Paper title: The Prince Charles Hospital Multicultural Working Group as the Community Consultation Model

Authors: Bozica Stumfol, Sharon Stocker and Anne Gooley Bozica Stumfol: Multicultural Mental Health Coordinator & TPCH MWG Chair Metro North Mental Health Services TPCH Aspley Community Health Centre, 776 Zillmere Road ASPLEY Q 4034 bozica_stumfol@health.qld.gov.au antigona55@yahoo.com.au

Sharon Stocker:

The Chair of TPCH Consumer Advisory Group tpchcag@gmail.com

Anne Gooley:

Project Manager, Resettlement, ARMS Refugee & Migrant Services Spiritus agooley@spiritus.org.au

Abstract The aim of this paper is to describe the Prince Charles Hospital Multicultural Working Group (TPCH MWG) at Metro North Mental Health Services, as an example of good practice in consulting and forming partnerships with the culturally and linguistically diverse (CALD) communities and various government and nongovernment organisations that work with CALD communities. The benefits of the community consultation model formed through the work of TPCH MWG is described in the context of facilitation of culturally responsive mental health care to consumers, their carers and families from CALD backgrounds as per objectives identified by this group. A special consideration is given to successful cooperation with TPCH Consumer Advisory Group in the provision of various health promotion activities across the district and Spiritus Anglican Refugee and Migrant Services in the provision of health literacy, information and education sessions to Karen speaking communities in TPCH catchment area. Examples of TPCH MWG activities are linked into contemporary multicultural mental health literature and policy documents including Queensland Health Strategic Plan for Multicultural Health 2007-2012, Queensland Plan for Mental Health 20072017, The Fourth National Mental Health Plan An agenda for collaborative government action in mental health 2009-2014 and National Standards for Mental Health Services. Key words: mental health, consultation, health promotion, health literacy, diverse communities

An overview of TPCH MWG The TPCH MWG was established in April 2008 through the position of TPCH Multicultural Mental Health Coordinator (MMHC) as part of a state-wide multicultural mental health program recurrently funded and coordinated by the Queensland Transcultural Mental Health Centre (QTMHC). The role of the MMHC is to facilitate the development of a culturally responsive Mental Health Service (MHS); liaise and provide clinical consultation to clinicians on issues relating to culturally appropriate service provision; provide information and resources; and collaborate with other key service staff in the development and implementation of plans, policies and procedures relating to the service provision to culturally and linguistically diverse (CALD) consumers and to network with various local multicultural groups and organisations. From December 2007 until March 2008, the MMHC identified relevant government and non-government agencies in TPCH geographical area that work with people from CALD backgrounds to form TPCH MWG. Community members have been nominated through the main interagency networks. The first two meetings were attended by both government and non-government agencies, external to our MHS. Mental health staff joined this group in August 2008, at the point of the third MWG meeting. Current membership comprises of 28 members (18 external and 10 internal members). External members are the representatives of the various community organisations including neighbourhood centres, migrant and resource centres, housing agency, settlement service and TPCH Consumer Advisory Group (CAG). Government agencies include the representatives from Centrelink, Queensland Police Service and Department of Immigration and Citizenship (DIAC). Internal members are case workers, nurse unit managers, team leaders and service directors. TPCH MWG meetings are bi-monthly, chaired by the MMHC. Review of the meeting attendance shows that between 7 to 21 members attend the meetings with an average number of 13 participants per meeting. Partnerships and community consultation model The importance of linkages with the government and non-government/community organisations has been recently highlighted in the Fourth National Mental Health Plan. An agenda for collaborative government action in mental health 2009-2014 (Australian Health Ministers, 2009) and in a number of other policy documents including National Standards for Mental Health Services (NSMHS) (Commonwealth of Australia, 1996), Queensland Plan for Mental Health 2007-2017 (Queensland Government, 2008a) and Queensland Health Strategic Plan for Multicultural Health 2007 - 2012 (Queensland Government, 2007) as working in partnership with multicultural and community sector. TPCH MWG facilitates the development of partnerships in three layers of consultations: government - non-government, government government and nongovernment - non-government. All three layers of consultations are equally important in order to maintain and progress appropriate referral, liaison and engagement strategies for CALD consumers as per Standard 8.3 of the NSMHS. Perhaps more attention is given to non-government and community sector as having a key role in

providing non-clinical personal care and other flexible supports to people living with mental illness, families and carers (Queensland Government, 2008a, p.23). TPCH MWG community consultation model also contributes to building capacity of community organisations to assist and support people with mental illness to live full and meaningful lives in the community and access stable housing, income support, education and employment and sport/recreational activities as suggested by Carling (1995), Townsend et al. (2004), Whiteford (1994a) and Whiteford (1994b). Purpose and objectives of TPCH MWG The general purpose of TPCH MWG is to facilitate culturally responsive mental health care to consumers and their families from CALD backgrounds and to support the development of the MMHCs role. For this reason, TPCH MWG has committed to a number of objectives as outlined in TPCH MWG Terms of Reference (2010). Objectives and examples of collaborative activities are listed in Table 1. Table 1: Objectives and examples of TPCH MWG activities
Objective 1. Identify priorities related to CALD issues and implement strategies to address these issues. Actions: - Group members regularly share the information on needs and issues expressed by migrants and refugees settling in the area. The MMHC forwards this information to the service executives, QTMHC and Refugee Health Reference Committee for a further collaborative action. - Housing difficulties experienced by CALD population are often discussed as an agenda item. This information is fed back to relevant stakeholders responsible for housing issues. - Referral pathways to community agencies for follow up and support for CALD population are clarified and updates are provided regularly. - Changes to Family Tax Benefit and other Centrelink information are made known to the members of this network. Objective 2. Act as advocate for CALD consumers their carers and families. Actions: - Provision of logistic support to multicultural community organisations including the letters of support to MWG partners when putting in for funding application for CALD programs. - Consumer/carer consultant and CAG members attend the meetings and provide updates on the issues impacting on CALD consumers, seeking input and support from other members. CALD members of the CAG are included and share the information and concerns in the community. - New mental health teams such as Transitional Discharge Team and Consumer Support Program are introduced to members. - The Mental Health Inventory is translated in 14 languages and is easily accessible on TPCH Intranet Site to ensure that clinical outcomes are appropriately recorded for CALD consumers as suggested by Thornicroft et al. (2006, p.13). - Privacy and confidentiality is maintained at all times as per Standard 5 of the NSMHS. Objective 3. Share the information and provide opportunities for education and training across the government and non-government sector in TPCH catchment area. Actions: - Bi-yearly review of TPCH MWG meetings recorded twelve meetings including 14

