SUBMISSION TO THE QUEENSLAND MENTAL HEALTH … · The Child and Youth Mental Health Services (CYMHS) - have invested in clinical development and support programs for young people

SUBMISSION TO THE QUEENSLAND

MENTAL HEALTH COMMISSION

JANUARY 2014

BRISBANE LOCAL AREA COORDINATION NETWORK

Mental Health Issues Paper

Brisbane Local Area Coordination (January 2014) Page 2

Contributors:

Harmony Place

Mercy Community Services

QPASTT

Queensland Accessing

Interpreters Working Group

World Wellness Group



INTRODUCTION Queensland is a rapidly growing multicultural society in which newly arrived migrants and refugees settle successfully enriching our economy and our society. In 2011, 20% of the Queensland population was born overseas and almost 10% of Queenslanders spoke a language other than English at home. The annual intake of humanitarian refugees to Queensland contributes to the increasing diversity of Queensland’s population. In 2012-13, there were over 2,000 humanitarian entrants settled in Queensland with approximately 45% of these entrants settling in the Brisbane and Central Coast geographic settlement area. 52% are young people aged less than 261. This population group is highly diverse in terms of; ethnicity, age, religion, socio-economic status, rural/urban background, education levels and nature and duration of refugee experience. While refugee populations may not present as a homogenous group, there are a number of significant issues that are shared and unique to their situation which impact on mental health and wellbeing in settlement. Refugees are considered a vulnerable group who have experienced pre and post migration stressors that impact on their long term physical and mental health and well-being. It is well recognised that refugees arrive with a comparatively poorer state of wellbeing than other migrants2. However, many of these conditions are treatable and when these health issues are addressed early in the settlement period, people manage the acculturative process better. Timely access to appropriate early intervention for this population group will reduce the frequency of recurrent presentations for acute care and ensure long term health and wellbeing. KEY PRIORITIES FOR ACTION Refugees and asylum seekers are at greater risk of developing mental health problems and suicidal behaviours than the general Australian population3. However a pattern of underutlisation continues to be reported highlighting systemic inadequacies in service systems raising important questions about the need for service reform, community attitudes towards and beliefs about mental illness, barriers to service access, difficulties in diagnosis and racism.4 Towards this, the following priorities for action are identified: 1. Increase access to culturally tailored early intervention programs and support relevant to managing the

impacts of a refugee experience and settlement in a new country. This includes information about how to access the mental health system and education focussed on mental health literacy.

2. Improve access to mainstream services through increased cultural competence among mental health

professionals. 3. Improve integration of services and remove barriers to accessing mental health services.

4. Improve the quality, safety, performance and accountability of the mental health system through

appropriate data collection to inform service planning.

1 Humanitarian Settlement Services: Queensland 2012-13 Summary Statistics. Source: Dept. of Immigration and Border

Protection; Qld Settlement and Multicultural Affairs 2 Lehn A (1997) Recent Immigrant’s Health and Their Utilisation of Medical Service. Results from Longitudinal Survey of

Immigrants to Australia, Department of Immigration and Multicultural Affairs Update March Quarter, 32-38 3 Minas et al (2013) Mental Health Research and Evaluation in Multicultural Australia: Developing a Culture of Inclusion, Mental Health in Multicultural Australia, 28 4 Ibid p16



BACKGROUND

Brisbane Local Area Coordination (LAC) Network

The Brisbane LAC is a network of government and non-government organisations working together to provide a structured mechanism for coordinating settlement service. This includes the timely identification of settlement needs and solutions for humanitarian entrants to the region. (See Attachment 1 for details of the LAC network and representatives). This issues paper has been coordinated by MDA Inc as the Chair of the LAC network with contributions from member organisation. Through this paper, mental health issues experienced by our clients are outlined as well as recommendations for action. This paper also highlights some of the previously funded programs and pilot programs that have been successful with this population. The LAC has mental health services within its network that work with refugees in early settlment. The not-for-profit services include:

QPASTT - a specialist state-wide service that offers counselling and support to refugee survivors of torture and trauma;

Harmony Place - a Brisbane based community mental health service that offers counselling and wellbeing services for multicultural communities; and

World Wellness Group - a mental health and wellbeing clinic comprising GPs and allied health professionals that offers counselling and mental health support.

