Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Dual Vulnerabilities: Mental Illness in a Culturally and Linguistically Diverse Society

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Dual Vulnerabilities: Mental Illness in a Culturally and Linguistically Diverse Society

Article excerpt

In Australia, more than six million people are from culturally and linguistically diverse (CALD) backgrounds, speaking more than 200 languages and bringing with them attitudes, values and beliefs surrounding health, illness and mental health issues that are not fully consistent or compatible with Western approaches to health care (Green, Betancourt, & Carillo, 2002; Minas, Lambert, Kostov, & Boranga, 1996; Minas, Stuart, & Klimidis, 1994; Vega, 2005).

The cultural demography of Australia is never static and in 2007-2008, the top 10 countries of birth of permanent settlers (onshore and arrivals) were: United Kingdom (30,841); New Zealand (27,619); India (22,688); China (excluding Hong Kong, Macau and Taiwan; 21,208); South Africa (7,762); Philippines (7,382); Malaysia (5,139); Korea (4,953); Sri Lanka (4,824); and Thailand (3,384) comprising 66% of the total (Department of Immigration and Citizenship, Immigration Update 2007-2008). The remaining 34% of permanent settlers were born in over 190 other countries. Opening immigration to people from a large number of countries has resulted in a great diversity of established and emerging ethnic communities in Australia. It is projected that by 2026 one in four people in Australia aged 70 years and over will be from a CALD background (Gibson, Braun, Benham, & Mason, 2005). Likewise, Australia has taken the initiative to resettle over 700,000 refugees and humanitarian migrants since 1945 and resettles about 13,750 refugees yearly (State of Victoria, 2011).

According to a number of authors, equitable and effective mental health services do not adequately meet the specific needs of CALD communities, a situation that is tantamount to an infringement of reasonable health care access and rights (Bae, Brekke, & Bola, 2004; Minas, 1991; Yamada & Brekke, 2008). The consequences of this inadequacy include: increased personal suffering superimposed on the direct effects of the illness; increased direct and indirect health care costs through misdiagnosis; inappropriate and unnecessary investigations; increased chronicity; poor treatment options and detrimental effects on the health of carers and other family members (Minas, Silove, & Kunst, 1993; Whaley & Geller, 2003; Yamada & Brekke, 2008). This paper examines the cultural context of vulnerability focusing on mental health service delivery, patterns of service utilisation, influences of national policies and plans and epidemiological data related to mental illness among people from (CALD) backgrounds.

Significant changes in the delivery of mental health services have occurred in Australia and globally leading to a decline in the number of large institutional facilities in preference to the establishment of community-based ambulatory mental health services and psychiatric in-patient units located within general hospitals (National Mental Health Report, 2010). In addition, the use of major psychotropic medications has resulted in a reduction in severe and persistent mental illness. Thus, while 50% of admissions to in-patient units are related to mental health issues, such admissions involve more seriously disturbed cases of mental illness (Bhui, Warfa, Edonya, McKenzie, & Bhugra, 2007). Evidence also suggests that the rates and severity of admissions vary across ethnic sub-populations in the community (Bhui et al., 2007). A number of factors including social class, racism, stress (war, torture and trauma), bereavement, ease of settlement, community support, cultural differences and availability and acceptability of the services interact to affect manifest rates of mental illness in different ethnic groups (Bhugra & Becker, 2005; Bhugra et al., 2011; Yamada & Brekke, 2008).

Many studies point to the need for migrants to resettle in communities that have a preponderance of others from the same ethnic background. This 'ethnic enclave' buffers pre-migration stress and post-migration factors and is effective for both children and adults (Becares, Nazroo, & Stafford, 2009; Bhugra & Becker, 2005; McKelvey & Webb, 1996a,b). …

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