presentations, information sharing, consultations and discussions on various multicultural mental health topics. The topics include presentations on multicultural data collection, history of multicultural mental health in Queensland, utilisation of MHS by CALD population, the type and effectiveness of support provided by settlement services in the area, reports from the various seminars and conferences, cultural information on Italian seniors, introduction of new programs such as respite program for CALD carers and ongoing identification of training needs. - TPCH MWG organised a special multicultural training for its members to include the topics on: Diverse needs of CALD population in the district as perceived by the representatives of community/neighbourhood centres; cultural factors in mental health (presentation from the QTMHC) and presentation from TPCH Acute Care Team to explain pathways to mental health services. - Regular distribution of the information on multicultural mental health resources and upcoming training from the QTMHC. Objective 4. Assist in development, application and review of policies and procedures aimed to build cultural competency of the MHS workforce. Actions: - Annual review of the use of professional interpreters in the district. - Ongoing promotion of the on-line interpreter booking system. Since the introduction of the on-line booking system in Qld Health, the interpreters bookings have increased. - Group members have knowledge of the social and cultural groups in the area and participate in the review of Referral Guide for Culturally Appropriate Assessment and Treatment (Queensland Government, 2008b) as per Standard 7 of the NSMHS. - Consultation for the Queensland Plan for Multicultural Mental Health. - Ongoing consultation on Cultural Competency Standards and Self-Assessment Guide (Queensland Government, 2009). - The MMHC ensures that policies and procedures relating to CALD consumers are applied across the MHS. Objective 5. Generate ideas, initiatives and resources relating to CALD consumers their carers and families. Actions: - Regular updates for the Multicultural Clinical Support Resource Folder across the teams. - Dissemination of translated mental health information and other resources. - Provision of translated information relating to Mental Health Act 2000 (Queensland Government, 2010) and patients rights and responsibilities. - Promotion of the Queensland Multicultural Resource Directory (Multicultural Affairs Queensland, 2010) which contains details and contact numbers of diverse ethnic communities in Queensland. Objective 6. Assist the service in responding to Australian Council on Healthcare Standards relating to CALD consumers their carers and families. Actions: - Identification of available community organisations and their assistance in supporting consumers with cultural needs. - Application and review of policies relating to CALD consumers. - Promotion of cultural diversity, social inclusion and mental health. - TPCH Acute Care Team is made known to multicultural communities. - Demographic, linguistic, cultural and epidemiological information on CALD consumers is collected and reviewed annually. - TPCH Interpreter Service Coordinator is a member of the MWG and provides updates on issues relating to the use of interpreters as per Standard 7 of the NSMHS. - Group members provide updates on new languages and interpreters required in the geographical area. - Multicultural mental health training is available to all staff as per Cultural Competency Standards and Self-Assessment Guide (Queensland Government, 2009).

Objective 7. Engage with multicultural communities to reach possible consumer groups, promote mental health and well-being and facilitate equitable access for CALD population. Actions: - Community engagement list containing details and contact numbers of the MWG partners and diverse multicultural community groups in TPCH catchment area is made available to all staff. - Delivery of a mental health literacy workshop to conversational English group at the nearby library. - Regular participation in the collaborative Mental Health Week activities organised across the district. The MMHC spoke about the multicultural perspective on mental illness and recovery at the various interagency forums. In-service on the same topic is planned in October this year (Queensland Government, 2005). - These activities are aiming for increased and equitable access to MHS as per Standard 11.1.5 of the NSMHS.

Strategic partnership with TPCH CAG A number of collaborative mental health promotion activities were conducted in cooperation with TPCH CAG. The role of TPCH CAG is to support and nurture the people living with the conditions of a mental illness and their associated people and carers within the Metro North MHS (TPCH) area so as to empower them to effectively participate in the planning, implementation and evaluation of the MHS and to sustain outcomes using strategies to demonstrate the functions of the CAG (TPCH CAG Terms of Reference, 2010). The operational philosophy of TPCH CAG is to promote a clear communication and articulation of needs and expression of people with mental illness and expand their community involvement. Key functions of TPCH CAG are to advocate, lobby, educate, reduce stigma and raise community awareness in relation to mental illness (TPCH CAG Terms of Reference, 2010). These activities aim to improve the recovery process and subsequently the quality of care and life for all consumers and carers across the MHS (The Senate, 2008). Partnership between TPCH MWG and TPCH CAG resulted in forming another successful collaboration with the Zillmere Community Centre as the most suitable venue for majority of our mental health promotion activities including Harmony Day celebrations, Zillmere Multicultural Festival and Mental Health Week activities over the past 2 years. Apart from networking with a number of community organisations, these joint health promotion activities help in reducing stigma about mental illness in CALD communities by connecting with people, sharing stories and experiences, promoting trust and friendship and disseminating mental health information on the rights of consumers in a number of languages as per Standard 6 of the Cultural Competency Standards and Self-Assessment Guide (Queensland Government, 2009). Strategic partnership with the Spiritus Anglican Refugee and Migrant Services Overview of services provided by Spiritus ARMS for north side of Brisbane The DIAC funded the 2009/10 Settlement Grants Program (SGP) Project for the north side of Brisbane to Spiritus Anglican Refugee and Migrant Services (Spiritus ARMS).