Increasing demand for these niche services exceeds their capacity to respond and all LAC services rely strongly on the ability to refer to mainstream mental health and hospital services. The Government services services within LAC include:

Queensland Transcultural Mental Health Centre (QTMHC) - plays an integral role as a state-wide clinical consultation service in linking services and providing access to Queensland mental health services for this population. Members of the LAC rely substantially on the capacity of QTMHC to provide bicultural clinical assessments; community education; systems knowledge for clients and staff within our organisations; and referral pathways to acute and ongoing care.

The Child and Youth Mental Health Services (CYMHS) - have invested in clinical development and support programs for young people of refugee backgrounds over many years.

The Multicultural Mental Health Coordinator positions within some Health and Hospital Services - play an important role in facilitating access to acute services as well as referral options at discharge from Hospital.

Through the strong partnerships between QTMHC, CYMHS, QPASTT, Harmony Place and the newly established WWG, expertise and sector resources have been developed.



KEY ISSUES

LAC member services have identified the following key issues in accessing mental health support for newly arrived refugees.

1. Need for early intervention support

Given the evidence of the strong correlation between the social determinants and mental health of people from refugee backgrounds there is a strong case for early intervention programs. However, at present there is a lack of culturally tailored early intervention programs for people from refugee backgrounds. Many of the risk and protective factors for mental illness and suicide occur in the daily lives of individuals and communities and as such are outside the influence of mental health services. For newly arrived refugee community members, the resettlement process calls for significant adjustments including, learning about a new country, language and culture at the same time as managing the impacts of their refugee experience. Many people experience acculturative stress. While this process can impact on mental health, people may be experiencing quite normal reactions to the adversity experienced as a refugee and in settlement.

Individuals who are isolated or disconnected from their community, including women independently raising children, can find it particularly difficult.

It is important that early intervention support addresses the specific contextual issues of new arrivals and allows them to start to rebuild a sense of self and self determination. Targeted support such as this will prevent the escalation of acculturative stress to psychological distress.

New arrivals need opportunities for: social connection; access to mental health literacy programs that bridge cultural understanding; access to psycho-social support through group work; and general counselling services. It is important that this support is affordable and located in local communities to ensure effective access and cultural relevance.

There are a number of successful and evaluated programs that could be appropriately funded to provide this support. These include:

Building Resilience in Transcultural Australians (BRiTA Futures); www.health.qld.gov.au/metrosouthmentalhealth/qtmhc/brita_futures.asp

Wellbeing programs of Harmony Place; www.harmonyplace.org.au/default.asp?contentID=585

Multicultural Youth Peer Mentoring; www.harmonyplace.org.au/default.asp?contentID=587

QPASTT provide a range of services and programs; www.qpastt.org.au/whatwedo_programs.html

HEAL music and art therapy program at Milpera English Langugage School; www.fheal.com.au/page/history-of-FHEAL/default.asp

LAC network services have strong relationships with clients, their families and communities. It’s through settlement work that trust is developed which is an essential part of recovery, particularly for refugees who have been persecuted. Working in partnership with our LAC services will be important to offering effective early intervention support.

