Indigenous Spiritual Wellbeing Toolbox

Different beliefs

People from different cultures may have very different world views, belief systems and values regarding certain forms of behaviour and social relationships. The way different cultures view and explain 'mental illness' may be similar or very different to that of the dominant culture in which they live.

For example, traditional Aboriginal culture sees the wellbeing of an individual as intimately associated with the wellbeing of the community. Both involve harmony in social and spiritual relationships and the fundamental relationship with the land.

In some cultures mental illness may be seen as a spiritual rather than a medical or psychological one. Also, the symptoms of a particular mental illness, and the specific ways in which an individual may experience it, can vary markedly from one culture to another.

Barriers to accessing services

People from culturally and linguistically diverse (CALD) backgrounds might be reluctant to use mental health services in their community because of:

• cultural differences in approaches to mental health care
• mental illness being stigmatised in their culture
• fear of government services based on experience in country of origin
• fear that mental health services staff won't understand their cultural/religious beliefs and practices
• lack of knowledge of the law in relation to mental illness
• fear of hospitalisation and removal from their families/communities.

People from CALD backgrounds may want to access mental health services, but have difficulty doing so because of:

• language barriers which can hinder access to information and services
• lack of knowledge on the structure and how to access the range mental health services in Australia
• lack of knowledge of their rights and responsibilities
• conflict between the culture, attitudes, values and beliefs of the service and those of the CALD background person
• staff of mainstream services not understanding the specific needs of CALD background consumers and their carers
• overt and covert racism
• direct and indirect discrimination
• lack of culturally appropriate services
• lack of bilingual staff/interpreters.

Cultural sensitivity and awareness

To deliver effective mental health services it is important to gain knowledge of the culture, beliefs and values of people from CALD backgrounds such as undertaking cultural awareness training. Consult with:

• community leaders
• workers from CALD backgrounds
• consumers for service feedback.

Gender is a major issue in cross cultural health care. In some cultures, a woman is always seen by a female professional and a man by a male professional. People from some cultures may not accept a female psychiatrist or mental health worker as being appropriate to work with male consumers.

Develop awareness of your own beliefs, practices, expectations and cultural practices and how these may impact on the way you work with people from CALD backgrounds. For example, mental health services in Australia are mainly based on the biomedical model; other cultures may have very different beliefs about the causes and treatment of mental illness.

Mental health services are based on the predominant culture as well as the predominant medical model. Both of these factors influence practice and interactions with consumers. It is important that members of particular CALD groups are not seen as all being the same (ie not stereotyped). Within such groups, people vary as to:

• educational and literacy levels
• rural/urban background
• employment status
• English language proficiency.

Do not assume all people from a region are the same. For example, the 'Middle East' covers a wide range of racial, cultural and religious backgrounds.

Be aware that people from particular countries are more likely to have experienced war, political persecution and torture. This may profoundly affect their ability to trust others, particularly people in positions of authority. Some situations in the workplace, for example waiting in a small treatment room with no windows and door shut, may trigger a traumatic response.

In some cultures, the members of a family see themselves as a single client group rather than a collection of individuals with whom a mental health worker must interact. This may mean that the family unit needs to be involved in discussions and treatment (however, it is not advisable to use family members as interpreters). Even the term ‘family’ may mean different things in different cultures.

The same body language may express different messages in different cultures.

Strategies

To provide effective mental health services for people from a culturally and linguistically diverse (CALD) background, there are a number of things that can be done to make it easier for them. These include:

• employing a someone who can speak their language
• having policy and procedures in different languages
• staff showing cultural awareness and sensitivity
• treating others with dignity and respect
• showing patience when someone has trouble expressing what they feel
• discouraging racist remarks or behaviours in the workplace
• consulting with, and informing consumers about treatment options and procedures.