There are a significant number of research findings and analysis from the cross-cultural perspective in regards to how the migration process affects the mental health of immigrants and refugees. However, there are few opportunities provided to immigrants and leaders of ethnic communities to express their views in regards to mental health, illness and services.

Gaetano Greco, Chairman of the Darebin Ethnic Communities Council, Victoria said, “It is very important to understand the influence of culture and stigma towards mental illness and the risks of developing mental health problems by migrants and refugees. The absence of community supports such as appropriate cultural and community networks can also influence the risks of developing mental health problems. Therefore if services are going to be culturally relevant for the ethnic communities, service providers need to understand these issues. The forum organised last year provided a unique opportunity for mental health service providers to learn about how do ethnic communities perceive mental health, illness and services.”

On 21 October 1999, a major forum for ethnic communities was successfully organised. Representatives and leaders of ethnic communities in the Northern Area Mental Health Services, Victoria were asked to have their say, on “How do ethnic communities perceive mental health, illness and services”. Jorge Torrico, Ethnic Mental Health Services Consultant for the Northern Area Mental Health Services (NAMHS) and the North East Mental Health Services (NEAMH) Austin and Repatriation Medical Centre coordinated the forum. The forum was auspiced by the Darebin Ethnic Communities Council (DECC) and the following organisations participated in the partnership: The City of Darebin Municipal Health Plan, North East Health Promotion Unit, Women’s Health In the North, Darebin Community Health and Neami. A committee with representation from the above organisations was established to oversee the activities leading towards the forum and beyond.

Those who attended the forum included ethnic community leaders, senior managers, clinical staff, community workers and nursing staff. The number of participants on the day indicated that there is a great interest in the topic of this forum. This was the first forum on mental health targeting the ethnic communities in the northern region.

Discussions with DECC indicated that mental health and mental illness were not readily included on their agenda. For this reason it was determined to organise a forum with the ethnic communities during the Mental Health Week as the initial step to promoting their active participation.

The following organisations submitted their interest in speaking on the day: The Greek, Macedonian, Chinese, Vietnamese, and Somali communities. The representatives of the nominated communities then organised focus groups to prepare their papers. This forum was advertised as a means of providing a learning experience for both; the ethnic communities and staff from the area of mental health services and managers who are involved in the implementation of policies and the delivery of mental health services. Understanding how the ethnic communities perceive mental health, illness and services is vital for improving and addressing the mental health needs of ethnic communities especially of newly arrived migrants and refugees.

The presentations
The morning session comprised of speakers from ethnic and service representatives. The Mayor from the City of Darebin Cr. Chris Kelly welcomed the participants and congratulated the organisations for their involvement in addressing the issues of mental health. The Chief Executive Officer of Neami, Mr. Arthur Papakotsias spoke about the difficulties faced by immigrant communities in navigating through the mental health system. Dr Tim Lambert, Associate Professor and Director of Clinical Services NAMHS, addressed the forum on the topic entitled “Ethnicity and the variables that should not be neglected in the practice of Pharmacology.”

What were the views of the ethnic communities regarding mental health, illness and Services?
Dr On Lien, Psychiatric registrar from the Alfred Hospital represented the Vietnamese community. The Vietnamese people believe that the causes of mental illness are grouped in the following causes: supernatural, animistic, magical, and natural causes. Depressive illness is due to karma and fate, whilst psychosis is perceived as the loss of one’s soul. The early detection of mental illness and taking into consideration the cultural and religious beliefs of the Vietnamese community by the service providers is important in successful treatment. Community education to minimise stigma will improve access to mental health services and treatment for people suffering mental illness. For the Vietnamese community the acculturation process, English language proficiency especially for the elderly and unemployment remain major hurdles.

Shaza Nur, spoke about the Somali community which is one of the more recent communities to arrive in Australia. Their previous experiences of civil war and subsequent famines have dislocated the Somali community. Shaza elaborated on the differences between the Somalian traditional methods in the treatment of mental illness, as opposed to the western approach of treating mental illness in the clinical and conventional method. The religious Somali beliefs interprets seeing visions as the ability to be in touch with higher spirits, however in the western world this experience may be interpreted as a psychotic experience. The recommendations made by the Somalian group would attempt to address the cultural, religious and linguistic needs of the Somalian community.

Mrs. Amal Diab, from the Arabic community said that “mental health and illness issues are usually accompanied by the stigmas of shame, dishonour and denial within the Arabic speaking community at large, particularly where the educational background is of a low standard. It is even, for many, considered a curse of evil spirits inflicted upon their family. In general, the knowledge available is scarce due to lack of acceptance, denial and avoidance of mental health issues.” She said that socio-economic background, education, religion and culture of the afflicted family come into play when deciding at which point to reach out to health service providers. The Arabic community generally would be very reluctant to use mental health services due to the sensitivity of the issue and traditional beliefs in relation to mental illness. There is also a lack of understanding of these factors on the part of mainstream professionals. The Arabic Speaking Community believes that mental health services are not flexible enough to respond with preventative strategies.

Other speakers included Nicholas Lykopandis from the Greek community of Darebin, Dr. Cynthia Fan, Senior Lecturer Department of Psychology at Victorian University and Victor Tsakmakis from the Macedonian community.

Concerns shared by the speakers were around how ethnic communities perceive mental illness. Within the Chinese community, people feel inhibited to speak about mental illness. However, ‘mental health’ was related to wellness and to resilient factors to cope with adverse effects in difficult situations of trauma, life hardships and grief. This created a dichotomy of feeling safe to speak about mental health, and feeling inhibited to speak freely about mental illness.

So what was achieved?
The forum provided an opportunity for ethnic communities to confront the issues of shame and stigma around mental illness and they welcomed the forum in dispelling these issues. It also provided the opportunity for links between ethnic communities, mental health services and other community services to be made. The forum achieved the following:
· ethnic communities to express their views about mental health, illness and services by putting forward their recommendations to improve access to mental health services.
· the increasing of awareness about the role that ethnic communities have a role in lobbying mental health services and government agencies on behalf of their communities.
· Opportunities for the development of partnerships with ethnic communities.
· learning opportunity for all the forum participants.

The participants recommended more of these forums, workshops and follow up activities as a result of their recommendations. The forum enabled the proactive participation and identified opportunities for organisations like DECC to facilitate ethnospecific activities in conjunction with mental health services.

In conclusion, a consumer member of the Ethnic Mental Health Advisory Group NAMHS & NEAMH Mr. Evan Bichara, made the following comment after the forum “The forum organised at this level put mental health as a priority of concern to the participants and particularly the ethnic communities. I feel that by sharing knowledge, a practical approach towards addressing the stigma attached to mental illness is made. This is something I have been working on and I am very pleased to see it happening.”

The Ethnic Mental Health Consultant of the NAMHS and NEAMHS in conjunction with DECC has documented the proceedings of the forum. This includes the papers presented during the day as a resource for those wanting to increase their understanding of transcultural mental health.

For further information contact:
Jorge Torrico
Ethnic Mental Health Consultant, Northern Area Mental Health Service
185 Cooper St Epping, Vic. 3076
Tel. (03) 9408 9510.