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A Transcultural Mental Health Research Agenda Information for Better Decisions

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

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  1. A Transcultural Mental Health Research AgendaInformation for Better Decisions Harry Minas Victorian Transcultural Psychiatry Unit Centre for International Mental Health

  2. 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

  3. 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

  4. Victoria Burden of Disease Study

  5. 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

  6. 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

  7. 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

  8. Rates of community mental health service use

  9. 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?

  10. 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

  11. 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

  12. 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)

  13. 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

  14. 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

  15. 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

  16. Strengthening Capacity 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

  17. Increasing transcultural mental health research • 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

  18. Research and the policy cycle Problem identification Evaluation Option development Research Implementation Political decision

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