Partnerships & Community Consultation Model

7/29/2019 Partnerships & Community Consultation Model

1/22

1

Paper title: The Prince Charles Hospital Multicultural Working Group as the

Community Consultation Model

Authors: Bozica Stumfol, Sharon Stocker and Anne Gooley

Bozica Stumfol: Multicultural Mental Health Coordinator & TPCH MWG Chair

Metro North Mental Health Services TPCH

Aspley Community Health Centre, 776 Zillmere Road

ASPLEY Q 4034

[email protected]

[email protected]

Sharon Stocker: The Chair of TPCH Consumer Advisory Group

[email protected]

Anne Gooley: Project Manager, Resettlement,

ARMS Refugee & Migrant Services Spiritus

[email protected]

Abstract

The aim of this paper is to describe the Prince Charles Hospital Multicultural

Working Group (TPCH MWG) at Metro North Mental Health Services, as an

example of good practice in consulting and forming partnerships with the culturally

and linguistically diverse (CALD) communities and various government and non-

government organisations that work with CALD communities.

The benefits of the community consultation model formed through the work of TPCH

MWG is described in the context of facilitation of culturally responsive mental health

care to consumers, their carers and families from CALD backgrounds as per

objectives identified by this group. A special consideration is given to successful

cooperation with TPCH Consumer Advisory Group in the provision of various health

promotion activities across the district and Spiritus Anglican Refugee and Migrant

Services in the provision of health literacy, information and education sessions toKaren speaking communities in TPCH catchment area.

Examples of TPCH MWG activities are linked into contemporary multicultural

mental health literature and policy documents including Queensland Health Strategic

Plan for Multicultural Health 2007-2012, Queensland Plan for Mental Health 2007-

2017, The Fourth National Mental Health Plan An agenda for collaborative

government action in mental health 2009-2014 and National Standards for Mental

Health Services.

Key words:

mental health, consultation, health promotion, health literacy, diverse communities


2/22

2

An overview of TPCH MWG

The TPCH MWG was established in April 2008 through the position of TPCH

Multicultural Mental Health Coordinator (MMHC) as part of a state-wide

multicultural mental health program recurrently funded and coordinated by the

Queensland Transcultural Mental Health Centre (QTMHC). The role of the MMHC isto facilitate the development of a culturally responsive Mental Health Service (MHS);

liaise and provide clinical consultation to clinicians on issues relating to culturally

appropriate service provision; provide information and resources; and collaborate

with other key service staff in the development and implementation of plans, policies

and procedures relating to the service provision to culturally and linguistically diverse

(CALD) consumers and to network with various local multicultural groups and

organisations.

From December 2007 until March 2008, the MMHC identified relevant government

and non-government agencies in TPCH geographical area that work with people from

CALD backgrounds to form TPCH MWG. Community members have beennominated through the main interagency networks. The first two meetings were

attended by both government and non-government agencies, external to our MHS.

Mental health staff joined this group in August 2008, at the point of the third MWG

meeting. Current membership comprises of 28 members (18 external and 10 internal

members). External members are the representatives of the various community

organisations including neighbourhood centres, migrant and resource centres, housing

agency, settlement service and TPCH Consumer Advisory Group (CAG).

Government agencies include the representatives from Centrelink, Queensland Police

Service and Department of Immigration and Citizenship (DIAC). Internal members

are case workers, nurse unit managers, team leaders and service directors.

TPCH MWG meetings are bi-monthly, chaired by the MMHC. Review of the meeting

attendance shows that between 7 to 21 members attend the meetings with an average

number of 13 participants per meeting.

Partnerships and community consultation model

The importance of linkages with the government and non-government/community

organisations has been recently highlighted in the Fourth National Mental Health

Plan. An agenda for collaborative government action in mental health 2009-2014

(Australian Health Ministers, 2009) and in a number of other policy documents

includingNational Standards for Mental Health Services (NSMHS) (Commonwealthof Australia, 1996), Queensland Plan for Mental Health 2007-2017 (Queensland

Government, 2008a) and Queensland Health Strategic Plan for Multicultural Health

2007 - 2012 (Queensland Government, 2007) as working in partnership with

multicultural and community sector.

TPCH MWG facilitates the development of partnerships in three layers of

consultations: government - non-government, government government and non-

government - non-government. All three layers of consultations are equally important

in order to maintain and progress appropriate referral, liaison and engagement

strategies for CALD consumers as per Standard 8.3 of the NSMHS. Perhaps more

attention is given to non-government and community sector as having a key role in


3/22

3

providing non-clinical personal care and other flexible supports to people living with

mental illness, families and carers (Queensland Government, 2008a, p.23).

TPCH MWG community consultation model also contributes to building capacity of

community organisations to assist and support people with mental illness to live full

and meaningful lives in the community and access stable housing, income support,education and employment and sport/recreational activities as suggested by Carling

(1995), Townsend et al. (2004), Whiteford (1994a) and Whiteford (1994b).

Purpose and objectives of TPCH MWG

The general purpose of TPCH MWG is to facilitate culturally responsive mental

health care to consumers and their families from CALD backgrounds and to support

the development of the MMHCs role. For this reason, TPCH MWG has committed to

a number of objectives as outlined in TPCH MWG Terms of Reference (2010).

Objectives and examples of collaborative activities are listed in Table 1.

Table 1: Objectives and examples of TPCH MWG activities

Objective 1. Identify priorities related to CALD issues and implement strategies to

address these issues.

Actions:

- Group members regularly share the information on needs and issues expressed bymigrants and refugees settling in the area. The MMHC forwards this information to the

service executives, QTMHC and Refugee Health Reference Committee for a further

collaborative action.

- Housing difficulties experienced by CALD population are often discussed as an agendaitem. This information is fed back to relevant stakeholders responsible for housing

issues.

- Referral pathways to community agencies for follow up and support for CALDpopulation are clarified and updates are provided regularly.

- Changes to Family Tax Benefit and other Centrelink information are made known to themembers of this network.

Objective 2. Act as advocate for CALD consumers their carers and families.

