0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Brief Report   |    
Initiatives for Improving Mental Health Services to Ethnic Minorities in Australia
Stephen J. Ziguras, M.A., B.S.W.; Malina Stankovska, B.Ec., Gr.Dip. (Com.Dev.); I. Harry Minas, M.B.B.S., D.P.M.
Psychiatric Services 1999; doi:

Several major policy initiatives have been undertaken in Victoria, Australia's second-largest state, to address difficulties in providing accessible and culturally sensitive mental health services to ethnic minorities. These initiatives include the development and publication of a policy statement, alteration of funding formulas to take into account populations of persons with non-English-speaking backgrounds, incentive funding mechanisms, new funding specifically devoted to ethnic mental health, the establishment of service development positions in the major public hospital networks, and the establishment of a pilot project to employ bilingual staff as psychiatric case managers.

Abstract Teaser
Figures in this Article

Difficulties in providing mental health services to ethnic minorities are well documented and include underutilization of services, communication barriers, and cultural differences in the understanding of illness and treatment (1,2,3,4). This article discusses some major policy initiatives undertaken in Victoria, Australia's second-largest state, in an attempt to address these difficulties.

Victoria has a population of 4.4 million people. Of the adult population, 20.8 percent are immigrants from countries where English is not the main language spoken; that is, they have a non-English-speaking background. These immigrants originated from more than 100 countries—from Southern and Western Europe in the immediate post-World-War-II period, and more recently from Asian and other non-European countries, including countries in Southeast Asia, South and Central America, the Horn of Africa, and the Middle East.

In Victoria, public mental health services are provided through public hospitals and nonprofit community agencies. Responsibility for policy development and funding lies with the mental health branch of the Victoria Department of Human Services. Between 1996 and 1998, after a process of consultation and planning involving policy makers, service providers, ethnic organizations, consumers, caregivers, and staff of the Victorian transcultural psychiatry unit, the department introduced several important policy initiatives, which are described below.

In 1996 the mental health branch released a policy document on improving services for people from non-English-speaking backgrounds (5). The report summarized current problems of access and quality of care and listed key areas for change, including service planning, interpreting and translating services, culturally sensitive service delivery, access to information, quality assurance, and research. The document included goals and standards that all services were expected to meet in each area. Examples from existing practices were also included as guides to possible strategies that could be implemented.

Until 1994 funding for mental health services was distributed based on historical patterns, with little consideration of needs in each area. Several large inpatient institutions that covered large geographical areas consumed a significant proportion of revenue, making it difficult to establish smaller inpatient units and more locally based community services consistent with current national and state mental health policy.

In the absence of empirical data about the geographical prevalence of mental illness in Victoria, a funding framework using weighted population data to estimate the need for mental health services was developed. After a period of consultation and review, the final weighted population model included loadings for the population of persons with non-English-speaking backgrounds and for the aboriginal population (6), which meant that areas with higher proportions of these groups received relatively more funding. The additional funding was included to take into account the extra time and money involved in providing services to these groups, such as the cost of hiring interpreters and the additional time for interpreted interviews. It is not known how services chose to use these funds.

After a state government election in March 1996, the re-elected government allocated an additional $2.1 million (Australian dollars) over four years to fund strategies for ethnic mental health service improvement. The majority of these funds were used to create positions for ethnic mental health consultants in each of the five major health care networks. These positions were intended to help mental health services implement policies for improved services to persons with non-English-speaking backgrounds and develop and implement local initiatives. Although the bulk of the funding went to the Melbourne metropolitan area—based on the fact that 90 percent of the target population in Victoria lived in Melbourne—each of the five rural regions was given the equivalent of .2 of a position.

The ethnic mental health consultants program aims at increasing the accessibility of public mental health services for people from non-English-speaking backgrounds by facilitating cross-cultural training and culturally sensitive work practices, enhancing use of interpreting services and bilingual staff, and developing links and partnerships with ethnic communities. Besides playing a key role in the implementation of policy, the consultants utilize community development principles and processes to engender change from the bottom up, based on consultation with consumers and ethnic communities.

To increase the number and accessibility of bilingual staff in mental health services, seed funding for the establishment of ten bilingual case management positions in the western region of Melbourne was made available during 1996-1997. This program aimed at improving access to and adequacy of area mental health services for people from non-English-speaking backgrounds and to assist in accurate diagnosis and assessment of people in this population presenting to a mental health service. Other goals were to assist in the development of individual service plans for clients in conjunction with case managers and to establish, in conjunction with other staff, targeted support and educational programs for clients from a non-English-speaking background and their families. These positions were to have a primarily clinical focus but were to include secondary consultation and assessment, staff development, consumer and caregiver support and education activities, and community education (7).

The mental health branch agreed to "pump-prime" this program by providing additional funding for one year for half the positions. The positions were included in the ongoing budget of services after the first year. By the end of 1997, a total of 11 positions had been created and filled. The languages spoken by staff included Croatian, Greek, Italian, Macedonian, Turkish, and Vietnamese. An evaluation to be conducted over four years by the Victorian transcultural psychiatry unit was also funded.

The quality bonus strategy introduced new financial incentives for high-quality services, targeting in its first year—1996-1997—the areas of consumer and caregiver satisfaction, services to people from non-English-speaking backgrounds, and timeliness of data reporting. The inclusion of services for people from non-English-speaking backgrounds was partly prompted by research that had found that previous ethnic access policy had not been implemented in mental health services (8). The mental health branch developed an assessment tool to rate the achievement of service standards for clients from non-English-speaking backgrounds, as outlined in the policy document referred to above.

In January 1997 consultants were contracted to undertake an evaluation of the responsiveness of adult public mental health services to people from non-English-speaking backgrounds. All adult mental health services participated in the evaluation, which involved service visits, interviews with managers and key staff, and assessment of supporting documentation.

