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We acknowledge the traditional owners of the lens on which this podcast has been produced, and we pay our respects to Aboriginal and Torres Strait Islander peoples and to elder’s past and present.
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Welcome to snack, the aged care podcast where we break down some of the big questions around what it really means to be person centered. This podcast is brought to you by the ethnic communities Council of Queensland, also known as ECC Q, the peak body for multicultural communities in Queensland.
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This episode focuses on mental health for culturally diverse seniors. Not all cultures recognize mental health and well being the same way Western cultures do.
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Wellbeing is more than the individual. It also includes the person’s family, community, and faith. And it’s important to have the right balance of support.
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We will hear about strategies for care workers to approach mental health with respectful curiosity when providing person centered care for culturally and linguistically diverse communities.
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leading the discussion, we have read Duffy from ECC cues multicultural advisory service, and Millie Magarpatta, multicultural mental health coordinator for Queensland Health on the golf course, we start with re talking about sense of control being an important element of mental health for older people.
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The World Health Organization actually talks about the determinants of health.
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They say that the greatest determinant of someone’s health is actually your sense of control, not even having control.
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But your sense of control as the greatest determinant of your health. And what we know in terms of culture and mental health is that if you have that sense of control, that sense of identity, social connections, ability to cope, so the more we can support mental health and any of our seniors lives, and all of us really, but in particular, as we age as things change for us, then the more chance we’ve got that people feel they’ve got their own sense of determination or or sovereignty or a sense of control.
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And also being well acculturated into the Australian community as well is also it gives people a sense of identity as well, because they keep true to their own culture, while also adopting to some of the Australian cultural views. So having a well acculturated approach can also be a contributing factor to promoting good mental well being as well. And Australia, people realize that we’ve all got such different backgrounds. And people cherish the culture of Australia life. And as we’re aging, we might think that the way that we do things is the way that everyone does things. But we know with this change and population, we’re going to find people who’ve got different religious beliefs, or values and faith beliefs. And perhaps they’ve even had experiences that have bought them here to Australia, that many of us would never have had any exposure to.
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And when we’re thinking about people’s well being, and we’re thinking about our seniors and our aged population,
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when the workforce visits people in their homes, or when organizations plan for programs to be offered for our seniors and our culturally and linguistically diverse communities, there is going to be a need to think differently about how we provide those services, isn’t there? Definitely. And I like the fact that you also included the aspect of religion and spirituality as well. And those are some of the things that you know, as workers we may forget to, or we may overlook, and we may not see that as important when we’re working with people from culturally and linguistically diverse backgrounds. And when it comes to working with older people as well, health is seen in a holistic way. It’s not just about the
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that emotional well being. It’s also it includes the physical, the spiritual, and the religious well being so and collectivism and most of the older people that we work with and that I’ve come across as well. They live in a collectivist community as well. And sometimes is the older they get, the more lonely they become, especially with their children who will be busy at work and not having enough time to spend with their families as well. So that could also lead to loneliness as well, which can also be a major risk factor of developing mental illness as well for our older people. Let’s unpack that a little bit. Because mental health is often considered as different things by different people culturally as well as perhaps ideologically. And if we think about mental health and mental well being.
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you’ve alluded to how some cultures see it in perhaps just a mind or mental only space. In some cultures. Also think about it in that holistic way. What’s the goal? What do we want for people in terms of their mental health and well being.
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Before we listen to Millie talk about the goals for mental health and wellbeing for diverse cultures. Let’s look at the difference between the biomedical and explanatory models of mental health.
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The biomedical model for mental health, which is used in western healthcare settings, where the focus is the diagnosis and treatment of illness may not be the best model when working with culturally and linguistically diverse consumers. Instead, an explanatory model is seen as more useful when working with these clients.
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This model was introduced by Dr. Arthur Kleinman, who has worked with diverse cultures. He suggests asking consumers a series of questions to understand the beliefs about their mental illness, and the personal, social, spiritual and religious meaning they attach to the illness. Some cultures might even consider being able to hear voices, or experiencing different times of low mood as not being a clinically negative thing.
