epidemiological studies of ethnic communities
Thank You
Contact details:
 Australian Polish Community Services
77 Droop St, Footscray 3011
Tel (03) 9689 9170
Fax (03) 9687 7446
 Cambodian Community Welfare Centre Inc.
16-20 Silver Grove, Nanawading, Vic 3131
Ph/Fax: (03) 9877 9732
Email: [email protected]
 Chinese Health Foundation of Australia
Suite 12, 27 Bank Street, Town Hall Hub, Box Hill
Town Hall, Box Hill, 3128.
Te: (03) 9285 4812
Fax: (03) 9285 4813
Email: [email protected]
 Macedonian Community Welfare (MCWA)
Shop 19 Princess St., St. Albans
Ph: 9310 75566
 Victorian Arabic Social Services (VASS)
178 Dallas Drive, Broadmeadows
Ph: 9309 0055
Email:[email protected]
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Why is Mental Health an issue in our community today