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A Transcultural Mental Health Research Agenda Information for Better Decisions Harry Minas Victorian Transcultural Psychiatry Unit Centre for International Mental Health Challenges of Diversity

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A transcultural mental health research agenda information for better decisions l.jpg

A Transcultural Mental Health Research AgendaInformation for Better Decisions

Harry Minas

Victorian Transcultural Psychiatry Unit

Centre for International Mental Health


Challenges of diversity l.jpg
Challenges of Diversity

  • Cultural and linguistic diversity confronts societies with a series of important challenges and potentially divisive questions.

  • These questions include:

    • issues of national, regional, community and personal identity

    • the legitimate role of government

    • distribution of resources

    • the purposes, structure and operations of social institutions - such as health systems

  • Current backlash against multiculturalism


Scope and content of transcultural psychiatry l.jpg
Scope and Content of Transcultural Psychiatry

  • Exploration of similarities and differences in the manifestations of mental illness in different cultures.

  • Identification of cultural factors that predispose to mental illness and mental health.

  • Assessment of the effect of identified cultural factors on the frequency, nature and distribution of mental illness.

  • Attitudes toward the mentally ill in different cultures.

  • Study of the forms of care and treatment practised or preferred in different cultural settings.

  • Culture and clinical practice, including the clinician-patient relationship.

  • Design and evaluation of mental health services in multicultural societies.

  • Human rights concerns



Burden what can and cannot be averted l.jpg
Burden: What can and cannot be averted

100%

Not avertable with existing interventions

Researchon newinterventions

z

Combinedefficacy ofinterventionmix

Averted with

current mix of

interventions & populationcoverage

Avertablewithimprovedclinical

efficiency

(evidence-based

practice) and

population

coverage

Avertable withincreased resourceinput

Researchto reducethe cost ofinterventions

100%

x

y

0%

Population coverage

Research on healthsystems & policies

x - current population coveragey - max achievable population coveragez - efficacy of mix of all interventions

Global Forum, 1999


What kinds of research l.jpg
What kinds of research?

  • Agenda-driven research

  • Investigator-initiated research

  • A clear research agenda is a powerful instrument for improving the quality and accessibility of the Victorian public mental health system


Mh services some continuing issues l.jpg
MH Services: Some continuing Issues

  • Little high quality epidemiological information

    • ? Needs

  • Inadequate information on risk and resilience -determinants

    • Pre- and post-migration factors

  • Continuing under-use of MH services

    • Inadequate understanding of reasons

  • Inadequate understanding of the pathways to mental health care

    • Initial access to mental services is particularly problematic

  • Significant language/communication barriers

    • Interpreter services are under-utilized

  • Little information on quality of clinical and social outcomes

    • Data that’s available(e.g. HoNOS) is not routinely analysed to explore this issue



Basic questions l.jpg
Basic Questions

  • What are the mental health service needs of Victoria’s diverse communities?

    • Are the needs of various communities the same or different?

  • Does the Victorian mental health system have the capacity to effectively meet the mental health service needs of the population, regardless of language and culture?

    • Does this capacity vary for different communities?

  • Where needs are not being adequately met, what needs to be done?

  • When things are done, how effective are they?


Slide12 l.jpg

Increased capacity of the Victorian public mental health system to provide clinically effective and

culturally appropriate services to Victoria’s culturally and linguistically diverse population.

Priority Area 1:

Policies and

implementation

plans

(State, AMHS)

Priority Area 2:

Understanding of

CALD communities’

needs for service

Priority Area 3:

Quality of

clinical

communication

Priority Area 4:

Equitable

access to

services

Priority Area 5:

Skilled

clinical

workforce

Priority Area 6:

Clinical and

social

outcomes

Priority

Areas


Slide13 l.jpg

Increased capacity of the Victorian public mental health system to provide clinically effective and

culturally appropriate services to Victoria’s culturally and linguistically diverse population.

Objective 2.4

 Understanding of

Community needs

Objective 3.5

 Quality of clinical

communication in

cross-cultural

clinical encounters

Objective 4.5

Improved

(equitable)

access to

services

Objective 5.5

Improvement in

relevant clinical

skills of workforce

Objective 6.5

Equitable clinical

and social

outcomes

Objective 3.4

 Training in

of mental health

interpreters

Objective 1.2

Implementation

plans at AMHS

and agency level

in place

Objective 2.3

Improved levels

and processes

for participation

Objective 4.3

 Access to

disability

support and rehab

Objective 5.3

 % of clinical

workforce

trained

Objective 6.3

Employment

 DSP rates

Stable accomm

Objective 3.3

 Training in

Working with

interpreters

Objective 2.2

 Training of CCC

in effective

participation

Objective 4.2

 Access to

non-drug

treatments

Objective 5.2

Competency-

based training

developed

Objective 6.2

Institute targetted

quality improvement

programs

Objective 3.2

 Use of interpreter

services

Objective 1.1

Policies in place at

State and AMHS

levels

Objective 2.1

Improved and

expanded

CCC networks

Objective 4.1

 Use of MH

services

Objective 5.1

Relevant clinical

competencies

defined

Objective 6.1

Identify

unacceptable

outcomes

Objective 3.1

 Assessment

of English

proficiency

Priority Area 1:

Policies and

implementation

plans

(State, AMHS)

Priority Area 2:

Understanding of

CALD communities’

needs for service

Priority Area 3:

Quality of

clinical

communication

Priority Area 4:

Equitable

access to

services

Priority Area 5:

Skilled

clinical

workforce

Priority Area 6:

Clinical and

social

outcomes

Priority

Areas


Slide14 l.jpg

Increased capacity of the Victorian public mental health system to provide clinically effective and

culturally appropriate services to Victoria’s culturally and linguistically diverse population.