The aim of the SGP is to fund services that help clients to become self-reliant and participate equitably in Australian society as soon as possible after arrival. Spiritus ARMS has designed the program to improve access to mainstream services for humanitarian entrants through orientation to Australian services such as group information sessions (Learning Circles). Community development is facilitated by activities such as driver education, sewing classes and the establishment of a community garden. All activities are designed to develop life skills and overcome social isolation for refugees so that they may have a better life in the future. One of the Refugee Community groups who has participated enthusiastically in the program has been the Karen community. And for the purposes of this paper and examples of partnering with TPCH MWG, the Karen community needs and their progress into Brisbane life is addressed. History of the Karen people Karen is a group of ethnic people who make up approximately 7 percent of the total Burmese population of approximately 50 million people (Radnofsky, 2008). Karen life, both in their own mythology and historical reality, is pervaded with persecution. For years, the Karen have been victims of a vicious and sustained campaign at the hands of successive regimes in Burma to destroy their ways of life and hopes of democracy and self-determination. Since the 1970s various governments have attempted to isolate the movement and its supporters by bombing their villages, cutting them off from food, information and financial support and forcing them from their homes. There is no end in sight to the suffering of the Karen people inside Burma (McDonald, 2006. Refugees prepare for new life in Australia. ABC News AM Transcript). The Armys brutality has forced thousands of Karen to flee their villages. Most of them have trekked up mountains and through thick jungles to come to the refugee camps on the northern Thailand border. Many Karen have been killed or raped, while others have been imprisoned without trials. Many of the Karen people who have settled in Australia have lost a parent, sibling or other relative (McDonald, 2006. Refugees prepare for new life in Australia. ABC News - AM Transcript). Settlement in Brisbane Karen people are recent arrivals to Brisbane but already, more than 300 families have resettled in Brisbane as of 1 January 2009 (MDA Community Profiles, 2009). Like most refugees, the Karen are trying to gradually deal with the effects of their experiences in Burma. Reportedly, they may experience trouble with sleeping, nightmares, worries and depression. They long for the land and culture they left behind. Years spent in refugee camps or isolated in border villages have also lead to some health problems.

A sense of anxiety, lack of self- esteem and the ability to make even small decisions to manage their lives has been recognised when discussions and feedback have taken place in the group information learning circles for the Karen participants. As a result of this feedback, the Spiritus Project Manager invited the MMHC from TPCH to provide (1) general information on how to access help from Metro North Mental Health Services which was delivered in 2007 and (2) to run a workshop on relaxation techniques in 2010. Throughout the project an emphasis has been placed on health and well-being, eating well, being active and learning to cope with stress. The relaxation workshop on How to relax and not worry included the participants drawing pictures of what makes them happy and what makes them worried and they discussed how they felt in both cases. This workshop was conducted in Karen language by having the Karen interpreter. Participants knowing each other very well shared their feelings openly. Their reports are presented in Table 2 below. Table 2: Worries and happy feelings as reported by participants
Worries about: - Not having a house and having to move quite often - The language barrier not being able to express themselves - Finding the right place/reception/lift/floor etc at the hospital. We know the address but cannot find the right floor or rooms. We are scared to press the button for the lift. - Their children getting ill and not knowing what to do. - Children walking to school especially on busy roads. - Heavy traffic and their children crossing the road. - Centrelink payments being late and not being able to pay the rent or buy food. Happy feelings: - Listening to music - Dancing Sometimes I dance by myself - Friendships Friendship has helped my marriage - Childrens birthdays and their friends come over to play. - Watching flowers in the garden - Trees and green grass

A discussion followed where it was explained what is a normal worry and what is an irrational worry with the acknowledgement of their currently experiences as quite normal and expected experiences in the new country. Another workshop will be held on problem solving skills. Education is a big issue for both parent and Karen children and almost all of them want more education so group sessions on how to gain new skills are warmly embraced. Many seek computers and tuition to develop their skills for themselves and their children. Whether it is attending classes on how to use industrial sewing machines to gain work skills, driving instructions classes, community garden classes, group information sessions or events to break down social isolation, the Karen people want to learn as they prepare for their new life in Australia.

Concluding comments Table 3: TPCH MWG members feedback

External/community members: Mental health staff: - I like the e-mails that provide various - ACT like to hear about new resources, information on multicultural mental health. particularly relating to accommodation, I usually forward these to my network. new NGOs, multicultural specific services, - Contacts with other government and nonGPs and bulk billing services. government organizations are very useful. - This is a really good group. The - Value the information on refugees and information provided is up to date. You specific information on Rohingya and are doing a good job by being proactive Burmese communities. and easily accessible. The meetings are - The meetings are organized very well. interesting and very useful. Like the - Discussions are nicely controlled by the information about the new multicultural chairperson. groups in the area. At the meetings, - Seeking participation from more NGOs. everyone has the opportunity to talk which - Current meeting time does not suite me. is a really good practice. Morning time would be better. - Case presenting identifying linkages. - Value our cooperation. - Example of partnership models. - I enjoyed the meeting it is the only - Lessons learned. meeting I have come away from feeling - I have found the group very useful when I totally at home in. have been able to attend. I find the emails - I found the MWG meetings very from the chairperson that includes multiinformative and a very good source of cultural resources very helpful and I developing networks and providing a attempt to include this new knowledge and platform of learning and referral pathways information in my education sessions. to better support CALD clients. - The timing of the group is not always - You are the first person who brought convenient as I do not always have the community to TPCH. staff able to cover up for me if I attend the mtg. Perhaps the venue closer to the hospital will work out better; however, it is all good, we really needed the position such as yours. - Regular review of membership list and members to ensure list is up to date.

