Encouraging Understanding Among Players in Mental Health
As an official soccer coach and later, an official soccer referee in the game of Junior, Senior & Women’s soccer, I have learnt the importance of supporting players in playing the game both off and on the field.
Using my concept of alliance and integration, the team would provide each player with a voice and an opportunity to be involved in the assessment, planning and implementation of the game and of an evaluation of new and old technical approaches after each match. These would reflect upon each player’s skills and ability, each player’s position on the field and each player’s past progress in order to understand how to give a winning performance where the entire team becomes satisfied.
From experience, the players should not be segregated, regardless of their position. Well defined partnerships and networks should be strengthened between these groups which have different roles to play but share the same goal or objective.
The reason I commenced my speech with soccer is that there is a strong analogy with it and the area of mental health. The stakeholders: the consumers, the clinicians, the academics and the government officials, need to relate to each in the field of mental health. All need to have a voice in the assessment, planning, implementation and evaluation of the service they provide. They need to reflect on the way that they each participate so that they can improve the result.
When I started working at the VTPU three years ago, I was overwhelmed by the existing needs faced by the NESB communities. I saw that there are many stakeholders who all have a particular and distinct role to engage in within the services. Some are better at it than others, however the ultimate objective or goal is unique among all the stakeholders - and that is to satisfy the consumers that they are dealing with.
Government policy states that consumer satisfaction needs to be met but they don’t usually say how. Projects to work on these issues are limited by the lack of available funding. Some projects do not lead to significant change while others can achieve really good results.
Consumer satisfaction can be met in an indefinite number of ways. We stakeholders have to identify service gaps with consumers from different cultural backgrounds and try to fill those gaps with projects and strategies in partnerships with ethnic communities, consumers and carers. It became clear to me that the mental health system can develop to be effective and user-friendly if it is structured to allow the forming of creative partnerships and networks between the various stakeholders.
Because our mental health system originated in a western society, it has hasn’t been designed to meet the needs of consumers and carers from culturally diverse backgrounds.
This, my fellow friends, is why I have endeavoured to direct my labours not only to the ethnic communities, but also to the wider community. I have not segregated one from the other. This has created a flexible approach that has the ability to address the nature of problems that face particular communities. The sharing, caring, and bearing each others’ burden alleviates the pressures some communities face in mental health.
One of the projects that I have undertaken is examining the Complaints System via the College of Psychiatrists. The outcome of my involvement will be the production of a brochure to enable consumers or families who have complaints about either professionals or the system, to learn about the options available to them in dealing with their issues. The idea is that when the complaints come in, the system can be changed to solve the problem which led to the complaint of the consumer or carer. This should also lead to the improvement of consumer satisfaction in the future because procedures would have been set in place to deal with issues. This brochure will be published in many languages and will be available shortly through the College. The College envisages that it will distribute the brochures nationally to psychiatrists in the private and public sectors.
I also participate as a trainer with the VTPU Professional Development and Education program, providing the consumer perspective to mental health service staff. This work is important because it increases the awareness of mental health staff of the many different consumer issues. I mention the importance of having the consumer find employment, of having family members included in treatment and of the sort of problems they may have in accessing the service. I also mention the importance of communication with consumers – not just about working with interpreters but trying to understand where the consumer is at. These programs help mental health workers to become more sensitive to the problems that consumers and carers have.
My work with the VTPU Service Development program includes a number of stigma reduction strategies. One is publicising the stories of various people with mental illness - about their experiences and their ability to lead full and happy lives. These have been published in a number of local papers as well as some books. I have also spoken on community radio about these issues. This is a really useful thing to do because it provides some balance in the community about people with mental illness. Often the media portrays people with mental illness as being dangerous or violent, or that somehow they are different to everyone else. The stories help to provide another perspective.
Further to this, I present sessions regularly to secondary school and TAFE college students to raise awareness about mental health issues and to challenge stigmatising attitudes. I talk to the students about the symptoms of mental illness, the medications, the forms of treatment and how, over time, the symptoms can flare up unless treated. I give my personal case study as an example that people with mental illness can lead useful and fulfilling lives. This type of information can be mind boggling for students so I find that it is really important to illustrate the points I make with graphs, flow charts and diagrams as it makes it easier for them to grasp. I explain to them that it is really important to accept the illness and that this removes a lot of anxiety. I always try to get the students to participate by asking questions. These sessions help to change the attitudes of young people so that they can recognise that there is a lot of misinformation about mental illness in the general community.
I have worked extensively with local and state mental health and disability networks. Examples of this work include:
· Serving as a member of Thinking CAP, an innovative group of the Northern Area Mental Health Service in Victoria which receives input from consumers and then considers how this information may be channelled towards service improvement. The types of things that we have worked on include the development of a local complaints system for the Northern AMHS. It is hoped that consumers will feel free to use the new complaints system. Thinking Cap has had service managers as guest speakers to hear directly about the issues of consumers and to enable the consumers to hear the point of view of the managers. I bring in ethnic issues when they are relevant so we deal with things in an integrated way. This group is a good example of encouraging communication and understanding between consumers and service management.
· I serve as Ethnic Consumer Consultant on the NAMHS Cultural Advisory Committee. This group has planned strategies on cultural issues. They have conducted forums where people from different ethnic communities to speak on their cultures and on the mental health issues of their communities. Community leaders, consumers and carers were invited as well as clinicians so that they could listen to the issues people were confronted with.
· Assisting consumer organizations (VMIAC) and Norwood Association on particular issues confronting consumers from different cultural backgrounds. With VMIAC we have monthly consumer days where any consumer can come for a social get together and discuss any problems they have if they want to. They also have monthly Consumer Consultant days where Consumer Consultants employed with the various mental health services meet for a statewide information sharing day. In relation to ethnic issues, a worker from VMIAC has been allocated to establish an ethnic support group and I am involved in trying to assist with this.
· With the Norwood Association, we have formed a Cultural Advisory committee and they have decided to look at a different culture every six months. At the moment, they are looking at Vietnamese culture, inviting community leaders to come to the group and talk about the mental health issues in their community. The committee then tries to assist by adapting the Norwood service to their needs.
· Participating on the DHS Quality Improvement Reference Group in improving outcome measurements for psychiatric disability support services. This work will mean that pdss have to develop strategies annually to improve their services eg by consumer/carer satisfaction surveys or collating the electronic data base from each service to get statistics to highlight the priorities.
· I am a Victorian delegate on the Australian Mental Health Consumer Network and am participating by conversing with delegates from other states on a national level primarily looking after consumer issues. I am on the Media Sub committee where I will be looking at media coverage for the network and I am also on the Ethnic Cultural Sub-committee where we will be looking at funding sources to activate different cultural projects on a national level. This sort of work has not happened before and so it is quite innovative.
My most recent project is planning to establish an Ethnic Consumer group. Although it is not clear yet what sort of group it will be, I will be asking consumers from different cultural backgrounds about what they think needs to be done.
In all of the work I am doing, I have always endeavoured to consider how the work can be helpful to our wider ethnic communities. It must be realized that even though some of their needs are different to consumers from the wider Australian society, many are the same. Each project brings together various stakeholders and tries to improve the communication and understanding of the position of consumers, carers, service providers and government.
In concluding, I would like to say that there is plenty of scope to improve service delivery to consumers, carers and communities of diverse cultural backgrounds and our challenge is to strive towards that platform where the system is redeveloped in a way that achieves strong consumer satisfaction.
By Evan Bichara and Malina Stankovska
Victorian Transcultural Psychiatry Unit
October, 2003