Actions:

- Provision of logistic support to multicultural community organisations including theletters of support to MWG partners when putting in for funding application for CALD

programs.

- Consumer/carer consultant and CAG members attend the meetings and provide updateson the issues impacting on CALD consumers, seeking input and support from othermembers. CALD members of the CAG are included and share the information and

concerns in the community.

- New mental health teams such as Transitional Discharge Team and Consumer SupportProgram are introduced to members.

- The Mental Health Inventory is translated in 14 languages and is easily accessible onTPCH Intranet Site to ensure that clinical outcomes are appropriately recorded for CALD

consumers as suggested by Thornicroft et al. (2006, p.13).

- Privacy and confidentiality is maintained at all times as per Standard 5 of the NSMHS.Objective 3. Share the information and provide opportunities for education and training

across the government and non-government sector in TPCH catchment area.

Actions:- Bi-yearly review of TPCH MWG meetings recorded twelve meetings including 14


4/22

4

presentations, information sharing, consultations and discussions on various multicultural

mental health topics. The topics include presentations on multicultural data collection,

history of multicultural mental health in Queensland, utilisation of MHS by CALD

population, the type and effectiveness of support provided by settlement services in the

area, reports from the various seminars and conferences, cultural information on Italian

seniors, introduction of new programs such as respite program for CALD carers and

ongoing identification of training needs.

- TPCH MWG organised a special multicultural training for its members to include thetopics on: Diverse needs of CALD population in the district as perceived by the

representatives of community/neighbourhood centres; cultural factors in mental health

(presentation from the QTMHC) and presentation from TPCH Acute Care Team to

explain pathways to mental health services.

- Regular distribution of the information on multicultural mental health resources andupcoming training from the QTMHC.

Objective 4. Assist in development, application and review of policies and procedures

aimed to build cultural competency of the MHS workforce.

Actions:

- Annual review of the use of professional interpreters in the district.- Ongoing promotion of the on-line interpreter booking system. Since the introduction of

the on-line booking system in Qld Health, the interpreters bookings have increased.

- Group members have knowledge of the social and cultural groups in the area andparticipate in the review ofReferral Guide for Culturally Appropriate Assessment and

Treatment(Queensland Government, 2008b) as per Standard 7 of the NSMHS.

- Consultation for the Queensland Plan for Multicultural Mental Health.- Ongoing consultation on Cultural Competency Standards and Self-Assessment Guide

(Queensland Government, 2009).

- The MMHC ensures that policies and procedures relating to CALD consumers areapplied across the MHS.

Objective 5. Generate ideas, initiatives and resources relating to CALD consumers theircarers and families.

Actions:

- Regular updates for the Multicultural Clinical Support Resource Folder across the teams.- Dissemination of translated mental health information and other resources.- Provision of translated information relating to Mental Health Act 2000 (Queensland

Government, 2010) and patients rights and responsibilities.

- Promotion of the Queensland Multicultural Resource Directory (Multicultural AffairsQueensland, 2010) which contains details and contact numbers of diverse ethnic

communities in Queensland.

Objective 6. Assist the service in responding to Australian Council on Healthcare

Standards relating to CALD consumers their carers and families.

Actions:- Identification of available community organisations and their assistance in supporting

consumers with cultural needs.

- Application and review of policies relating to CALD consumers.- Promotion of cultural diversity, social inclusion and mental health.- TPCH Acute Care Team is made known to multicultural communities.- Demographic, linguistic, cultural and epidemiological information on CALD consumers

is collected and reviewed annually.

- TPCH Interpreter Service Coordinator is a member of the MWG and provides updates onissues relating to the use of interpreters as per Standard 7 of the NSMHS.

- Group members provide updates on new languages and interpreters required in thegeographical area.

- Multicultural mental health training is available to all staff as per Cultural CompetencyStandards and Self-Assessment Guide (Queensland Government, 2009).


5/22

5

Objective 7. Engage with multicultural communities to reach possible consumer groups,

promote mental health and well-being and facilitate equitable access for CALD

population.

Actions:

- Community engagement list containing details and contact numbers of the MWGpartners and diverse multicultural community groups in TPCH catchment area is madeavailable to all staff.

- Delivery of a mental health literacy workshop to conversational English group at thenearby library.

- Regular participation in the collaborative Mental Health Week activities organised acrossthe district. The MMHC spoke about the multicultural perspective on mental illness and

recovery at the various interagency forums. In-service on the same topic is planned in

October this year (Queensland Government, 2005).

- These activities are aiming for increased and equitable access to MHS as per Standard11.1.5 of the NSMHS.

Strategic partnership with TPCH CAG

A number of collaborative mental health promotion activities were conducted in

cooperation with TPCHCAG. The role of TPCH CAG is to support and nurture the

people living with the conditions of a mental illness and their associated people and

carers within the Metro North MHS (TPCH) area so as to empower them to

effectively participate in the planning, implementation and evaluation of the MHS and

to sustain outcomes using strategies to demonstrate the functions of the CAG (TPCH

CAG Terms of Reference, 2010). The operational philosophy of TPCH CAG is to

promote a clear communication and articulation of needs and expression of people

with mental illness and expand their community involvement. Key functions of TPCHCAG are to advocate, lobby, educate, reduce stigma and raise community awareness

in relation to mental illness (TPCH CAG Terms of Reference, 2010). These activities

aim to improve the recovery process and subsequently the quality of care and life for

all consumers and carers across the MHS (The Senate, 2008).

Partnership between TPCH MWG and TPCH CAG resulted in forming another

successful collaboration with the Zillmere Community Centre as the most suitable

venue for majority of our mental health promotion activities including Harmony Day

celebrations, Zillmere Multicultural Festival and Mental Health Week activities over

the past 2 years. Apart from networking with a number of community organisations,

these joint health promotion activities help in reducing stigma about mental illness inCALD communities by connecting with people, sharing stories and experiences,

promoting trust and friendship and disseminating mental health information on the

rights of consumers in a number of languages as per Standard 6 of the Cultural

Competency Standards and Self-Assessment Guide (Queensland Government, 2009).