Objective 1.2

Implementation

plans at AMHS

and agency level

in place

Objective 1.1

Policies in place at

State and AMHS

levels

Minas, I.H., Klimidis S, Kokanovic R. Policy, research and services

in relation to depression in ethnic minority communities in Australia.

Transcultural Psychiatry. (In press)

Priority Area 1:

Policies and

implementation

plans

(State, AMHS)


Slide15 l.jpg

Increased capacity of the Victorian public mental health system to provide clinically effective and

culturally appropriate services to Victoria’s culturally and linguistically diverse population.

Objective 3.5

 Quality of clinical

communication in

cross-cultural

clinical encounters

Miletic T, Minas H, Stolk Y, Gabb D, Klimidis S, Piu M,

Stankovska M. Improving the Quality of Mental Health

Interpreting in Victoria. Melbourne, Victorian Transcultural

Psychiatry Unit, 2005.

Objective 3.4

 Training in

of mental health

interpreters

Objective 3.3

 Training in

Working with

interpreters

Stuart GW, Minas, I.H., Klimidis S, O'Connell S.

English language ability and mental health service

utilisation: a census. Aust N Z J Psychiatry 1996; 30:270-7.

Objective 3.2

 Use of interpreter

services

Objective 3.1

 Assessment

of English

proficiency

Klimidis S, Reddy P, Minas IH, Lewis J.

Brief functional English proficiency measure

for health survey research. Australian

Psychologist. 2004; 39:154–165.

Priority Area 3:

Quality of

clinical

communication


Slide16 l.jpg

Increased capacity of the Victorian public mental health system to provide clinically effective and

culturally appropriate services to Victoria’s culturally and linguistically diverse population.

Objective 4.5

Improved

(equitable)

access to

services

Objective 4.3

 Access to

disability

support and rehab

Objective 4.2

 Access to

non-drug

treatments

Klimidis S, McKenzie DP, Lewis J, Minas, I.H. Continuity

of contact with psychiatric services: immigrant and

Australian-born patients. Social Psychiatry and Psychiatric

Epidemiology 2000; 35:554-63.

Objective 4.1

 Use of MH

services

Stuart GW, Klimidis S, Minas, I.H. The treated prevalence

of mental disorder amongst immigrants and the Australian-born:

community and primary-care rates. International Journal of

Social Psychiatry 1998; 44:22-34.

Priority Area 4:

Equitable

access to

services


Slide17 l.jpg

Increased capacity of the Victorian public mental health system to provide clinically effective and

culturally appropriate services to Victoria’s culturally and linguistically diverse population.

Objective 2.4

 Understanding of

Community needs

Objective 3.5

 Quality of clinical

communication in

cross-cultural

clinical encounters

Objective 4.5

Improved

(equitable)

access to

services

Objective 5.5

Improvement in

relevant clinical

skills of workforce

Objective 6.5

Equitable clinical

and social

outcomes

Objective 3.4

 Training in

of mental health

interpreters

Objective 1.2

Implementation

plans at AMHS

and agency level

in place

Objective 2.3

Improved levels

and processes

for participation

Objective 4.3

 Access to

disability

support and rehab

Objective 5.3

 % of clinical

workforce

trained

Objective 6.3

Employment

 DSP rates

Stable accomm

Objective 3.3

 Training in

Working with

interpreters

Objective 2.2

 Training of CCC

in effective

participation

Objective 4.2

 Access to

non-drug

treatments

Objective 5.2

Competency-

based training

developed

Objective 6.2

Institute targetted

quality improvement

programs

Objective 3.2

 Use of interpreter

services

Objective 1.1

Policies in place at

State and AMHS

levels

Objective 2.1

Improved and

expanded

CCC networks

Objective 4.1

 Use of MH

services

Objective 5.1

Relevant clinical

competencies

defined

Objective 6.1

Identify

unacceptable

outcomes

Objective 3.1

 Assessment

of English

proficiency

Priority Area 1:

Policies and

implementation

plans

(State, AMHS)

Priority Area 2:

Understanding of

CALD communities’

needs for service

Priority Area 3:

Quality of

clinical

communication

Priority Area 4:

Equitable

access to

services

Priority Area 5:

Skilled

clinical

workforce

Priority Area 6:

Clinical and

social

outcomes

Priority

Areas


Strengthening capacity l.jpg
Strengthening Capacity system to provide clinically effective and

Increase demand within Area Mental Health Services forimproved transcultural mental health practice and programs

Collaborative

Work

Systematic

Training

Increased

Research

Capacity

Networks

of Skilled

Researchers


Increasing transcultural mental health research l.jpg
Increasing transcultural mental health research system to provide clinically effective and

  • More systematic and intelligent use of existing data collections

    • e.g. service use and outcomes data

    • Ensure that essential data fields (e.g. country birth, COB of parents in CAMHS, English fluency) are included in routine data collections

  • Promote high quality service evaluation as an essential component of service delivery

  • Confront ethics of exclusion

    • Epidemiological and treatment efficacy studies should be based on truly representative samples of the population (NH&MRC, ARC, etc.)

  • Development of transcultural mental health research instruments and methods

  • Teaching programs in transcultural mental health research methods and ethics

  • Attract an increased number of Master and PhD students who are doing transcultural mental health research projects

     transcultural mental health research capacity

     competitive research funding for the field

     body of useful information


Research and the policy cycle l.jpg
Research and the policy cycle system to provide clinically effective and

Problem

identification

Evaluation

Option

development

Research

Implementation

Political

decision


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