http://www.health.qld.gov.au/metrosouthmentalhealth/qtmhc/brita_futures.asp

http://www.harmonyplace.org.au/default.asp?contentID=585

http://www.harmonyplace.org.au/default.asp?contentID=587

http://www.qpastt.org.au/whatwedo_programs.html

http://www.fheal.com.au/page/history-of-FHEAL/default.asp



Needs for Children & Young People of Refugee Background

Children, adolescents and their families from culturally and linguistically diverse backgrounds may be at risk of poor mental health outcomes due to a wide range of factors. These could include: intergenerational conflict; grief and loss; post traumatic stress from experiences prior to resettlement; and experiences of racism and discrimination after resettlement.5 Young people from refugee backgrounds face the challenge of developing a bi-cultural or multicultural identity and having to juggle cultural expectations6. Some may also experience a psychological reaction to trauma not dissimilar to the one found in adults. In addition, young people may be affected by their parent's exposure to pre-migration trauma. These refugee related issues interface with typical challenges facing young people such as; developing a sense of identity, self-esteem, future, relationships, sexuality, and transitions to education and employment. Young people also have difficulty in accessing services, including health services, because a result of their age and parental beliefs. Good Starts is a longitudinal study (2004—2008) that investigated the experiences of settlement among a group of 120 young people with refugee backgrounds settling in Melbourne, Australia. It identified getting a good education as the single most important goal in the early settlement years for refugee young people. Young people reported a positive experience (with the exception of teasing and bullying) while at their initial ESL School. However, transition to a mainstream high school was less positive and feelings of belonging and safety decreased with more experiences of discrimination.7 There is limited understanding in Schools of the impact of trauma on participation and learning for refugee students. Schools are not equipped to manage these issues and are not aware of the services available to support. More needs to be done in Schools to prevent and manage the impacts of racism. Targeted prevention and early intervention programs have been demonstrated to be effective in reducing mental health risk factors. Infant mental health and ‘early years’ services, which focus on parenting and the parent–child relationship have also been found to be significant mediators of positive outcome8. However, many are not aware of the impacts of refugee experience on infants. Service planning and development will need to consider the specific child and youth mental health needs of the young refugee population and resources will be required to support effective service delivery in a culturally sensitive and appropriate context.9

5 Pope, Suzanne; Scanlon, Kym; Raphael, Beverley; Heslep, Jan; Cassaniti, Maria and Spiteri, John (2000).

Multicultural Family Help Kit New South Wales Public Health Bulletin 11(6) 104 - 105 6 Good Practice guide: Youth Work With Young People From Refugee and Migrant Backgrounds (2011). Centre for

Multicultural Youth www.cmy.net.au/ResourcesfortheSector#GPGs 7 Gifford SM, Correa-Velez I and Sampson R. (2009). Good Starts for recently arrived youth with refugee

backgrounds: Promoting wellbeing in the first three years of settlement in Melbourne, Australia. Melbourne: La Trobe Refugee Research Centre. 8 Queensland Mental Health Commission Strategic Planning Issues Papers: Submission by Queensland Children’s

Health Hospital and Health Service CYMHS in collaboration with partners 9 ibid

http://www.cmy.net.au/ResourcesfortheSector#GPGs



Strategies for refugee youth mental health and well-being include flexible approaches such as outreach counselling services, drop-in models and family-centred practices. Schools can play a positive role in settlement as this is the primary context for their settlement experience. Young people can connect with peers and families can be assisted by Schools to address issues such as alcohol use. Teaching staff are a central point of contact between parents, students and services. They foster the conditions known to promote children’s successful adaptation and resilience10. In 2014, the Youth Support Coordinator (YSC) positions located within Schools will be funded to develop local responses for ‘at risk’ students. It will be important that these workers develop a strong understanding of how to support vulnerabilities refugee young people.

2. Need for a culturally competent workforce

2.1 Cross-cultural clinical practice

A culturally competent mental health workforce is a necessary component of a culturally responsive mental health system.

Practitioners in both public and private practices often do not have the time or support from their organisation as well as the expertise to understand and incorporate the cultural context of the refugee experience within their practice. Services often provide a universal approach which is not suitable or effective for a diverse client group. Referring clients to mainstream mental health services where staff are not competent in working with people of culturally diverse backgrounds and who don’t have an understanding of the complexities of the refugee experience can exacerbate issues and lead to clients disengaging with the mental health system. The high rates for diagnosis of psychosis for people from CALD backgrounds, including refugees, has been questioned in the literature as a possible consequence of lack of cultural competence in diagnostic skills.