Both, external and internal members like the meetings as well as group e-mails providing the information and resources on various multicultural mental health issues and new multicultural groups and services in the area. Both groups value networking in between government and non-government sector. They see the meetings as a good platform to learn and establish pathways for referral and advice when considering mental health needs of people from CALD backgrounds (Australian Health Ministers, 2009). Both groups identified some incompatibilities regarding the meeting times and venues. External members prefer the venues located in the community while internal members would rather attend the meetings somewhere closer to the hospital. No doubts that the lack of parking availability at the hospital grounds plays a major role in those differences. While experiencing parking difficulties, the community members readily acknowledged the importance of reducing the stigma relating to mental illness

by coming to the meetings at the Mental Health Unit of TPCH. Further, internal members greatly value community input and everyone having the opportunity to talk. Facilitation of such diverse group of participants and balancing community vs. mental health staff input has been one of the major challenges experienced by the MMHC as TPCH MWG chairperson. At the same time, this challenge was the most popular reason for participants to come to the meetings and share their ideas and experiences while celebrating diversity. TPCH MWG community consultation model has achieved a lot in the past 2 years as evidenced by a number of collaborative activities described in this paper. However, there is more to be done to develop strategic partnerships with the government and community organisations to build individual and community resilience and well-being (Standard 6 of the NSMHS) and to provide the continuity of care for chronic patients with mental illness so that consumers can move between services as their needs change (Commonwealth of Australia, 2006, p.213).

Acknowledgements To all TPCH MWG members for their active participation, enthusiasm and commitment. A special acknowledgement to Keryn Fenton, the Operations Director of Metro North MHS - TPCH for her membership, expert advice, impressive leadership and ongoing support provided to TPCH MWG members and the MMHC.

References Australian Health Ministers. (2009). Fourth National Mental Health Plan. An Agenda for collaborative government action in mental health 2009-2014 (Draft). Fourth National Mental Health Plan Working Group. Australian Government. Canberra. Carling, P. (1995). Return to Community Building Support Systems for People with Psychiatric Disabilities. New York: The Guildford Press. Chapter 2 Foundations for a New Approach. Commonwealth of Australia. (1996). National Standards for Mental Health Services (NSMHS). Canberra: Australian Government. Commonwealth of Australia. (2006). A national approach to mental health from crisis to community; First Report. The Senate Printing Unit, Parliament House. Canberra. McDonald, P. (Reporter). (2006, July 8). Refugees prepare for new life in Australia. ABC News - AM Transcript. Multicultural Affairs Queensland. (2010). Queensland Multicultural Resource Directory 2009. Multicultural Affairs Queensland. Brisbane. Multicultural Development Association (MDA). (2009). Community Profiles. Presentation given at MDA conference on 23 May 2009. Brisbane. Queensland Government. (2005). Sharing Responsibility for Recovery: creating and sustaining recovery oriented systems of care for mental health. Queensland Government. Brisbane. Queensland Government. (2007). Queensland Health Strategic Plan for Multicultural Health 2007- 2012. Queensland Government. Brisbane. Queensland Government. (2008a). Queensland Plan for Mental Health 2007-2017. Queensland Government. Brisbane. Queensland Government. (2008b). Referral Guide for Culturally Appropriate Assessment and Treatment. Queensland Government. Brisbane. (Available from the QTMHC, Macgregor, Queensland). Queensland Government. (2009). Cultural Competency Standards and SelfAssessment Guide. A guide to assist mental health services to implement the Cultural Competency Standards. Queensland Government. Brisbane. Queensland Government. (2010). Mental Health Act 2000. Queensland Government. Brisbane. Radnofsky, L. (2008). Burmese rebel leaders shot dead. The Guardian. Retrieved (8 March 2008), from: http//www.guardian.co.uk/world2008/feb/14burma

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The Prince Charles Hospital Consumer Advisory Group (TPCH CAG). (2010). TPCH CAG Terms of Reference (Version 2.10), Metro North Mental Health Service TPCH, Brisbane. (Available from TPCH, Chermside, Queensland). The Prince Charles Hospital Multicultural Working Group (TPCH MWG). (2010). TPCH MWG Terms of Reference (Draft), Metro North Mental Health Service TPCH, Brisbane. (Available from TPCH, Chermside, Queensland). The Senate Community Affairs Committee Secretariat. (2008). Towards recovery: mental health services in Australia. The Senate Printing Unit. Parliament House. Canberra. Thornicroft, G., Becker, T., Knapp, M., Knudsen, H.C., Schene, A., Tansella, M. & Vasquez-Barquero, J.L. (2006). International Outcome Measures in Mental Health; Quality of life, needs, service satisfaction, costs and impact on carers. London: Gaskell. Townsend, C., Whiteford, H., Baingana, F., Gulbinat, W., Jenkins, R., Baba, A., Mak, F. L., Manderscheid, R., Mayeya, J., Minoletti, A., Mubbashar, M. H., Khandelwal, S., Schilder, K., Tomov, T. & Deva, M. P. (2004). The Mental Health Policy Template: domains and elements for mental health policy formulation. International Review of Psychiatry, 16(1-2), 18-23. Whiteford, H.A. (1994a). The first National Mental Health Report. The Medical Journal of Australia, 161(4), 438-440. Whiteford, H. (1994b). Intersectoral policy reform is critical to the National Mental Health Strategy. Australian Journal of Public Health, 18(3), 342-344.

