Overview

Edited by:

Graham Martin OAM, MD, FRANZCP, DPM
Professor and Director, Child and Adolescent Psychiatry, The University of Queensland

Nicholas G. Proctor
Associate Professor, School of Nurisng and Midwifery, University of South Australia;
Associate Professor, School of Health Sciences, RMIT University.

Meg Griffiths
National Program Manager, Multicultural Mental Health Australia, Parramatta

Leslie Swartz
Psychology, Stellenbosch University, South Africa

After a damning Senate Report into Australia's mental health system, there is finally a sense across Australia that something is actually happening to help make a difference to people with a mental illness and their carers. The $1.9 billion allocated by the Federal Government for a new National Action Plan on Mental Health (Council of Australian Governments: COAG, 2006) over the next 5 years is a welcome commitment. The funding will lift mental health's share of the total health expenditure in Australia from 7% to 8%, but is still well short of the 12% called for by the Mental Health Council of Australia. But will the needs of people from diverse cultural and linguistic backgrounds be better met through this action plan?

Earlier this year the Commonwealth Ombudsman released a report into the circumstances of the immigration detention of an Australian citizen with a mental illness. Originally from Vietnam, the report reveals how 'Mr T' who suffers from schizophrenia was detained by officers of the Department of Immigration and Multicultural Affairs (DIMA) as a suspected unlawful non-citizen on three occasions between 1999 and 2003. On one of those occasions he was detained in Villawood Detention Centre for a period of eight months. Immigration officials, police and mental health professional shortcomings led to a monumental failure of duty of care for Mr T who, due to his mental illness, his homelessness and lack of an effective personal social support structure, his poor English language skills and his ethnic background, could not possibly advocate for himself.

The mistakes of the Australian immigration detention system don't come as a surprise. It is a system unregulated by public scrutiny and where mental health care has been heavily criticised by people who fundamentally know what they are talking about. The detention environment is injurious to mental health and the people who are inside it will express their injury in ways that are in keeping with their culture. We don't often hear about the nature and scope of mental injury unless there is something that makes the story newsworthy.

In June this year the National Health and Medical Research Council endorsed Cultural Competency in Health: A Guide for Policy, Partnerships and Participation (NHMRC, 2006). The report argues that to effectively promote positive mental health and social environments to a diverse nation, a national approach is required. This should target all levels of government and promote better services through the creation of networks.

This Special Issue of research reports and case studies explores conceptualisations of mental illness, the stressors, stigma, and pathways to seeking help in a multi-cultural context. While it is impossible for any one of us to grasp the nuances of all cultures, this Issue provides a thorough exploration of mental health and treatment issues across a wide variety of ethnic groups, making it a remarkably rich and insightful read. It examines more specific obstacles than prior research - language barriers, a lack of knowledge about service availability, and the incongruence between the multicultural experience and that of mainstream culture. There is clearly much work to be done at multiple levels. This rich overview of current transcultural thinking and activity seeks to inform that work.

This very instructive Special Issue ends on an optimistic note - that while there are still challenges in the operationalisation of how mental health services ensure they are responsive in both policy and practice for 'migrants, refugees and Asians', progress is being made.

The content of this issue will certainly build on that progress and is thus essential reading for those involved with advancing mental health promotion, prevention of mental illness, and early intervention approaches to mental health within a multicultural environment.

Table of Contents

Editorial: On disadvantage
Graham Martin 

Guest Editorial: 'They first killed his heart (then) he took his own life': Reaching out, connecting and responding as key enablers for mental health service provision to multicultural Australia
Nicholas G Procter 

Guest Editorial: Moving multicultural mental health into the mainstream: Building capacity and facilitating partnerships
Meg Griffiths 

Guest Editorial: Useful conflicts: Dispatches from the culture wars
Leslie Swartz 

A culturally sensitive consultation model
Jill Benson 

Weddings and parties: Cultural healing in one community of Somali women
Pauline Guerin, Fatuma Hussein Elmi, Bernard Guerin 

Unipolar depression across cultures: A Delphi analysis of the methodological and conceptual issues confronting the cross-cultural study of depression
Melinda Redmond, Rosanna Rooney, Brian Bishop 

What CALD consumers say about mental illness prevention
Rita Prasad-Ildes, Elvia Ramirez 

Issues faced by carers of people with a mental illness from culturally and linguistically diverse backgrounds: Carers' and practitioners' perceptions
Rosanna Rooney, Bernadette Wright, Krissa O'Neil 

Serve, subvert or emancipate?: Promoting mental health in immigration detention
Pauline J McLoughlin 

Sailing in a new direction: Multicultural mental health in New Zealand
Ruth DeSouza