Strategic partnership with the SpiritusAnglican Refugee and Migrant Services

Overview of services provided by Spiritus ARMS for north side of Brisbane

The DIAC funded the 2009/10 Settlement Grants Program (SGP) Project for the north

side of Brisbane to Spiritus Anglican Refugee and Migrant Services(Spiritus ARMS).


6/22

6

The aim of the SGP is to fund services that help clients to become self-reliant and

participate equitably in Australian society as soon as possible after arrival.

Spiritus ARMS has designed the program to improve access to mainstream servicesfor humanitarian entrants through orientation to Australian services such as group

information sessions (Learning Circles). Community development is facilitated by

activities such as driver education, sewing classes and the establishment of a

community garden. All activities are designed to develop life skills and overcome

social isolation for refugees so that they may have a better life in the future.

One of the Refugee Community groups who has participated enthusiastically in the

program has been the Karen community. And for the purposes of this paper and

examples of partnering with TPCH MWG, the Karen community needs and their

progress into Brisbane life is addressed.

History of the Karen people

Karen is a group of ethnic people who make up approximately 7 percent of the total

Burmese population of approximately 50 million people (Radnofsky, 2008). Karen

life, both in their own mythology and historical reality, is pervaded with persecution.

For years, the Karen have been victims of a vicious and sustained campaign at the

hands of successive regimes in Burma to destroy their ways of life and hopes of

democracy and self-determination. Since the 1970s various governments have

attempted to isolate the movement and its supporters by bombing their villages,

cutting them off from food, information and financial support and forcing them fromtheir homes. There is no end in sight to the suffering of the Karen people inside

Burma (McDonald, 2006. Refugees prepare for new life in Australia. ABC News -

AM Transcript).

The Armys brutality has forced thousands of Karen to flee their villages. Most of

them have trekked up mountains and through thick jungles to come to the refugee

camps on the northern Thailand border. Many Karen have been killed or raped, while

others have been imprisoned without trials. Many of the Karen people who have

settled in Australia have lost a parent, sibling or other relative (McDonald, 2006.

Refugees prepare for new life in Australia. ABC News - AM Transcript).

Settlement in Brisbane

Karen people are recent arrivals to Brisbane but already, more than 300 families have

resettled in Brisbane as of 1 January 2009 (MDA Community Profiles, 2009).

Like most refugees, the Karen are trying to gradually deal with the effects of their

experiences in Burma. Reportedly, they may experience trouble with sleeping,

nightmares, worries and depression. They long for the land and culture they left

behind. Years spent in refugee camps or isolated in border villages have also lead to

some health problems.


7/22

7

A sense of anxiety, lack of self- esteem and the ability to make even small decisions

to manage their lives has been recognised when discussions and feedback have taken

place in the group information learning circles for the Karen participants. As a result

of this feedback, the Spiritus Project Manager invited the MMHC from TPCH to

provide (1) general information on how to access help from Metro North Mental

Health Services which was delivered in 2007 and (2) to run a workshop on relaxationtechniques in 2010. Throughout the project an emphasis has been placed on health

and well-being, eating well, being active and learning to cope with stress.

The relaxation workshop on How to relax and not worry included the participants

drawing pictures of what makes them happy and what makes them worried and they

discussed how they felt in both cases. This workshop was conducted in Karen

language by having the Karen interpreter. Participants knowing each other very well

shared their feelings openly. Their reports are presented in Table 2 below.

Table 2: Worries and happy feelings as reported by participants

Worries about: Happy feelings:

- Not having a house and having to movequite often

- The language barrier not being able toexpress themselves

- Finding the right place/reception/lift/flooretc at the hospital. We know the

address but cannot find the right floor or

rooms. We are scared to press the

button for the lift.

- Their children getting ill and notknowing what to do.

- Children walking to school especially onbusy roads.

- Heavy traffic and their children crossingthe road.

- Centrelink payments being late and notbeing able to pay the rent or buy food.

- Listening to music- Dancing Sometimes I dance by myself- Friendships Friendship has helped my

marriage

- Childrens birthdays and their friendscome over to play.

- Watching flowers in the garden- Trees and green grass

A discussion followed where it was explained what is a normal worry and what is an

irrational worry with the acknowledgement of their currently experiences as quite

normal and expected experiences in the new country. Another workshop will be held

on problem solving skills.

Education is a big issue for both parent and Karen children and almost all of them

want more education so group sessions on how to gain new skills are warmly

embraced. Many seek computers and tuition to develop their skills for themselves and

their children. Whether it is attending classes on how to use industrial sewing

machines to gain work skills, driving instructions classes, community garden classes,

group information sessions or events to break down social isolation, the Karen people

want to learn as they prepare for their new life in Australia.


8/22

8

Concluding comments

Table 3: TPCH MWG members feedback

External/community members: Mental health staff:

-I like the e-mails that provide variousinformation on multicultural mental health.I usually forward these to my network.

-Contacts with other government and non-government organizations are very useful.

-Value the information on refugees andspecific information on Rohingya and

Burmese communities.

-The meetings are organized very well.-Discussions are nicely controlled by the

chairperson.

-Seeking participation from more NGOs.-Current meeting time does not suite me.Morning time would be better.

-Value our cooperation.-I enjoyed the meeting it is the only

meeting I have come away from feeling

totally at home in.

-I found the MWG meetings veryinformative and a very good source of

developing networks and providing a

platform of learning and referral pathways

to better support CALD clients.

-You are the first person who broughtcommunity to TPCH.

- ACT like to hear about new resources,particularly relating to accommodation,new NGOs, multicultural specific services,

GPs and bulk billing services.

- This is a really good group. Theinformation provided is up to date. You

are doing a good job by being proactive

and easily accessible. The meetings are

interesting and very useful. Like the

information about the new multicultural

groups in the area. At the meetings,

everyone has the opportunity to talk which

is a really good practice.- Case presenting identifying linkages.-Example of partnership models.-Lessons learned.