There are many varied explanations of mental health and illness across individuals, families and cultures. This impacts on peope’s beliefs, perceptions of symptoms and how they seek help. Most people do not communicate the concerns directly and expect the mental health practitioner or GP to ask relevant questions and to investigate the concerns. It is widely accepted that if the GP did not ask, or investigate, then the issue is not important.

Many people from diverse cultural backgrounds fear stigma, shame and potential isolation from their ethnic community because of mental health issues. Professionals need to repond to these needs in order to build rapport and trust.

10

Cited in The Rainbow Program for Children in Refugee Families: A collaborative, school-based program to support refugee children and their families. Produced by: The Victorian Foundation for Survivors of Torture Inc. (2002)



A study by the Victorian Transcultural Psychiatry Unit in 2011, highlighted that services are currently only responding to the needs of a small proportion of migrants and refugees and largely in crisis situations to those with more severe mental illness:

“…due to cultural and linguistic barriers and stigma, ethnic community members may not access mental health services until the dysfunction associated with severe mental illness causes the family or individual to seek intervention. Consequently involuntary admission may be required and overrepresentation of diagnoses of psychoses amongst NESC [Non English Speaking Community] clients. This does not rule out that mental health staff may be lacking in cross-cultural clinical competence, possibly misdiagnosing unfamiliar manifestations of mental disorder, and resorting to involuntary admission when lacking confidence in their assessment of an NESC client.”11

The provision of culturally competent services is essential to ensure refugee clients are engaged, assessed and treated appropriately. This includes assistance to access treatment after Hospital discharge. Effective cross-cultural engagement will ensure concerns are expressed and prevent omissions, undiagnosis or misdiagnosis. In the mental health system, assessment questioning can often be confusing to people as phrases and contextual information are not understood. People will often agree or say yes, even when they mean no or when they don’t understand. Sometimes patients may not be open to the questioning because they find the process frightening due to their understanding of mental health services in their country of origin, or worry about whether their Visa status will be impacted.

Case Example

A settlement service Case Manager, who had accompanied a client to the Emergency Department, was able to inform her client about the assessment process and explain some of the assessment questions. For example, "how has your energy been lately," and other questions that can confuse a client and elicit an incorrect answer. The client later reported to the case manager that explaining some questions beforehand assisted him, otherwise he wouldn't have understood what was being asked of him.

Lack of cross-cultural understanding and appropriate engagement, often results in a perception of lack of responsiveness on both sides and leads to non-compliance. Often the practitioner is perceived as non-interested, uncaring, not understanding while the client is perceived as non-willing, non-compliant and non-engaging. 2.2. Engaging Interpreters An essential component of cultural compentence is access to and a willingness to engage interpreters to provide safe and quality services. Provision of professionally qualified interpreters can have a significant positive impact on refugee patient experiences and mental health and well-being. Often professionals rely upon family members or clients who may not be confident in English, particularly when stressed. Many practitioners within the Queensland Health system are reluctant to engage interpreters and often make assumptions about what the person has communicated. This has resulted in misdiagnosis, prescribing inappropriate medication, difficulties with compliance as well as poor follow up.

11

Cited in Regional Settlement – Health. Background Paper: Migrant Settlement and Mental Health In Far North Queensland (2013). Centacare Migrant Services, Cairns



A significant barrier is the lack of fee-free interpreting services for private mental health professionals. 12 Lack of accredited interpreters or the inappropriate use of interpreters can have serious implications for assessment, treatment and recovery in the mental health system. Engaging interpreters greatly reduces risk of inappropriate or unwanted interventions or Hospital admissions (or repeat presentations at Hospitals). Interpreting support through programs such as ATAPS can be limited and inconsistent as it is up to the respective Medicare Local to provide this. There is no interpreting support available under the Better Access initiative. LAC services regularly advocate for the use of interpreters within Queensland health services.