11

Paper title: The Prince Charles Hospital Multicultural Working Group as the Community Consultation Model

Authors: Bozica Stumfol, Sharon Stocker and Anne Gooley Bozica Stumfol: Multicultural Mental Health Coordinator & TPCH MWG Chair Metro North Mental Health Services TPCH Aspley Community Health Centre, 776 Zillmere Road ASPLEY Q 4034 bozica_stumfol@health.qld.gov.au antigona55@yahoo.com.au

Sharon Stocker:

The Chair of TPCH Consumer Advisory Group tpchcag@gmail.com

Anne Gooley:

Project Manager, Resettlement, ARMS Refugee & Migrant Services Spiritus agooley@spiritus.org.au

Abstract The aim of this paper is to describe the Prince Charles Hospital Multicultural Working Group (TPCH MWG) at Metro North Mental Health Services, as an example of good practice in consulting and forming partnerships with the culturally and linguistically diverse (CALD) communities and various government and nongovernment organisations that work with CALD communities. The benefits of the community consultation model formed through the work of TPCH MWG is described in the context of facilitation of culturally responsive mental health care to consumers, their carers and families from CALD backgrounds as per objectives identified by this group. A special consideration is given to successful cooperation with TPCH Consumer Advisory Group in the provision of various health promotion activities across the district and Spiritus Anglican Refugee and Migrant Services in the provision of health literacy, information and education sessions to Karen speaking communities in TPCH catchment area. Examples of TPCH MWG activities are linked into contemporary multicultural mental health literature and policy documents including Queensland Health Strategic Plan for Multicultural Health 2007-2012, Queensland Plan for Mental Health 20072017, The Fourth National Mental Health Plan An agenda for collaborative government action in mental health 2009-2014 and National Standards for Mental Health Services. Key words: mental health, consultation, health promotion, health literacy, diverse communities

An overview of TPCH MWG The TPCH MWG was established in April 2008 through the position of TPCH Multicultural Mental Health Coordinator (MMHC) as part of a state-wide multicultural mental health program recurrently funded and coordinated by the Queensland Transcultural Mental Health Centre (QTMHC). The role of the MMHC is to facilitate the development of a culturally responsive Mental Health Service (MHS); liaise and provide clinical consultation to clinicians on issues relating to culturally appropriate service provision; provide information and resources; and collaborate with other key service staff in the development and implementation of plans, policies and procedures relating to the service provision to culturally and linguistically diverse (CALD) consumers and to network with various local multicultural groups and organisations. From December 2007 until March 2008, the MMHC identified relevant government and non-government agencies in TPCH geographical area that work with people from CALD backgrounds to form TPCH MWG. Community members have been nominated through the main interagency networks. The first two meetings were attended by both government and non-government agencies, external to our MHS. Mental health staff joined this group in August 2008, at the point of the third MWG meeting. Current membership comprises of 28 members (18 external and 10 internal members). External members are the representatives of the various community organisations including neighbourhood centres, migrant and resource centres, housing agency, settlement service and TPCH Consumer Advisory Group (CAG). Government agencies include the representatives from Centrelink, Queensland Police Service and Department of Immigration and Citizenship (DIAC). Internal members are case workers, nurse unit managers, team leaders and service directors. TPCH MWG meetings are bi-monthly, chaired by the MMHC. Review of the meeting attendance shows that between 7 to 21 members attend the meetings with an average number of 13 participants per meeting. Partnerships and community consultation model The importance of linkages with the government and non-government/community organisations has been recently highlighted in the Fourth National Mental Health Plan. An agenda for collaborative government action in mental health 2009-2014 (Australian Health Ministers, 2009) and in a number of other policy documents including National Standards for Mental Health Services (NSMHS) (Commonwealth of Australia, 1996), Queensland Plan for Mental Health 2007-2017 (Queensland Government, 2008a) and Queensland Health Strategic Plan for Multicultural Health 2007 - 2012 (Queensland Government, 2007) as working in partnership with multicultural and community sector. TPCH MWG facilitates the development of partnerships in three layers of consultations: government - non-government, government government and nongovernment - non-government. All three layers of consultations are equally important in order to maintain and progress appropriate referral, liaison and engagement strategies for CALD consumers as per Standard 8.3 of the NSMHS. Perhaps more attention is given to non-government and community sector as having a key role in

providing non-clinical personal care and other flexible supports to people living with mental illness, families and carers (Queensland Government, 2008a, p.23). TPCH MWG community consultation model also contributes to building capacity of community organisations to assist and support people with mental illness to live full and meaningful lives in the community and access stable housing, income support, education and employment and sport/recreational activities as suggested by Carling (1995), Townsend et al. (2004), Whiteford (1994a) and Whiteford (1994b). Purpose and objectives of TPCH MWG The general purpose of TPCH MWG is to facilitate culturally responsive mental health care to consumers and their families from CALD backgrounds and to support the development of the MMHCs role. For this reason, TPCH MWG has committed to a number of objectives as outlined in TPCH MWG Terms of Reference (2010). Objectives and examples of collaborative activities are listed in Table 1. Table 1: Objectives and examples of TPCH MWG activities
Objective 1. Identify priorities related to CALD issues and implement strategies to address these issues. Actions: - Group members regularly share the information on needs and issues expressed by migrants and refugees settling in the area. The MMHC forwards this information to the service executives, QTMHC and Refugee Health Reference Committee for a further collaborative action. - Housing difficulties experienced by CALD population are often discussed as an agenda item. This information is fed back to relevant stakeholders responsible for housing issues. - Referral pathways to community agencies for follow up and support for CALD population are clarified and updates are provided regularly. - Changes to Family Tax Benefit and other Centrelink information are made known to the members of this network. Objective 2. Act as advocate for CALD consumers their carers and families. Actions: - Provision of logistic support to multicultural community organisations including the letters of support to MWG partners when putting in for funding application for CALD programs. - Consumer/carer consultant and CAG members attend the meetings and provide updates on the issues impacting on CALD consumers, seeking input and support from other members. CALD members of the CAG are included and share the information and concerns in the community. - New mental health teams such as Transitional Discharge Team and Consumer Support Program are introduced to members. - The Mental Health Inventory is translated in 14 languages and is easily accessible on TPCH Intranet Site to ensure that clinical outcomes are appropriately recorded for CALD consumers as suggested by Thornicroft et al. (2006, p.13). - Privacy and confidentiality is maintained at all times as per Standard 5 of the NSMHS. Objective 3. Share the information and provide opportunities for education and training across the government and non-government sector in TPCH catchment area. Actions: - Bi-yearly review of TPCH MWG meetings recorded twelve meetings including 14