- I have found the group very useful when Ihave been able to attend. I find the emails

from the chairperson that includes multi-

cultural resources very helpful and I

attempt to include this new knowledge and

information in my education sessions.

- The timing of the group is not alwaysconvenient as I do not always have the

staff able to cover up for me if I attend the

mtg. Perhaps the venue closer to the

hospital will work out better; however, it is

all good, we really needed the position

such as yours.

- Regular review of membership list andmembers to ensure list is up to date.

Both, external and internal members like the meetings as well as group e-mails

providing the information and resources on various multicultural mental health issues

and new multicultural groups and services in the area. Both groups value networkingin between government and non-government sector. They see the meetings as a good

platform to learn and establish pathways for referral and advice when considering

mental health needs of people from CALD backgrounds (Australian Health Ministers,

2009).

Both groups identified some incompatibilities regarding the meeting times and

venues. External members prefer the venues located in the community while internal

members would rather attend the meetings somewhere closer to the hospital. No

doubts that the lack of parking availability at the hospital grounds plays a major role

in those differences. While experiencing parking difficulties, the community members

readily acknowledged the importance of reducing the stigma relating to mental illness


9/22

9

by coming to the meetings at the Mental Health Unit of TPCH. Further, internal

members greatly value community input and everyone having the opportunity to talk.

Facilitation of such diverse group of participants and balancing community vs.

mental health staff input has been one of the major challenges experienced by the

MMHC as TPCH MWG chairperson. At the same time, this challenge was the most

popular reason for participants to come to the meetings and share their ideas andexperiences while celebrating diversity.

TPCH MWG community consultation model has achieved a lot in the past 2 years as

evidenced by a number of collaborative activities described in this paper. However,

there is more to be done to develop strategic partnerships with the government and

community organisations to build individual and community resilience and well-being

(Standard 6 of the NSMHS) and to provide the continuity of care for chronic patients

with mental illness so that consumers can move between services as their needs

change (Commonwealth of Australia, 2006, p.213).

Acknowledgements

To all TPCH MWG members for their active participation, enthusiasm and

commitment.

A special acknowledgement to Keryn Fenton, the Operations Director of Metro North

MHS - TPCH for her membership, expert advice, impressive leadership and ongoing

support provided to TPCH MWG members and the MMHC.


10/22

10

References

Australian Health Ministers. (2009). Fourth National Mental Health Plan. An Agenda

for collaborative government action in mental health 2009-2014 (Draft). Fourth

National Mental Health Plan Working Group. Australian Government. Canberra.

Carling, P. (1995). Return to Community Building Support Systems for People with

Psychiatric Disabilities. New York: The Guildford Press. Chapter 2 Foundations for a

New Approach.

Commonwealth of Australia. (1996). National Standards for Mental Health Services

(NSMHS). Canberra: Australian Government.

Commonwealth of Australia. (2006). A national approach to mental health from

crisis to community; First Report. The Senate Printing Unit, Parliament House.

Canberra.

McDonald, P. (Reporter). (2006, July 8). Refugees prepare for new life in Australia.

ABC News - AM Transcript.

Multicultural Affairs Queensland. (2010). Queensland Multicultural Resource

Directory 2009. Multicultural Affairs Queensland. Brisbane.

Multicultural Development Association (MDA). (2009). Community Profiles.

Presentation given at MDA conference on 23 May 2009. Brisbane.

Queensland Government. (2005). Sharing Responsibility for Recovery: creating and

sustaining recovery oriented systems of care for mental health. Queensland

Government. Brisbane.

Queensland Government. (2007). Queensland Health Strategic Plan for Multicultural

Health 2007- 2012. Queensland Government. Brisbane.

Queensland Government. (2008a). Queensland Plan for Mental Health 2007-2017.

Queensland Government. Brisbane.

Queensland Government. (2008b). Referral Guide for Culturally Appropriate

Assessment and Treatment. Queensland Government. Brisbane. (Available from theQTMHC, Macgregor, Queensland).

Queensland Government. (2009). Cultural Competency Standards and Self-

Assessment Guide. A guide to assist mental health services to implement the Cultural

Competency Standards. Queensland Government. Brisbane.

Queensland Government. (2010).Mental Health Act 2000. Queensland Government.

Brisbane.

Radnofsky, L. (2008). Burmese rebel leaders shot dead. The Guardian. Retrieved (8

March 2008), from: http//www.guardian.co.uk/world2008/feb/14burma


11/22

11

The Prince Charles Hospital Consumer Advisory Group (TPCH CAG). (2010). TPCH

CAG Terms of Reference (Version 2.10), Metro North Mental Health Service

TPCH, Brisbane. (Available from TPCH, Chermside, Queensland).

The Prince Charles Hospital Multicultural Working Group (TPCH MWG). (2010).

TPCH MWG Terms of Reference (Draft), Metro North Mental Health Service TPCH, Brisbane. (Available from TPCH, Chermside, Queensland).

The Senate Community Affairs Committee Secretariat. (2008). Towards recovery:

mental health services in Australia. The Senate Printing Unit. Parliament House.

Canberra.

Thornicroft, G., Becker, T., Knapp, M., Knudsen, H.C., Schene, A., Tansella, M. &

Vasquez-Barquero, J.L. (2006). International Outcome Measures in Mental Health;

Quality of life, needs, service satisfaction, costs and impact on carers. London:

Gaskell.

Townsend, C., Whiteford, H., Baingana, F., Gulbinat, W., Jenkins, R., Baba, A., Mak,

F. L., Manderscheid, R., Mayeya, J., Minoletti, A., Mubbashar, M. H., Khandelwal,

S., Schilder, K., Tomov, T. & Deva, M. P. (2004). The Mental Health Policy

Template: domains and elements for mental health policy formulation. International

Review of Psychiatry, 16(1-2), 18-23.

Whiteford, H.A. (1994a). The first National Mental Health Report. The Medical

Journal of Australia, 161(4), 438-440.

Whiteford, H. (1994b). Intersectoral policy reform is critical to the National Mental

Health Strategy. Australian Journal of Public Health, 18(3), 342-344.