Case Example An MDA client with psychotic symptoms was brought to the Hospital by the Police. The client’s settlement Case Manager spoke with the Doctor at the Mental Health Unit who was very negative about the client’s behaviour. The situation was more difficult because the client was guarded and did not disclose much information about his symptoms. The Doctor said the client spoke sufficient English and that language was not a difficulty for a full assessment. The Doctor twice assessed the client’s mental health condition without an interpreter. He believed the client would stay longer in that ward because his prognosis was very poor and he was not responding to treatment. He also said the client did not have any insight into his condition. Later, when the Case Manager visited the client at the hospital with a Cultural Support Worker who speaks client’s language, the client was engaging and could articulate some of his needs. Also, the client suffers from a speech impairment, a stutter, which worsens when he gets stressed. The Doctor did not believe these factors impacted on the assessment and he commented that he found the client’s behaviour difficult. It is common for people when stressed to find communication in their 2nd or 3rd or 4th languages difficult. To reduce stress and to ensure effective communication, it is essential that an interpreter is provided in the patients preferred language. It is also important to check with the patient that the interpreter provided is appropriate for them and that they are able to communicate effectively.

2.3 Addressing racism and discrimination Racism and discrimination are concerns for new arrivals accessing support services. Many people report discriminatory behaviour by service providers preventing them from accessing services. Individuals and organisations can instil strong policies and practices to prevent racism and discrimation in the workplace and this should form part of ongoing training for all service staff.

12

Still a Matter of Interpretation (2012). Report developed by QCOSS in consultation with the Qld Accessing Interpreters Working Group (QAIWG). The report provided a snapshot of the state of access to interpreters for culturally & linguistically diverse communities in some services in Queensland. QAIWG comprises organisations concerned with equitable service provision for people from CALD communities in Queensland, including: Queensland Council of Social Services Inc., AMPARO Advocacy Inc., MDA Inc, Ethnic Communities Council of Queensland, Nambour Community Centre Inc, Centacare Cairns, Immigrant Women’s Support Service, and Mater Health Services. Since 2008, the group has been working with government, community services sector and the language services industry towards a more equitable system to access credentialed interpreters in the provision of services and information for people CALD backgrounds who are not proficient in English.



3. Improved integration of services and removal of barriers to accessing mental health services

3.1 Welcome & Trust

MDA consultations and national research show that trust is a key barrier to accesing mental health services for refugees. For people who have been persecuted, often by Government services in their country or orgin, re-building of trust is a critical part of recovery. Negative experiences are often communicated between community members and therefore have negative impacts on the whole community.

Pathways to access mental health services often do not engender welcome and trust. Telephone only referral options; inconsistent and unfriendly staff; lack of interpreters; rigid program eligibility and complex referral processes all impede understanding and confidence in clients to access a safe and reliable service.

There are significant gaps between primary care (GPs), private practitioners, hospital services and community based services. Improved integration through facilitated referral pathways and sharing information and good practice will contribute to the welcome and trust people will experience.

3.2 Lack of Knowledge about Services

In settlement lifeskills, all new arrivals are offered essential health service orientation. However, the mental health system is complex and for most new arrivals it is completely unfamiliar to them. People also have very different experiences and therefore expectations of services.

Many new arrivals are not aware of the access points to the mental health system. Clients experience difficulties at intake, assessment and discharge from Hospital services due to a lack of understanding of instructions and the processes involved. For people in early settlement, services like MDA offer case management support and should be contacted to facilitate support for the client.

Case Example An MDA client in early settlement required a crisis intervention by an MDA case worker. A mental health assessment was required as part of this intervention and referral advice about this client was sought from the Acute Care Team at the Hospital. The case worker was advised that the easiest pathway for a referral would be through an Emergency Department assessment. The client had to stay overnight in the Hospital and the case worker asked to be informed about discharge as the client had no family or support people in Brisbane. The next day, the case worker called the hospital multiple times to find out what had happened and eventually found someone who recalled the client. The case worker was informed that client was released as the Hospital could detect no issues with him. The case worker tried to make contact with the client and was unsuccessful and the client remained disengaged with services.