presentations, information sharing, consultations and discussions on various multicultural mental health topics. The topics include presentations on multicultural data collection, history of multicultural mental health in Queensland, utilisation of MHS by CALD population, the type and effectiveness of support provided by settlement services in the area, reports from the various seminars and conferences, cultural information on Italian seniors, introduction of new programs such as respite program for CALD carers and ongoing identification of training needs. - TPCH MWG organised a special multicultural training for its members to include the topics on: Diverse needs of CALD population in the district as perceived by the representatives of community/neighbourhood centres; cultural factors in mental health (presentation from the QTMHC) and presentation from TPCH Acute Care Team to explain pathways to mental health services. - Regular distribution of the information on multicultural mental health resources and upcoming training from the QTMHC. Objective 4. Assist in development, application and review of policies and procedures aimed to build cultural competency of the MHS workforce. Actions: - Annual review of the use of professional interpreters in the district. - Ongoing promotion of the on-line interpreter booking system. Since the introduction of the on-line booking system in Qld Health, the interpreters bookings have increased. - Group members have knowledge of the social and cultural groups in the area and participate in the review of Referral Guide for Culturally Appropriate Assessment and Treatment (Queensland Government, 2008b) as per Standard 7 of the NSMHS. - Consultation for the Queensland Plan for Multicultural Mental Health. - Ongoing consultation on Cultural Competency Standards and Self-Assessment Guide (Queensland Government, 2009). - The MMHC ensures that policies and procedures relating to CALD consumers are applied across the MHS. Objective 5. Generate ideas, initiatives and resources relating to CALD consumers their carers and families. Actions: - Regular updates for the Multicultural Clinical Support Resource Folder across the teams. - Dissemination of translated mental health information and other resources. - Provision of translated information relating to Mental Health Act 2000 (Queensland Government, 2010) and patients rights and responsibilities. - Promotion of the Queensland Multicultural Resource Directory (Multicultural Affairs Queensland, 2010) which contains details and contact numbers of diverse ethnic communities in Queensland. Objective 6. Assist the service in responding to Australian Council on Healthcare Standards relating to CALD consumers their carers and families. Actions: - Identification of available community organisations and their assistance in supporting consumers with cultural needs. - Application and review of policies relating to CALD consumers. - Promotion of cultural diversity, social inclusion and mental health. - TPCH Acute Care Team is made known to multicultural communities. - Demographic, linguistic, cultural and epidemiological information on CALD consumers is collected and reviewed annually. - TPCH Interpreter Service Coordinator is a member of the MWG and provides updates on issues relating to the use of interpreters as per Standard 7 of the NSMHS. - Group members provide updates on new languages and interpreters required in the geographical area. - Multicultural mental health training is available to all staff as per Cultural Competency Standards and Self-Assessment Guide (Queensland Government, 2009).

Objective 7. Engage with multicultural communities to reach possible consumer groups, promote mental health and well-being and facilitate equitable access for CALD population. Actions: - Community engagement list containing details and contact numbers of the MWG partners and diverse multicultural community groups in TPCH catchment area is made available to all staff. - Delivery of a mental health literacy workshop to conversational English group at the nearby library. - Regular participation in the collaborative Mental Health Week activities organised across the district. The MMHC spoke about the multicultural perspective on mental illness and recovery at the various interagency forums. In-service on the same topic is planned in October this year (Queensland Government, 2005). - These activities are aiming for increased and equitable access to MHS as per Standard 11.1.5 of the NSMHS.

Strategic partnership with TPCH CAG A number of collaborative mental health promotion activities were conducted in cooperation with TPCH CAG. The role of TPCH CAG is to support and nurture the people living with the conditions of a mental illness and their associated people and carers within the Metro North MHS (TPCH) area so as to empower them to effectively participate in the planning, implementation and evaluation of the MHS and to sustain outcomes using strategies to demonstrate the functions of the CAG (TPCH CAG Terms of Reference, 2010). The operational philosophy of TPCH CAG is to promote a clear communication and articulation of needs and expression of people with mental illness and expand their community involvement. Key functions of TPCH CAG are to advocate, lobby, educate, reduce stigma and raise community awareness in relation to mental illness (TPCH CAG Terms of Reference, 2010). These activities aim to improve the recovery process and subsequently the quality of care and life for all consumers and carers across the MHS (The Senate, 2008). Partnership between TPCH MWG and TPCH CAG resulted in forming another successful collaboration with the Zillmere Community Centre as the most suitable venue for majority of our mental health promotion activities including Harmony Day celebrations, Zillmere Multicultural Festival and Mental Health Week activities over the past 2 years. Apart from networking with a number of community organisations, these joint health promotion activities help in reducing stigma about mental illness in CALD communities by connecting with people, sharing stories and experiences, promoting trust and friendship and disseminating mental health information on the rights of consumers in a number of languages as per Standard 6 of the Cultural Competency Standards and Self-Assessment Guide (Queensland Government, 2009). Strategic partnership with the Spiritus Anglican Refugee and Migrant Services Overview of services provided by Spiritus ARMS for north side of Brisbane The DIAC funded the 2009/10 Settlement Grants Program (SGP) Project for the north side of Brisbane to Spiritus Anglican Refugee and Migrant Services (Spiritus ARMS).