12/22

1

Paper title: The Prince Charles Hospital Multicultural Working Group as the

Community Consultation Model

Authors: Bozica Stumfol, Sharon Stocker and Anne Gooley

Bozica Stumfol: Multicultural Mental Health Coordinator & TPCH MWG Chair

Metro North Mental Health Services TPCH

Aspley Community Health Centre, 776 Zillmere Road

ASPLEY Q 4034

[email protected]

[email protected]

Sharon Stocker: The Chair of TPCH Consumer Advisory Group

[email protected]

Anne Gooley: Project Manager, Resettlement,

ARMS Refugee & Migrant Services Spiritus

[email protected]

Abstract

The aim of this paper is to describe the Prince Charles Hospital Multicultural

Working Group (TPCH MWG) at Metro North Mental Health Services, as an

example of good practice in consulting and forming partnerships with the culturally

and linguistically diverse (CALD) communities and various government and non-

government organisations that work with CALD communities.

The benefits of the community consultation model formed through the work of TPCH

MWG is described in the context of facilitation of culturally responsive mental health

care to consumers, their carers and families from CALD backgrounds as per

objectives identified by this group. A special consideration is given to successful

cooperation with TPCH Consumer Advisory Group in the provision of various health

promotion activities across the district and Spiritus Anglican Refugee and Migrant

Services in the provision of health literacy, information and education sessions toKaren speaking communities in TPCH catchment area.

Examples of TPCH MWG activities are linked into contemporary multicultural

mental health literature and policy documents including Queensland Health Strategic

Plan for Multicultural Health 2007-2012, Queensland Plan for Mental Health 2007-

2017, The Fourth National Mental Health Plan An agenda for collaborative

government action in mental health 2009-2014 and National Standards for Mental

Health Services.

Key words:

mental health, consultation, health promotion, health literacy, diverse communities


13/22

2

An overview of TPCH MWG

The TPCH MWG was established in April 2008 through the position of TPCH

Multicultural Mental Health Coordinator (MMHC) as part of a state-wide

multicultural mental health program recurrently funded and coordinated by the

Queensland Transcultural Mental Health Centre (QTMHC). The role of the MMHC isto facilitate the development of a culturally responsive Mental Health Service (MHS);

liaise and provide clinical consultation to clinicians on issues relating to culturally

appropriate service provision; provide information and resources; and collaborate

with other key service staff in the development and implementation of plans, policies

and procedures relating to the service provision to culturally and linguistically diverse

(CALD) consumers and to network with various local multicultural groups and

organisations.

From December 2007 until March 2008, the MMHC identified relevant government

and non-government agencies in TPCH geographical area that work with people from

CALD backgrounds to form TPCH MWG. Community members have beennominated through the main interagency networks. The first two meetings were

attended by both government and non-government agencies, external to our MHS.

Mental health staff joined this group in August 2008, at the point of the third MWG

meeting. Current membership comprises of 28 members (18 external and 10 internal

members). External members are the representatives of the various community

organisations including neighbourhood centres, migrant and resource centres, housing

agency, settlement service and TPCH Consumer Advisory Group (CAG).

Government agencies include the representatives from Centrelink, Queensland Police

Service and Department of Immigration and Citizenship (DIAC). Internal members

are case workers, nurse unit managers, team leaders and service directors.

TPCH MWG meetings are bi-monthly, chaired by the MMHC. Review of the meeting

attendance shows that between 7 to 21 members attend the meetings with an average

number of 13 participants per meeting.

Partnerships and community consultation model

The importance of linkages with the government and non-government/community

organisations has been recently highlighted in the Fourth National Mental Health

Plan. An agenda for collaborative government action in mental health 2009-2014

(Australian Health Ministers, 2009) and in a number of other policy documents

includingNational Standards for Mental Health Services (NSMHS) (Commonwealthof Australia, 1996), Queensland Plan for Mental Health 2007-2017 (Queensland

Government, 2008a) and Queensland Health Strategic Plan for Multicultural Health

2007 - 2012 (Queensland Government, 2007) as working in partnership with

multicultural and community sector.

TPCH MWG facilitates the development of partnerships in three layers of

consultations: government - non-government, government government and non-

government - non-government. All three layers of consultations are equally important

in order to maintain and progress appropriate referral, liaison and engagement

strategies for CALD consumers as per Standard 8.3 of the NSMHS. Perhaps more

attention is given to non-government and community sector as having a key role in


14/22

3

providing non-clinical personal care and other flexible supports to people living with

mental illness, families and carers (Queensland Government, 2008a, p.23).

TPCH MWG community consultation model also contributes to building capacity of

community organisations to assist and support people with mental illness to live full

and meaningful lives in the community and access stable housing, income support,education and employment and sport/recreational activities as suggested by Carling

(1995), Townsend et al. (2004), Whiteford (1994a) and Whiteford (1994b).

Purpose and objectives of TPCH MWG

The general purpose of TPCH MWG is to facilitate culturally responsive mental

health care to consumers and their families from CALD backgrounds and to support

the development of the MMHCs role. For this reason, TPCH MWG has committed to

a number of objectives as outlined in TPCH MWG Terms of Reference (2010).

Objectives and examples of collaborative activities are listed in Table 1.

Table 1: Objectives and examples of TPCH MWG activities

Objective 1. Identify priorities related to CALD issues and implement strategies to

address these issues.

Actions:

- Group members regularly share the information on needs and issues expressed bymigrants and refugees settling in the area. The MMHC forwards this information to the

service executives, QTMHC and Refugee Health Reference Committee for a further

collaborative action.

- Housing difficulties experienced by CALD population are often discussed as an agendaitem. This information is fed back to relevant stakeholders responsible for housing

issues.

- Referral pathways to community agencies for follow up and support for CALDpopulation are clarified and updates are provided regularly.

- Changes to Family Tax Benefit and other Centrelink information are made known to themembers of this network.

Objective 2. Act as advocate for CALD consumers their carers and families.

Actions:

- Provision of logistic support to multicultural community organisations including theletters of support to MWG partners when putting in for funding application for CALD

programs.