People often rely on community members or elders to link them with a practitioner who has proven to be accessible, understanding and is perceived as friendly. Some people may have few or no networks of support.

New arrivals will require additional support from mental health providers in terms of:

understanding the nature of the services offered;

how to make appointments;

cost and payment methods;

how to fill scripts and referral processes;



how to take medication and the importance of non-compliance;

where to access medication and other service supports;

how to access the service by public transport.

Psycho-education is very important as many concepts of prevention, self care and relapse prevention may not be familiar and may need to be taught to clients.

Case Example

A client was admitted to the Hospital emergency where he was assessed and discharged with a prescription for medication. This client was not linked with a GP in the community. He presented at Emergency a week later as the medication script was not filled out. He had no knowledge of his condition or understanding of his discharge instructions, including how to get the prescribed medication.

3.3 Barriers to Primary Healthcare

Access to mainstream mental health services is not an easy option for clients. General referral options include Federal Government funded programs such as - Access to Allied Psychological Services (ATAPS) and Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule.

These programs offer access to clinical psychologists and allied mental health workers via a GP mental health plan. For many clients there are barriers to accessing these services – including:

Access to bulk billing GPs who will engage interpreters;

Access to GPs willing to make mental health plans;

Ability to articulate a case for a mental health plan;

Very few allied health practitioners bulk bill under the Better Access initiative as the return is relatively low and there is no access to free interpreting ;

Limited and inconsistent interpreting support available through programs such as ATAPS as it is up to the respective Medicare local to provide this;

Inconsistent ATAPS models can mean inequitable service delivery results for people of refugee backgrounds; and

Ability of health professionals to address cultural and refugee contextual needs.

Other Federal Government community mental health programs include PHAMS and Family Relationship programs can provide services to refugees on Humanitarian visas. The availability and use of all the above services to clients from refugee backgrounds is influenced by clients’ ease of access and the cultural competence demonstrated.

3.4 Cost of Services

Many people will not be able to afford access to private mental health services.

Most new arrivals are reliant upon Centrelink in their first months of arrivals so they can establish themselves. It takes some months to secure accommodation, attend English classes, enrol children in school and find a job. It can be difficult for many families to support themselves in early settlement as they adjust to life in Australia.

The cost of public transport and parking are also significant barriers for new arrivals to access mental heatlh services.



4. Community Engagement

To overcome barriers associated with traditional beliefs, stigma, shame and lack of awareness, it is essential that refugee communities have the opportunity to input to mental health service systems and program planning. Community members need early intervention support, including targeted mental health literacy and system navigation education to improve access and engage positively with mental health services. Through consultation with representatives of newly arrived communities and LAC services that already engage with these representatives, the priorty needs for communities can be determined. A successful example of effective community engagement to facilitate better health and cultural information exchange is the Mater Hospital’s Women & Youth Multicultural Health Leaders program.

Case Example – Refugee Women & Youth Health Leaders Project The Refugee Women & Youth Health Leaders project developed out of research conducted with refugee communities and health services in Brisbane in 2010. The research highlighted that recently arrived people from refugee backgrounds are likely to consult the leaders of their own community about health issues including seeking advice about health services. The project aims to build the health literacy of women and young people from refugee backgrounds by identifying women/young people from refugee backgrounds regarded as leaders to their community (or potential leaders) and who are able to fulfil the requirements of the Health Development Worker (HDW) role. Potential leaders identified, are trained around concepts of health literacy, health systems and advocacy. Trained HDWs help develop and articulate a community Health Action Plan based on a series of meetings within their own communities. Each HDW is engaged for a period of approximately 150 hours spread over a 30 week period. The training period is spread over a 10 week training period and a 12 week community engagement project. All indemnity and HR requirements are managed through employment contracts between MDA and the Health Development Workers. Training and support is provided through the Mater Centre. The Health Development Workers are required to:

1. attend and participate in a consultation, orientation and training program; 2. convene a series of community meetings to map the strengths and needs of their community; 3. in consultation with their community, develop an appropriate Health Action Plan; 4. participate in the evaluation and project report back.

