Mental health services have changed substantially over the past 30 years. Consumer Advocate at the Victorian Transcultural Psychiatry Unit, Evan Bichara, should know. He was diagnosed with having schizophrenia in 1977.

“Mental health services were not readily available in the ‘70s,” he explained. “There weren’t many mental health clinics. Mental health wasn’t what it is today.”

Evan said he was first diagnosed with having a nervous breakdown after visiting his doctor a few times about his illness. “He gave me some tablets and I went home,” he said.

Sadly for Evan his Greek-Egyptian parents had minimal knowledge about mental illness and because they didn’t know what to do, they turned to their faith.

Evan said he visited a number of priests for help. “Back then it was just prays and prays and prays. The priests’ understanding of mental illness wasn’t what it is today,” he explained. “Today they’re more open to accept that guiding people to treatment is the way to go, which is good.”

It wasn’t until an American priest came to Australia that Evan was guided in the right direction. The priest suggested that Evan needed to seek medical treatment at a hospital. His parents took this advice and Evan was eventually diagnosed with having schizophrenia.
 
While Evan gained the medical assistance he needed at the time, he said on reflection he believed that the mental health profession had very little understanding of cultural competency.

“Back then they needed to highlight the fact that I did come from a different ethnic background,” he stated.

Evan explained that his Egyptian-Greek background had taught him to respect elders and if doctors at the time understood this, they would have realised that Evan strongly respected his parents’ views about his illness.

While the mental health profession today has a better understanding of what causes mental illness, Evan said back in the ‘70s it was still struggling to determine if genetics, environment or chemical imbalances were the cause.

He explained how the health profession eventually adopted the environmental theory as a key factor.

“Some people blamed their parents or siblings for their illness because they believed it was caused by the way they were brought up,” Evan said.  “But because I came from a collective culture and a culture that respects the elderly, I didn’t go through that blame game too much.”

It’s now thirty years since Evan was first diagnosed and a lot has changed.  “I can see a lot of differences in the mental health sector now. I can see a lot of respect for people’s value systems and their religious beliefs. Cultures are now respected,” he stated.

Evan said this positive change is due to more mental health consumers from CALD backgrounds seeking medical treatment.

“It wasn’t until a lot of people from ethnic backgrounds came with these problems that the profession started progressing towards trying to understand people and their cultures, belief systems and values,” he said.

“It’s important to understand that these belief systems and values need to be respected in diagnoses, treatment and care. The cultural factors are crucial in these three areas.”

According to Evan if clinicians respect other people’s beliefs and cultures, then that respect is reciprocated and can then help forge stronger links between practitioners and consumers. “If I don’t get respect for what I believe in, then I’m likely to put up a defensive wall between me and the clinician. This barrier makes it harder for the clinician to get through to me and for me to get through to the clinician,” he said.

“I can see that if a clinician is respecting my belief systems and my values, then I will in turn respect theirs. I will open up to their viewpoints and then open up to the treatment that they’re offering me.”
 
Evan has maintained a respectful solid relationship with his doctor, who he has been seeing for nearly 25 years. Evan describes his doctor as more like a friend.

“We share each other’s culture. He’s from an Italian background and I respect that.”

While Evan said he understands that doctors must be objective and shouldn’t bring their culture into their treatment, he believed that it would help if clinicians were a little bit subjective in what they offered. “We are all humans and if we share humanity – discrimination about mental illness will be removed.

“I respect people’s cultures and I think if people enrich themselves with cultural understanding, it makes the subject a little bit easier to communicate,” he explained.