- Consumer/carer consultant and CAG members attend the meetings and provide updateson the issues impacting on CALD consumers, seeking input and support from othermembers. CALD members of the CAG are included and share the information and

concerns in the community.

- New mental health teams such as Transitional Discharge Team and Consumer SupportProgram are introduced to members.

- The Mental Health Inventory is translated in 14 languages and is easily accessible onTPCH Intranet Site to ensure that clinical outcomes are appropriately recorded for CALD

consumers as suggested by Thornicroft et al. (2006, p.13).

- Privacy and confidentiality is maintained at all times as per Standard 5 of the NSMHS.Objective 3. Share the information and provide opportunities for education and training

across the government and non-government sector in TPCH catchment area.

Actions:- Bi-yearly review of TPCH MWG meetings recorded twelve meetings including 14


15/22

4

presentations, information sharing, consultations and discussions on various multicultural

mental health topics. The topics include presentations on multicultural data collection,

history of multicultural mental health in Queensland, utilisation of MHS by CALD

population, the type and effectiveness of support provided by settlement services in the

area, reports from the various seminars and conferences, cultural information on Italian

seniors, introduction of new programs such as respite program for CALD carers and

ongoing identification of training needs.

- TPCH MWG organised a special multicultural training for its members to include thetopics on: Diverse needs of CALD population in the district as perceived by the

representatives of community/neighbourhood centres; cultural factors in mental health

(presentation from the QTMHC) and presentation from TPCH Acute Care Team to

explain pathways to mental health services.

- Regular distribution of the information on multicultural mental health resources andupcoming training from the QTMHC.

Objective 4. Assist in development, application and review of policies and procedures

aimed to build cultural competency of the MHS workforce.

Actions:

- Annual review of the use of professional interpreters in the district.- Ongoing promotion of the on-line interpreter booking system. Since the introduction of

the on-line booking system in Qld Health, the interpreters bookings have increased.

- Group members have knowledge of the social and cultural groups in the area andparticipate in the review ofReferral Guide for Culturally Appropriate Assessment and

Treatment(Queensland Government, 2008b) as per Standard 7 of the NSMHS.

- Consultation for the Queensland Plan for Multicultural Mental Health.- Ongoing consultation on Cultural Competency Standards and Self-Assessment Guide

(Queensland Government, 2009).

- The MMHC ensures that policies and procedures relating to CALD consumers areapplied across the MHS.

Objective 5. Generate ideas, initiatives and resources relating to CALD consumers theircarers and families.

Actions:

- Regular updates for the Multicultural Clinical Support Resource Folder across the teams.- Dissemination of translated mental health information and other resources.- Provision of translated information relating to Mental Health Act 2000 (Queensland

Government, 2010) and patients rights and responsibilities.

- Promotion of the Queensland Multicultural Resource Directory (Multicultural AffairsQueensland, 2010) which contains details and contact numbers of diverse ethnic

communities in Queensland.

Objective 6. Assist the service in responding to Australian Council on Healthcare

Standards relating to CALD consumers their carers and families.

Actions:- Identification of available community organisations and their assistance in supporting

consumers with cultural needs.

- Application and review of policies relating to CALD consumers.- Promotion of cultural diversity, social inclusion and mental health.- TPCH Acute Care Team is made known to multicultural communities.- Demographic, linguistic, cultural and epidemiological information on CALD consumers

is collected and reviewed annually.

- TPCH Interpreter Service Coordinator is a member of the MWG and provides updates onissues relating to the use of interpreters as per Standard 7 of the NSMHS.

- Group members provide updates on new languages and interpreters required in thegeographical area.

- Multicultural mental health training is available to all staff as per Cultural CompetencyStandards and Self-Assessment Guide (Queensland Government, 2009).


16/22

5

Objective 7. Engage with multicultural communities to reach possible consumer groups,

promote mental health and well-being and facilitate equitable access for CALD

population.

Actions:

- Community engagement list containing details and contact numbers of the MWGpartners and diverse multicultural community groups in TPCH catchment area is madeavailable to all staff.

- Delivery of a mental health literacy workshop to conversational English group at thenearby library.

- Regular participation in the collaborative Mental Health Week activities organised acrossthe district. The MMHC spoke about the multicultural perspective on mental illness and

recovery at the various interagency forums. In-service on the same topic is planned in

October this year (Queensland Government, 2005).

- These activities are aiming for increased and equitable access to MHS as per Standard11.1.5 of the NSMHS.

Strategic partnership with TPCH CAG

A number of collaborative mental health promotion activities were conducted in

cooperation with TPCHCAG. The role of TPCH CAG is to support and nurture the

people living with the conditions of a mental illness and their associated people and

carers within the Metro North MHS (TPCH) area so as to empower them to

effectively participate in the planning, implementation and evaluation of the MHS and

to sustain outcomes using strategies to demonstrate the functions of the CAG (TPCH

CAG Terms of Reference, 2010). The operational philosophy of TPCH CAG is to

promote a clear communication and articulation of needs and expression of people

with mental illness and expand their community involvement. Key functions of TPCHCAG are to advocate, lobby, educate, reduce stigma and raise community awareness

in relation to mental illness (TPCH CAG Terms of Reference, 2010). These activities

aim to improve the recovery process and subsequently the quality of care and life for

all consumers and carers across the MHS (The Senate, 2008).

Partnership between TPCH MWG and TPCH CAG resulted in forming another

successful collaboration with the Zillmere Community Centre as the most suitable

venue for majority of our mental health promotion activities including Harmony Day

celebrations, Zillmere Multicultural Festival and Mental Health Week activities over

the past 2 years. Apart from networking with a number of community organisations,

these joint health promotion activities help in reducing stigma about mental illness inCALD communities by connecting with people, sharing stories and experiences,

promoting trust and friendship and disseminating mental health information on the

rights of consumers in a number of languages as per Standard 6 of the Cultural

Competency Standards and Self-Assessment Guide (Queensland Government, 2009).