The Health Development Worker position has a key role in building the health literacy of the whole community with a particular focus on women and youth health. It also aims to bring to the fore the voice of communities who are often forgotten or not identified by mainstream providers. This program is funded through short term philanthropic funds and has successfully created a pool of Community Health Development Workers.



5. Improving the quality, safety, performance and accountability of the mental health system through appropriate data collection to inform service planning.

There are indicators that refugees and asylum seekers have low admission rates for treatment of mental disorder and low access to mental health care services.13 There is also very little research on mental health outcomes or factors influencing patterns of service use in refugee and asylum seeker clients including; the influence of carers/family, mental health beliefs and prior experience of mental health services on help seeking and service access pathways.14 Knowledge about prevalence of mental disorders in refugee communities is also limited, with the reported observations of higher prevelance of mental disorders in these communities (than that of the general Australian population) not backed by comprehensive research. What we increasingly know about the mental health of the Australian-born population we do not know about immigrant and refugee communities. This exclusion of immigrant and refugee participants, particularly non-English speaking persons, from national surveys and from individual epidemiological research projects does not allow any confident statement about prevalence of mental disorders in specific immigrant and refugee communities15.

A Mental Health in Multicultural Australia report recently commissioned by the National Mental Health Commission, found a systematic absence of key CALD data variables from virtually all Commonwealth, State and Territory funded data collections and recommends the following minimum data set:

(1) country of birth,

(2) main language spoken at home and

(3) proficiency in spoken English16.

Without the inclusion of the variables of visa type,ethnicity, and year of arrival Queensland mental health services will not be able to distinguish how many clients from refugee backgrounds have accessed their services.

13

Minas, Harry et al (2013). Mental health research and evaluation in multicultural Australia: Developing a culture of inclusion. Mental Health in Multicultural Australia (MHiMA) 14

ibid. 15

ibid 16

ibid



RECOMMENDATIONS

The Local Area Coordination network provides the following specific recommendations to the Queensland Mental Health Commission.

1. Need for early intervention support

Increase funding for culturally tailored early intervention programs targeted to the needs of new arrivals to alleviate stress on mental health services funded by the State

Increase funding of culturally tailored mental health literacy programs to bridge cultural gaps

Strengthen current Schools’ mental health initiatives to respond to the needs of refugee young people

Advocate for the improved integration between primary healthcare and the Health and Hospital Services to ensure refugees have access to timely and culturally competent support

Lead on cross Queensland Health Department initiatives that support holistic wellbeing, ie address mental health with homelessness, needs of young people and parenting support.

2. Need for a culturally competent workforce

Lead on the development of a cultural diversity action plan for mental health across Queensland Government in response to the Government’s Cultural Diversity Policy

Advocate for the inclusion of cross cultural mental health training for all mental health practitioners on the assessment and treatment of consumers from CALD backgrounds, including children and young people, at least once per year as mandatory professional development

Advocate for the inclusion of training for all mental health professionals on working with interpreters as part of mandatory training.

Advocate for the provision of fee free interpreters for private allied mental health practitioners who deliver services under the Better Access Initiative.

Advocate for continued and expanded funding for: Multicultural Mental Health workers and Interpreter Coordinators in Health and Hospital Services

Advocate for the continued funding for the state-wide Queensland Transcultural Mental Health Centre and its Transcultural Clinical Consultation Service , community education programs, capacity building work and mental health workforce training work and clarify its state-wide role.