The aim of the SGP is to fund services that help clients to become self-reliant and participate equitably in Australian society as soon as possible after arrival. Spiritus ARMS has designed the program to improve access to mainstream services for humanitarian entrants through orientation to Australian services such as group information sessions (Learning Circles). Community development is facilitated by activities such as driver education, sewing classes and the establishment of a community garden. All activities are designed to develop life skills and overcome social isolation for refugees so that they may have a better life in the future. One of the Refugee Community groups who has participated enthusiastically in the program has been the Karen community. And for the purposes of this paper and examples of partnering with TPCH MWG, the Karen community needs and their progress into Brisbane life is addressed. History of the Karen people Karen is a group of ethnic people who make up approximately 7 percent of the total Burmese population of approximately 50 million people (Radnofsky, 2008). Karen life, both in their own mythology and historical reality, is pervaded with persecution. For years, the Karen have been victims of a vicious and sustained campaign at the hands of successive regimes in Burma to destroy their ways of life and hopes of democracy and self-determination. Since the 1970s various governments have attempted to isolate the movement and its supporters by bombing their villages, cutting them off from food, information and financial support and forcing them from their homes. There is no end in sight to the suffering of the Karen people inside Burma (McDonald, 2006. Refugees prepare for new life in Australia. ABC News AM Transcript). The Armys brutality has forced thousands of Karen to flee their villages. Most of them have trekked up mountains and through thick jungles to come to the refugee camps on the northern Thailand border. Many Karen have been killed or raped, while others have been imprisoned without trials. Many of the Karen people who have settled in Australia have lost a parent, sibling or other relative (McDonald, 2006. Refugees prepare for new life in Australia. ABC News - AM Transcript). Settlement in Brisbane Karen people are recent arrivals to Brisbane but already, more than 300 families have resettled in Brisbane as of 1 January 2009 (MDA Community Profiles, 2009). Like most refugees, the Karen are trying to gradually deal with the effects of their experiences in Burma. Reportedly, they may experience trouble with sleeping, nightmares, worries and depression. They long for the land and culture they left behind. Years spent in refugee camps or isolated in border villages have also lead to some health problems.

A sense of anxiety, lack of self- esteem and the ability to make even small decisions to manage their lives has been recognised when discussions and feedback have taken place in the group information learning circles for the Karen participants. As a result of this feedback, the Spiritus Project Manager invited the MMHC from TPCH to provide (1) general information on how to access help from Metro North Mental Health Services which was delivered in 2007 and (2) to run a workshop on relaxation techniques in 2010. Throughout the project an emphasis has been placed on health and well-being, eating well, being active and learning to cope with stress. The relaxation workshop on How to relax and not worry included the participants drawing pictures of what makes them happy and what makes them worried and they discussed how they felt in both cases. This workshop was conducted in Karen language by having the Karen interpreter. Participants knowing each other very well shared their feelings openly. Their reports are presented in Table 2 below. Table 2: Worries and happy feelings as reported by participants
Worries about: - Not having a house and having to move quite often - The language barrier not being able to express themselves - Finding the right place/reception/lift/floor etc at the hospital. We know the address but cannot find the right floor or rooms. We are scared to press the button for the lift. - Their children getting ill and not knowing what to do. - Children walking to school especially on busy roads. - Heavy traffic and their children crossing the road. - Centrelink payments being late and not being able to pay the rent or buy food. Happy feelings: - Listening to music - Dancing Sometimes I dance by myself - Friendships Friendship has helped my marriage - Childrens birthdays and their friends come over to play. - Watching flowers in the garden - Trees and green grass

A discussion followed where it was explained what is a normal worry and what is an irrational worry with the acknowledgement of their currently experiences as quite normal and expected experiences in the new country. Another workshop will be held on problem solving skills. Education is a big issue for both parent and Karen children and almost all of them want more education so group sessions on how to gain new skills are warmly embraced. Many seek computers and tuition to develop their skills for themselves and their children. Whether it is attending classes on how to use industrial sewing machines to gain work skills, driving instructions classes, community garden classes, group information sessions or events to break down social isolation, the Karen people want to learn as they prepare for their new life in Australia.

Concluding comments Table 3: TPCH MWG members feedback

External/community members: Mental health staff: - I like the e-mails that provide various - ACT like to hear about new resources, information on multicultural mental health. particularly relating to accommodation, I usually forward these to my network. new NGOs, multicultural specific services, - Contacts with other government and nonGPs and bulk billing services. government organizations are very useful. - This is a really good group. The - Value the information on refugees and information provided is up to date. You specific information on Rohingya and are doing a good job by being proactive Burmese communities. and easily accessible. The meetings are - The meetings are organized very well. interesting and very useful. Like the - Discussions are nicely controlled by the information about the new multicultural chairperson. groups in the area. At the meetings, - Seeking participation from more NGOs. everyone has the opportunity to talk which - Current meeting time does not suite me. is a really good practice. Morning time would be better. - Case presenting identifying linkages. - Value our cooperation. - Example of partnership models. - I enjoyed the meeting it is the only - Lessons learned. meeting I have come away from feeling - I have found the group very useful when I totally at home in. have been able to attend. I find the emails - I found the MWG meetings very from the chairperson that includes multiinformative and a very good source of cultural resources very helpful and I developing networks and providing a attempt to include this new knowledge and platform of learning and referral pathways information in my education sessions. to better support CALD clients. - The timing of the group is not always - You are the first person who brought convenient as I do not always have the community to TPCH. staff able to cover up for me if I attend the mtg. Perhaps the venue closer to the hospital will work out better; however, it is all good, we really needed the position such as yours. - Regular review of membership list and members to ensure list is up to date.