Strategic partnership with the SpiritusAnglican Refugee and Migrant Services

Overview of services provided by Spiritus ARMS for north side of Brisbane

The DIAC funded the 2009/10 Settlement Grants Program (SGP) Project for the north

side of Brisbane to Spiritus Anglican Refugee and Migrant Services(Spiritus ARMS).


17/22

6

The aim of the SGP is to fund services that help clients to become self-reliant and

participate equitably in Australian society as soon as possible after arrival.

Spiritus ARMS has designed the program to improve access to mainstream servicesfor humanitarian entrants through orientation to Australian services such as group

information sessions (Learning Circles). Community development is facilitated by

activities such as driver education, sewing classes and the establishment of a

community garden. All activities are designed to develop life skills and overcome

social isolation for refugees so that they may have a better life in the future.

One of the Refugee Community groups who has participated enthusiastically in the

program has been the Karen community. And for the purposes of this paper and

examples of partnering with TPCH MWG, the Karen community needs and their

progress into Brisbane life is addressed.

History of the Karen people

Karen is a group of ethnic people who make up approximately 7 percent of the total

Burmese population of approximately 50 million people (Radnofsky, 2008). Karen

life, both in their own mythology and historical reality, is pervaded with persecution.

For years, the Karen have been victims of a vicious and sustained campaign at the

hands of successive regimes in Burma to destroy their ways of life and hopes of

democracy and self-determination. Since the 1970s various governments have

attempted to isolate the movement and its supporters by bombing their villages,

cutting them off from food, information and financial support and forcing them fromtheir homes. There is no end in sight to the suffering of the Karen people inside

Burma (McDonald, 2006. Refugees prepare for new life in Australia. ABC News -

AM Transcript).

The Armys brutality has forced thousands of Karen to flee their villages. Most of

them have trekked up mountains and through thick jungles to come to the refugee

camps on the northern Thailand border. Many Karen have been killed or raped, while

others have been imprisoned without trials. Many of the Karen people who have

settled in Australia have lost a parent, sibling or other relative (McDonald, 2006.

Refugees prepare for new life in Australia. ABC News - AM Transcript).

Settlement in Brisbane

Karen people are recent arrivals to Brisbane but already, more than 300 families have

resettled in Brisbane as of 1 January 2009 (MDA Community Profiles, 2009).

Like most refugees, the Karen are trying to gradually deal with the effects of their

experiences in Burma. Reportedly, they may experience trouble with sleeping,

nightmares, worries and depression. They long for the land and culture they left

behind. Years spent in refugee camps or isolated in border villages have also lead to

some health problems.


18/22

7

A sense of anxiety, lack of self- esteem and the ability to make even small decisions

to manage their lives has been recognised when discussions and feedback have taken

place in the group information learning circles for the Karen participants. As a result

of this feedback, the Spiritus Project Manager invited the MMHC from TPCH to

provide (1) general information on how to access help from Metro North Mental

Health Services which was delivered in 2007 and (2) to run a workshop on relaxationtechniques in 2010. Throughout the project an emphasis has been placed on health

and well-being, eating well, being active and learning to cope with stress.

The relaxation workshop on How to relax and not worry included the participants

drawing pictures of what makes them happy and what makes them worried and they

discussed how they felt in both cases. This workshop was conducted in Karen

language by having the Karen interpreter. Participants knowing each other very well

shared their feelings openly. Their reports are presented in Table 2 below.

Table 2: Worries and happy feelings as reported by participants

Worries about: Happy feelings:

- Not having a house and having to movequite often

- The language barrier not being able toexpress themselves

- Finding the right place/reception/lift/flooretc at the hospital. We know the

address but cannot find the right floor or

rooms. We are scared to press the

button for the lift.

- Their children getting ill and notknowing what to do.

- Children walking to school especially onbusy roads.

- Heavy traffic and their children crossingthe road.

- Centrelink payments being late and notbeing able to pay the rent or buy food.

- Listening to music- Dancing Sometimes I dance by myself- Friendships Friendship has helped my

marriage

- Childrens birthdays and their friendscome over to play.

- Watching flowers in the garden- Trees and green grass

A discussion followed where it was explained what is a normal worry and what is an

irrational worry with the acknowledgement of their currently experiences as quite

normal and expected experiences in the new country. Another workshop will be held

on problem solving skills.

Education is a big issue for both parent and Karen children and almost all of them

want more education so group sessions on how to gain new skills are warmly

embraced. Many seek computers and tuition to develop their skills for themselves and

their children. Whether it is attending classes on how to use industrial sewing

machines to gain work skills, driving instructions classes, community garden classes,

group information sessions or events to break down social isolation, the Karen people

want to learn as they prepare for their new life in Australia.


19/22

8

Concluding comments

Table 3: TPCH MWG members feedback

External/community members: Mental health staff:

-I like the e-mails that provide variousinformation on multicultural mental health.I usually forward these to my network.

-Contacts with other government and non-government organizations are very useful.

-Value the information on refugees andspecific information on Rohingya and

Burmese communities.

-The meetings are organized very well.-Discussions are nicely controlled by the

chairperson.

-Seeking participation from more NGOs.-Current meeting time does not suite me.Morning time would be better.

-Value our cooperation.-I enjoyed the meeting it is the only

meeting I have come away from feeling

totally at home in.

-I found the MWG meetings veryinformative and a very good source of

developing networks and providing a

platform of learning and referral pathways

to better support CALD clients.

-You are the first person who broughtcommunity to TPCH.

- ACT like to hear about new resources,particularly relating to accommodation,new NGOs, multicultural specific services,

GPs and bulk billing services.

- This is a really good group. Theinformation provided is up to date. You

are doing a good job by being proactive

and easily accessible. The meetings are

interesting and very useful. Like the

information about the new multicultural

groups in the area. At the meetings,

everyone has the opportunity to talk which

is a really good practice.- Case presenting identifying linkages.-Example of partnership models.-Lessons learned.

- I have found the group very useful when Ihave been able to attend. I find the emails

from the chairperson that includes multi-

cultural resources very helpful and I

attempt to include this new knowledge and

information in my education sessions.

