A range of approaches exist to inform and guide the explorations and initiatives designed to enhance mental health service access, equity and quality for people from diverse backgrounds.
VTMH currently uses the VTMH Cultural Responsiveness Planning Tool to guide a conversational approach in exploring and developing culturally responsive mental health services across Victoria, services can also access the MHiMA National Cultural Competency Tool on-line.
VTMH consultants continue to explore and develop new ways to frame our cultural change conversations in order to support Victoria's mental health services to make a meaningful difference in the lives of those who use its services. This includes addressing diversity within migrant communities and within mental health services.
Cultural Competence has often been associated with ‘ethnicity’ rather than broad concepts of culture. This leads to a tendency to stereotype cultures and view ethnic diversities as single identifying factors rather than identifying factors in a range of presenting issues. We avoid limiting people to fixed cultural characteristics independent of their life history, societal and political contexts. It is possible to be informed about culture, to be growing in flexibility and knowledge, to be constantly learning and exploring but not to be ‘competent’ in the sense of acquiring a definitive knowledge or skill base.
The term Cultural Responsiveness is more reflective of culture in the broadest sense, inclusive of ethnicity and other cultural identities. Much of the past literature uses the terminology of cultural competence so we therefore use this term when citing these references or other authors. VTMH uses the terms and concepts of cultural responsiveness and diversity.
VTMH supports an inclusive approach to CR which incorporates cultural safety, cultural humility and cultural competency inrecognition of the multiple influences on people’s development.
The recognition that people have diverse cultural experiences and psychosocial histories. factors, beliefs, values, knowledge and experiences. We are more than our ethnicity; we are players in a range of social cultures and shifting power alliances.
"Diversity is a broad concept that includes age, personal and corporate background, education, function and personality. Includes lifestyle, sexual orientation, ethnicity and status within the general community." (National Standards for Mental Health Services 2010).
An intersectionality perspective takes the view that inequities are “never the result of single, distinct factors. Rather, they are the outcome of intersections of different social locations, power relations and experiences” (Hankivsky 2014, p. 2)
Addressing cultural factors in health care is a two-way process of reflection on our own cultural beliefs and motivations and their interplay with other cultural beliefs and motivations.
Threats to cultural safety may include inability to communicate with practitioners, not being able to have family present and participating in care, not being listened to, and not being respected.
VTMH identifies cultural safety, not imposing one’s own cultural values on others, as a key component of cultural responsiveness.
CONSIDER RIGHTS AND OBLIGATIONS IN CULTURAL SAFETY
In some cultures obligation and responsibility to family and community precedes ‘rights’ in the more abstract sense of rights as understood in the West. Adoption of new cultural markers and identities is balanced against cultural expectations to significant others. Mental health workers are often facilitators or support persons in negotiating these potential conflicts and changes.
Certain behaviours while culturally unacceptable may nonetheless be common, it is only in naming and politicising the behaviour that it becomes a problem in the community. The western way is often to politicise an issue and fight for political and social ‘rights’. In some cultures the personal and social risks of this approach are high. Our services need to respect this reality by focussing beyond the individual to the family, community and cultural context that gives meaning to the person.
With this re orientation comes an understanding that longer term social change requires support at both the individual and community level. Community development is therefore an essential tool in supporting social inclusion and understanding.
Commonwealth of Australia (2010). National Standards for Mental Health Services http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-servst10-toc
Hankivsky, O. (2014). Intersectionality 101. Institute for Intersectionality. Vancouver, BC, Research and Policy, Simon Fraser University. https://www.sfu.ca/iirp/documents/resources/101_Final.pdf