Both, external and internal members like the meetings as well as group e-mails providing the information and resources on various multicultural mental health issues and new multicultural groups and services in the area. Both groups value networking in between government and non-government sector. They see the meetings as a good platform to learn and establish pathways for referral and advice when considering mental health needs of people from CALD backgrounds (Australian Health Ministers, 2009). Both groups identified some incompatibilities regarding the meeting times and venues. External members prefer the venues located in the community while internal members would rather attend the meetings somewhere closer to the hospital. No doubts that the lack of parking availability at the hospital grounds plays a major role in those differences. While experiencing parking difficulties, the community members readily acknowledged the importance of reducing the stigma relating to mental illness

by coming to the meetings at the Mental Health Unit of TPCH. Further, internal members greatly value community input and everyone having the opportunity to talk. Facilitation of such diverse group of participants and balancing community vs. mental health staff input has been one of the major challenges experienced by the MMHC as TPCH MWG chairperson. At the same time, this challenge was the most popular reason for participants to come to the meetings and share their ideas and experiences while celebrating diversity. TPCH MWG community consultation model has achieved a lot in the past 2 years as evidenced by a number of collaborative activities described in this paper. However, there is more to be done to develop strategic partnerships with the government and community organisations to build individual and community resilience and well-being (Standard 6 of the NSMHS) and to provide the continuity of care for chronic patients with mental illness so that consumers can move between services as their needs change (Commonwealth of Australia, 2006, p.213).

Acknowledgements To all TPCH MWG members for their active participation, enthusiasm and commitment. A special acknowledgement to Keryn Fenton, the Operations Director of Metro North MHS - TPCH for her membership, expert advice, impressive leadership and ongoing support provided to TPCH MWG members and the MMHC.

References Australian Health Ministers. (2009). Fourth National Mental Health Plan. An Agenda for collaborative government action in mental health 2009-2014 (Draft). Fourth National Mental Health Plan Working Group. Australian Government. Canberra. Carling, P. (1995). Return to Community Building Support Systems for People with Psychiatric Disabilities. New York: The Guildford Press. Chapter 2 Foundations for a New Approach. Commonwealth of Australia. (1996). National Standards for Mental Health Services (NSMHS). Canberra: Australian Government. Commonwealth of Australia. (2006). A national approach to mental health from crisis to community; First Report. The Senate Printing Unit, Parliament House. Canberra. McDonald, P. (Reporter). (2006, July 8). Refugees prepare for new life in Australia. ABC News - AM Transcript. Multicultural Affairs Queensland. (2010). Queensland Multicultural Resource Directory 2009. Multicultural Affairs Queensland. Brisbane. Multicultural Development Association (MDA). (2009). Community Profiles. Presentation given at MDA conference on 23 May 2009. Brisbane. Queensland Government. (2005). Sharing Responsibility for Recovery: creating and sustaining recovery oriented systems of care for mental health. Queensland Government. Brisbane. Queensland Government. (2007). Queensland Health Strategic Plan for Multicultural Health 2007- 2012. Queensland Government. Brisbane. Queensland Government. (2008a). Queensland Plan for Mental Health 2007-2017. Queensland Government. Brisbane. Queensland Government. (2008b). Referral Guide for Culturally Appropriate Assessment and Treatment. Queensland Government. Brisbane. (Available from the QTMHC, Macgregor, Queensland). Queensland Government. (2009). Cultural Competency Standards and SelfAssessment Guide. A guide to assist mental health services to implement the Cultural Competency Standards. Queensland Government. Brisbane. Queensland Government. (2010). Mental Health Act 2000. Queensland Government. Brisbane. Radnofsky, L. (2008). Burmese rebel leaders shot dead. The Guardian. Retrieved (8 March 2008), from: http//www.guardian.co.uk/world2008/feb/14burma

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The Prince Charles Hospital Consumer Advisory Group (TPCH CAG). (2010). TPCH CAG Terms of Reference (Version 2.10), Metro North Mental Health Service TPCH, Brisbane. (Available from TPCH, Chermside, Queensland). The Prince Charles Hospital Multicultural Working Group (TPCH MWG). (2010). TPCH MWG Terms of Reference (Draft), Metro North Mental Health Service TPCH, Brisbane. (Available from TPCH, Chermside, Queensland). The Senate Community Affairs Committee Secretariat. (2008). Towards recovery: mental health services in Australia. The Senate Printing Unit. Parliament House. Canberra. Thornicroft, G., Becker, T., Knapp, M., Knudsen, H.C., Schene, A., Tansella, M. & Vasquez-Barquero, J.L. (2006). International Outcome Measures in Mental Health; Quality of life, needs, service satisfaction, costs and impact on carers. London: Gaskell. Townsend, C., Whiteford, H., Baingana, F., Gulbinat, W., Jenkins, R., Baba, A., Mak, F. L., Manderscheid, R., Mayeya, J., Minoletti, A., Mubbashar, M. H., Khandelwal, S., Schilder, K., Tomov, T. & Deva, M. P. (2004). The Mental Health Policy Template: domains and elements for mental health policy formulation. International Review of Psychiatry, 16(1-2), 18-23. Whiteford, H.A. (1994a). The first National Mental Health Report. The Medical Journal of Australia, 161(4), 438-440. Whiteford, H. (1994b). Intersectoral policy reform is critical to the National Mental Health Strategy. Australian Journal of Public Health, 18(3), 342-344.

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