Lead on workforce development diversity strategies to increase the cultural diversity of the QLD mental health services workforce – including, traineeships for people of CALD backgrounds, recognising prior learning in their country of origin.

3. Improved integration of services and removal barriers to accessing mental health services

Advocate for improved coordination and integration of services between primary care, Hospital and Health Service Mental Health Services and multicultural sectors services to incorporate the following:

Provide essential information and facilitate referral options for patients entering and existing Queensland mental health services

Ensure access to free and affordable mental health services

Provide practical information to mental health services about how to provide a welcoming service environment for refugee consumers

Ensure effective discharge processes from Hospital services where clients are confident to comply with treatments and have access to ongoing community support



Advocate for improved access to GPs for people of refugee background to ensure access to mental health plans and program such as ATAPs and Better Access when specialised Torture and Trauma service is not appropriate

4. Community Engagement

Engage refugee mental health consumers including young people and their families in the planning and delivery of mental health care across Queensland

Identify positions and mechanisms by which people of refugee backgrounds can participate in planning and program implementation

Ensure membership of the Mental Health & Drug Advisory Council is inclusive of current knowledge and experience to represent the issues of people from diverse cultural and linguistic backgrounds, including refugees

Fund initiatives to build leadership and consumer engagement for CALD consumers, including those from a refugee backgrounds via programs such as the Women and Youth Health Leaders project.

5. Improving the quality, safety, performance and accountability of the mental health system through

appropriate data collection for people of refugee and CALD backgrounds.

Work with Cultural Diversity Queensland to ensure inclusion of a cultural diversity mental health action plan for Queensland

Include the roll out in Queensland of the soon to be released new national Framework for Mental Health in Multicultural Australia in the QMHC’s forthcoming Mental Health and Drug Strategic Plan

Promote the minimum data set recommended by the ABS to capture cultural and linguistic diversity to inform mental health services of the demand for services and service needs for people from CALD and refugee backgrounds

Work with HHS Mental Health Services to identify key areas within the mental health system (e.g. Hospital intake/discharge) to evaluate outcomes for refugee community members over a period of time to improve service delivery.



ATTACHMENT 1

Brisbane Local Area Coordination Network The Humanitarian Settlement Service (HSS) is a program of intensive settlement support provided to newly arrived refugee and humanitarian entrants. Settlement Service providers like MDA Inc. deliver this program on behalf of the Department of Social Services and support new arrivals throughout their initial settlement period (6-12 months after arrival). As part of the service delivery, HSS service providers are contracted to hold quarterly network meetings (Local Area Coordination) to improve service coordination and cooperation between key service delivery agencies within the Contract Region. The LAC network meetings provide a structured mechanism for settlement service coordination and are a tool for high level strategic coordination of services. MDA Inc coordinate the LAC network meetings for the Brisbane & Central Coast HSS Contract region. Representatives from key government agencies, mainstream services and other settlement services participate in Brisbane LAC meetings in recognition of the role they can play in achieving sustainable settlement outcomes for newly arrived refugee clients. Organisations and Departments represented on the Brisbane LAC Network include:

Federal Government Departments (Department of Immigration and Border Protection and Department of Social Services - including Centrelink)

State Government Departments and Statutory Authorities (including Cultural Diversity Qld; Qld Police Service; Dept. of Communities; Qld Health; Qld TB Clinic and Refugee Health Clinics -North and South and Qld Transcultural Mental Health Centre)

Educational institutions – Milpera and TAFE/TELLS

Specialist services like Qld Program of Assistance to Survivors of Torture & Trauma (QPASTT) and Harmony Place

Settlement and Community Services and Peak Bodies (Red Cross; Mercy Family Services; St Vincent de Paul Red Cross; Life Without Barriers; ECCQ; QCOSS and Catholic Social Justice Commission)

Documents

SUBMISSION TO THE QUEENSLAND MENTAL HEALTH … · The Child and Youth Mental Health Services (CYMHS) - have invested in clinical development and support programs for young people