A report detailing outcomes of the evaluation was prepared for each service, highlighting strengths and weaknesses and pointing to potential areas of improvement. Additional funding was distributed to services based on the extent to which they had met the policy standards. After a review of the methodology, the evaluation was repeated for the 1997-1998 period. The second evaluation report concluded that "the service responsiveness evaluations have been a positive impetus for considerable development and improvement activity" and that the average scores on the rating scale had increased significantly since the previous year (9). It is noteworthy that staff at two clinics reported to the Victorian transcultural psychiatry unit that they believed their services had expended more energy on documenting proposed activities than on implementing them.

Two initiatives at the national policy level deserve mention, although limits on space prevent us from providing details. One initiative is the establishment of a national transcultural mental health network to promote a coherent, culturally appropriate national approach to mental health service development. The other is the inclusion of cultural awareness and sensitivity in the development of national standards for mental health services (10).

The programs and policies discussed in this article represent the most significant attempt yet to improve mental health services to ethnic minorities in Victoria. Whether the initiatives to improve services will be effective remains to be seen. Research is under way to examine the effects of the initiatives on service utilization and outcomes, including rates of utilization of community mental health services and outcomes for clients from non-English-speaking backgrounds.

The Victorian transcultural psychiatry unit is funded by the Victorian Government Department of Human Services. The authors thank Andrew Stripp and Val Gerrand for comments on a draft of this paper.

Mr. Ziguras is service development coordinator, Ms. Stankovska is service development officer, and Dr. Minas is director of the Victorian transcultural psychiatry unit at St. Vincent's Hospital, 41 Victoria Parade, Fitzroy 3065, Australia (e-mail, s.ziguras@medicine.unimelb.edu.au). Mr. Ziguras is also a doctoral candidate in the School of Social Work at the University of Melbourne. Ms. Stankovska also works with Action on Disability Within Ethnic Communities in Melbourne. Dr. Minas is also associate professor of transcultural psychiatry at the University of Melbourne.

After the Door Has Been Opened: Mental Health Issues Affecting Immigrants and Refugees in Canada. Report of the Canadian Task Force on Mental Health Issues Affecting Immigrants and Refugees. Ottawa, Health and Welfare Canada, 1988
 
Bhui K, Christie Y, Bhugra D: The essential elements of culturally sensitive psychiatric services. International Journal of Social Psychiatry 41:242-256,  1995
 
Minas IH, Lambert TJR, Kostov S, et al: Mental Health Services for NESB Immigrants: Transforming Policy Into Practice. Canberra, Australian Government Publishing Service, 1996
 
Moffic HS, Kinzie JD: The history and future of cross-cultural psychiatric services. Community Mental Health Journal 32:581-592,  1996
 
Victoria's Mental Health Services: Improving Services for People From a Non-English-Speaking Background. Melbourne, Victorian Government Department of Human Services, Psychiatric Services Branch, 1996
 
Purchasing Better Mental Health Services in Victoria 1996/97. Melbourne, Victorian Government Department of Human Services, Psychiatric Services Branch, 1996
 
Minas IH, Ziguras S, Klimidis S, et al: Extending the Framework: A Proposal for a Statewide Bilingual Clinical Support and Development Program. Melbourne, Victorian Transcultural Psychiatry Unit, 1995
 
Ziguras S: Implementation of ethnic health policy in community mental health centres in Melbourne. Australian and New Zealand Journal of Public Health 21:323-328,  1997
 
Evaluations of Area Mental Health Service Responsiveness to the Needs of People From Non-English-Speaking Backgrounds and to the Needs of Women. Melbourne, Shane Thomas & Associates, 1998
 
National Mental Health Standards. Canberra, Commonwealth of Australia, Department of Health and Family Services, 1997
 
+

References

After the Door Has Been Opened: Mental Health Issues Affecting Immigrants and Refugees in Canada. Report of the Canadian Task Force on Mental Health Issues Affecting Immigrants and Refugees. Ottawa, Health and Welfare Canada, 1988
 
Bhui K, Christie Y, Bhugra D: The essential elements of culturally sensitive psychiatric services. International Journal of Social Psychiatry 41:242-256,  1995
 
Minas IH, Lambert TJR, Kostov S, et al: Mental Health Services for NESB Immigrants: Transforming Policy Into Practice. Canberra, Australian Government Publishing Service, 1996
 
Moffic HS, Kinzie JD: The history and future of cross-cultural psychiatric services. Community Mental Health Journal 32:581-592,  1996
 
Victoria's Mental Health Services: Improving Services for People From a Non-English-Speaking Background. Melbourne, Victorian Government Department of Human Services, Psychiatric Services Branch, 1996
 
Purchasing Better Mental Health Services in Victoria 1996/97. Melbourne, Victorian Government Department of Human Services, Psychiatric Services Branch, 1996
 
Minas IH, Ziguras S, Klimidis S, et al: Extending the Framework: A Proposal for a Statewide Bilingual Clinical Support and Development Program. Melbourne, Victorian Transcultural Psychiatry Unit, 1995
 
Ziguras S: Implementation of ethnic health policy in community mental health centres in Melbourne. Australian and New Zealand Journal of Public Health 21:323-328,  1997
 
Evaluations of Area Mental Health Service Responsiveness to the Needs of People From Non-English-Speaking Backgrounds and to the Needs of Women. Melbourne, Shane Thomas & Associates, 1998
 
National Mental Health Standards. Canberra, Commonwealth of Australia, Department of Health and Family Services, 1997
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 10

Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 8.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 33.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 8.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 63.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 33.  >
Topic Collections
Psychiatric News
PubMed Articles