The Cultural Competency Standards and Audit Tool (the Tool) was developed and produced by the Multicultural Forum for Mental Health Practitioners. This Western Australia based group of mental health clinicians was a policy and advisory group to the state’s mental health directorate on issues concerning service development and provisions for Western Australia’s CALD mental health consumers.

In this context, the forum also undertook initiatives to promote clinical governance through quality improvements with the aim of enhancing service delivery to CALD consumers. 

The concept for the Tool arose from a consensus that the planning, development and evaluation of mental health services often excluded appropriate consideration of the needs of consumers from CALD backgrounds. 

Although mental health services acknowledged the need to ensure CALD consumers received equitable care services, it was seen that some lacked the mechanisms or knowledge to achieve this.

The central objective of the Tool is to ensure that the organisational culture and practice of mental health services effectively accommodates Western Australia’s growing multicultural population. It is imperative that cultural competency be in place within organisations before clinicians can be individually audited.

Despite the current national standards for mental health services, that advocate for cultural competency in service delivery, it’s believed that such standards provide limited practical guidelines to assist services in assessing and measuring their organisational and clinical endeavours to implement cultural awareness. A first step in developing the Tool was to address this problem. 

Guided by the work of Siegel, Haugland and Chambers (2002) for the mental health system in the United States, the concept of an Audit Tool, that could link cultural competency with quality improvement, emerged as a first step.

Eight new Cultural Competency Standards (CCS) and associated performance measures were subsequently developed.

These standards are closely aligned with other mental health, health and quality improvement standards to ensure organisations can easily adopt them. In particular, the principles underlying the CCS are also conveyed in the Framework for the Implementation of the National Mental Health Plan in Multicultural Australia 2003-2008; and in WA’s inaugural Transcultural Mental Health Policy (2001). 

The Performance Measures in the Tool were designed to have three functions: to measure the extent to which services can achieve the CCS; to guide services in how to strive for best practice and quality-assured service provisions to local CALD communities; and to assist services in implementing cultural competency initiatives at all levels. 

To minimise unfamiliarity and maximise ease of administration, the format for the Audit Tool was intentionally based on the template used by the Evaluation and Quality Improvement Program (EQuIP) for the Australian Council of Healthcare Standards (ACHS). 

Designed as a self-assessment instrument, it would enable a mental health service to cite actual processes that support good practice as evidenced by operational events.

Completion of the Tool will assist mental health services to meet the standards relating to cultural sensitivity in service provision as specified in the National Standards for Mental Health Services (1996) and the National Practice Standards for the Mental Health Workforce (2002).

A feasibility study using a qualitative approach was undertaken to identify barriers or difficulties in implementing the Tool and any potential or existing flaws. Appropriate changes were made before the Tool was disseminated.

One of the significant changes made was the development of a ‘how-to’ manual to assist services to conduct their own self-assessment audits. A mock exemplar of a completed audit was also included.

This resource was developed for application across the continuum of mental health service provision from child and adolescent to older people from CALD backgrounds, irrespective of the size, location or type of service.

It is envisaged that these new standards, performance measures and the Audit Tool will encourage mental health services to appreciate and value diversity in governance, service delivery and policy development. 

The Tool has since been adapted for use across Queensland’s mental health services. Western Australia’s Office of Chief Psychiatrist has also integrated a selection of the Cultural Competency Standards into its Clinical Governance framework to facilitate the monitoring of activities to achieve cultural competency by the state’s mental health services.

Copies of the Cultural Competency Standards and Self-Assessment Audit Tool may be obtained from the Mental Health Division, Department of Health, Western Australia - 08 9222 4222.