- The timing of the group is not alwaysconvenient as I do not always have the

staff able to cover up for me if I attend the

mtg. Perhaps the venue closer to the

hospital will work out better; however, it is

all good, we really needed the position

such as yours.

- Regular review of membership list andmembers to ensure list is up to date.

Both, external and internal members like the meetings as well as group e-mails

providing the information and resources on various multicultural mental health issues

and new multicultural groups and services in the area. Both groups value networkingin between government and non-government sector. They see the meetings as a good

platform to learn and establish pathways for referral and advice when considering

mental health needs of people from CALD backgrounds (Australian Health Ministers,

2009).

Both groups identified some incompatibilities regarding the meeting times and

venues. External members prefer the venues located in the community while internal

members would rather attend the meetings somewhere closer to the hospital. No

doubts that the lack of parking availability at the hospital grounds plays a major role

in those differences. While experiencing parking difficulties, the community members

readily acknowledged the importance of reducing the stigma relating to mental illness


20/22

9

by coming to the meetings at the Mental Health Unit of TPCH. Further, internal

members greatly value community input and everyone having the opportunity to talk.

Facilitation of such diverse group of participants and balancing community vs.

mental health staff input has been one of the major challenges experienced by the

MMHC as TPCH MWG chairperson. At the same time, this challenge was the most

popular reason for participants to come to the meetings and share their ideas andexperiences while celebrating diversity.

TPCH MWG community consultation model has achieved a lot in the past 2 years as

evidenced by a number of collaborative activities described in this paper. However,

there is more to be done to develop strategic partnerships with the government and

community organisations to build individual and community resilience and well-being

(Standard 6 of the NSMHS) and to provide the continuity of care for chronic patients

with mental illness so that consumers can move between services as their needs

change (Commonwealth of Australia, 2006, p.213).

Acknowledgements

To all TPCH MWG members for their active participation, enthusiasm and

commitment.

A special acknowledgement to Keryn Fenton, the Operations Director of Metro North

MHS - TPCH for her membership, expert advice, impressive leadership and ongoing

support provided to TPCH MWG members and the MMHC.


21/22

10

References

Australian Health Ministers. (2009). Fourth National Mental Health Plan. An Agenda

for collaborative government action in mental health 2009-2014 (Draft). Fourth

National Mental Health Plan Working Group. Australian Government. Canberra.

Carling, P. (1995). Return to Community Building Support Systems for People with

Psychiatric Disabilities. New York: The Guildford Press. Chapter 2 Foundations for a

New Approach.

Commonwealth of Australia. (1996). National Standards for Mental Health Services

(NSMHS). Canberra: Australian Government.

Commonwealth of Australia. (2006). A national approach to mental health from

crisis to community; First Report. The Senate Printing Unit, Parliament House.

Canberra.

McDonald, P. (Reporter). (2006, July 8). Refugees prepare for new life in Australia.

ABC News - AM Transcript.

Multicultural Affairs Queensland. (2010). Queensland Multicultural Resource

Directory 2009. Multicultural Affairs Queensland. Brisbane.

Multicultural Development Association (MDA). (2009). Community Profiles.

Presentation given at MDA conference on 23 May 2009. Brisbane.

Queensland Government. (2005). Sharing Responsibility for Recovery: creating and

sustaining recovery oriented systems of care for mental health. Queensland

Government. Brisbane.

Queensland Government. (2007). Queensland Health Strategic Plan for Multicultural

Health 2007- 2012. Queensland Government. Brisbane.

Queensland Government. (2008a). Queensland Plan for Mental Health 2007-2017.

Queensland Government. Brisbane.

Queensland Government. (2008b). Referral Guide for Culturally Appropriate

Assessment and Treatment. Queensland Government. Brisbane. (Available from theQTMHC, Macgregor, Queensland).

Queensland Government. (2009). Cultural Competency Standards and Self-

Assessment Guide. A guide to assist mental health services to implement the Cultural

Competency Standards. Queensland Government. Brisbane.

Queensland Government. (2010).Mental Health Act 2000. Queensland Government.

Brisbane.

Radnofsky, L. (2008). Burmese rebel leaders shot dead. The Guardian. Retrieved (8

March 2008), from: http//www.guardian.co.uk/world2008/feb/14burma


22/22

The Prince Charles Hospital Consumer Advisory Group (TPCH CAG). (2010). TPCH

CAG Terms of Reference (Version 2.10), Metro North Mental Health Service

TPCH, Brisbane. (Available from TPCH, Chermside, Queensland).

The Prince Charles Hospital Multicultural Working Group (TPCH MWG). (2010).

TPCH MWG Terms of Reference (Draft), Metro North Mental Health Service TPCH, Brisbane. (Available from TPCH, Chermside, Queensland).

The Senate Community Affairs Committee Secretariat. (2008). Towards recovery:

mental health services in Australia. The Senate Printing Unit. Parliament House.

Canberra.

Thornicroft, G., Becker, T., Knapp, M., Knudsen, H.C., Schene, A., Tansella, M. &

Vasquez-Barquero, J.L. (2006). International Outcome Measures in Mental Health;

Quality of life, needs, service satisfaction, costs and impact on carers. London:

Gaskell.

Townsend, C., Whiteford, H., Baingana, F., Gulbinat, W., Jenkins, R., Baba, A., Mak,

F. L., Manderscheid, R., Mayeya, J., Minoletti, A., Mubbashar, M. H., Khandelwal,

S., Schilder, K., Tomov, T. & Deva, M. P. (2004). The Mental Health Policy

Template: domains and elements for mental health policy formulation. International

Review of Psychiatry, 16(1-2), 18-23.

Whiteford, H.A. (1994a). The first National Mental Health Report. The Medical

Journal of Australia, 161(4), 438-440.

Whiteford, H. (1994b). Intersectoral policy reform is critical to the National Mental

Health Strategy. Australian Journal of Public Health, 18(3), 342-344.

Partnerships & Community Consultation Model

Documents

Transcript of Partnerships & Community Consultation Model