Teresa is a 51-year-old first generation Australian woman living in Melbourne. She has cared for her 82-year-old Italian mother, Giovanna, since she was diagnosed with a mental illness nearly 10 years ago. Being the eldest in her family, Teresa automatically adopted the role as her mother’s carer.

Teresa said she was happy to take on the carer role because getting her mother well was her first priority. The carer’s role has entailed accompanying her mother to medical appointments and researching the medical staff they saw as well as the illness her mum’s been diagnosed with. Teresa said while she did her homework before every appointment, she felt that the medical professionals failed to do theirs.
 
“Medically they [do their homework] because they are concerned about keeping my mum well, but I feel there is a lack of care in their understanding of culture and separating the medical care from the culture of the individual,” Teresa said. “Even though someone may live in a culture where they subconsciously have their own rules, they are individuals and each individual carries a history and a story.”

According to Teresa, the mental health profession doesn’t spend enough time dealing with people’s life stories. “Sometimes the reason why someone becomes mentally or psychologically ill is because of their life story and it may have nothing to do with their culture,” she said. “They’re just interested in hearing about people’s [medical] conditions. Once someone is stabilised – that’s the time to really find out what is going on, so there isn’t a recurrence [of the mental condition].”

Like many older migrants, Giovanna does not speak English and has had to rely on her daughter, Teresa, to interpret for her. While Teresa said she was aware of the limitations this imposed on mental health consultations, she had made extra effort to ensure the communication still flowed between her mother and her mother’s specialists.

“I try to arrange the seating so that mum sits closest to the doctor and I’m more removed,” Teresa explained. “I’m there [in the room], but I don’t want to be part of the main consultation. I try to get the GP to talk to mum. Some are great and do this and completely ignore me. But others talk directly to me and ignore my mum.”

She says while that may work for a little while, it invariably reverts back to the GP talking directly to Teresa and not her mother. “Sometimes I do have to take over when I don’t want to because I can see that time is running out and the doctor is getting frustrated and I have to answer on my mum’s behalf,” she said.

Teresa attempted to address this problem and decided to use a professionally trained interpreter instead. But unfortunately for Teresa and her mother, Giovanna, this strategy failed as well. Teresa said that they felt the interpreters were too clinical to deal with the sensitive issue at hand.

“Interpreters are trained just to give you the facts. They are there to do a job and to interpret exactly what is said,” she said. “I have had to interrupt an interpreter because the interpretation was so factual that the emotional side wasn’t coming out. But interpreters are only allowed to say what is said. I have had to interject even when the interpreter was being correct. I know interpreters can’t get involved with everybody. They’re there to do a job and that’s to interpret and that’s it.”

While some mental health professionals have managed to work around Giovanna’s needs, there was one incident when a nurse implied Giovanna could in fact speak English and that she could understand more than she was letting on. Teresa took great offence at this. “I became very angry and asked the nurse to clarify herself. While she didn’t repeat herself to me, she told another nurse who was in the room. At that point I said: ‘I don’t think this consultation can go on’.”

Teresa said there have even been instances in the past where she has specifically asked for a bilingual mental health professional. “I don’t think Italian is an obscure language,” she said. “Once we had an appointment with a Greek-speaking psychiatrist, despite the service providers knowing that we were Italian. I think I had also asked for a female psychiatrist, but we ended up with a Greek speaking male psychiatrist.”

Teresa said that she had deliberately asked for a female psychiatrist because she knew that her mother would have a better rapport speaking to another woman. And her theory proved correct. During the consultation, Giovanna felt completely uncomfortable sharing her story with the male practitioner and wouldn’t make any eye contact with him.

Despite those hurdles, Teresa said she had noticed that some public hospitals were recruiting Special Liaison Officers, but still felt more was needed to help people from CALD backgrounds living with a mental illness.

“You need to train people at the frontline and employ people who can speak other languages. You also have to roster these people on more often and send your staff to cross-cultural communication training sessions.”

While some services have become more culturally competent, Teresa said she firmly believed that language was vital and that people needed to be more assertive when dealing with the health system to ensure their health needs are met.