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From a cultural perspective, the goal for mental well being how I see it is ensuring that as we talked about that holistic support is available, because the absence of some of those factors that we’ve talked about, it can be family, it can be cultural beliefs, it can be their perception of treatment of health, or it can be spirituality, and it can be even that social connectedness. And an absence of one can be a major risk factor of developing mental illness as well. So it’s important that when coworkers or when people will work with older people, it’s important that we explore that with them. And we actually become curious and not be afraid to ask those questions. That’s one thing that I have seen since working in this in this specialist role, that sometimes workers are afraid to ask and understand the explanatory model of the people that we work with, because they fear that they’re being rude or disrespectful. But it’s being curious. So having that respect for you a respectful curiosity is very much welcomed from almost every older person that I have come across that I’ve worked with, because it shows that we are interested in what is important to them in how they view health and how we can also help support to contribute towards a holistic well being for them. So I think that’s just my encouragement to workers or care workers who work within the aged care sector and you’re working with older people from a culturally and linguistically diverse background because we may not know about every culture and we may not know about other people’s culture unless if we ask them and we understand okay, according to them, what is wellbeing to them, and you will see that you know that there is a lot to learn from rather than just using our definition of the biomedical model
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In telehealth a definition that we know of, but culturally, you can see that mental well being and mental health can have so many definitions that can help us to provide that culturally sensitive and culturally responsive support to the people we work with. I think being curious is probably the number one thing I would recommend to anybody working in Human Services, working in community, and knowing that your intent was there, and curiosity is actually just to be able to know more, so that you can do more.
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I recall a time when I had an inquiry from a service provider, they were concerned about an Asian client they had, he’d stopped eating. And he was starting to talk less and actually almost disengaged, they were quite concerned about him. They hadn’t used an interpreter before. And he reverted a bit to speaking in his own language. So we arranged this into their home. And what had happened was somehow in the assessment, or in the process of providing a care plan for this client,
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his normal cultural foods that he would eat for breakfast had started to be missed out of the shopping list.
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And as it turned out, once we got the interpreter, it was actually just
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simply he wasn’t eating, because he was being given some Western cereals.
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And he didn’t know how to really articulate it, that that wasn’t good for him. But what raised for everyone involved was that by not being able to participate and take part in his cultural rituals, his rice in the morning, how he liked it, and being able to be encouraged to do that, and prepare that for himself,
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that he actually began withdrawing. And mentally, he became very disconnected.
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And I was grateful that the key worker use that curiosity to inquire about that and find a solution that was so person centered. And one thing that the organization took out of that was that they needed to rethink how their cultural assessment was done, or how the assessment at the beginning of the person coming onto the CSP or the aged care journey. So they took some time as an organization to rethink how that looked for them. And later on, in the year, I remember them coming to a training that we ran, and they talked about that as being something that really turned the corner for them as an organization. And I think that that story is probably got quite legendary throughout the organization, but a simple thing. But because someone asked, and you don’t need another language, you don’t need a knowledge of other cultures for that. It’s actually about prioritizing somebody’s person centered care, and that’s relevant to the relevant to them. Yes, and I think that’s something when we think about mental health, there are many cultures that don’t believe in a medical model around mental health. Some cultures might even consider being able to hear voices, or perhaps experience different times of low mood as being not
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a clinically
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negative thing. But perhaps it’s a time where strength has gained when you go internally, and you consider and ponder and take spiritual steps towards learning something else. In another point as well, when it comes to accessing aged care services as well. There is a greater fear amongst older persons communities, that they are going to be put in residential homes. And also with that fear of government services as all government organizations, even though they know that, okay, they need the help, they are reluctant to seek out that support because of that fear. So, for example, it will be good for them to have that awareness that you know, besides viewing aged care services as being put in a in a nursing home, there are other services like that the aged care service sector can also support our elderly to continue living independently in their houses. I have an example of
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an older person I was working with, they were facing a lot of barriers. So
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one of the barriers was that they, they were looking after their adult child who was also going through mental illness as well. And the case manager who was working with this elderly person, the first to go to a solution, or recommendation for them was suggesting a nursing home for that elderly person, which made the, which made him disengage from the case manager. And the case manager didn’t understand, okay, now I’m facing this barriers. But this is the best solution for them, given that they don’t have capacity to look after their adult child who is currently going through their mental health issues. So I think in that example, when we explored it together, and when we gave recommendations is that sometimes we tend to think that our solutions are the best for the people that we work with, we tend to impose what we think is right. And I think most of the time is we’re using a western model when trying to provide that support. And usually, that doesn’t work when you’re working with people from culturally and linguistically diverse backgrounds, because obviously, you’re going to face barriers with engagement. It was about looking at it from a different perspective and saying, Okay, we may think that yes, this is the best solution, but have you asked them what they think is best for them?
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Incorporating cultural considerations into your care plans can create good outcomes for culturally diverse communities. Milley suggests that if you’re not familiar with cultures of different clients, to approach them with an attitude of respectful curiosity.
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what can organizations and care workers do? Going into people’s homes from different cultures? What? What can they think about doing that will increase? You know, the good outcomes we want to have for people? The first thing that I can say it’s okay not to know about all the cultures. And for them not to be afraid to ask those questions, as long as it’s respectful, and it’s respectful, respectful curiosity.
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And people are really happy to share what is important to them what values and beliefs are important to them, that they feel that they need to be incorporated in their treatment or in their care. So for example, when we are doing assessments, taking time to check, okay, the languages of people to, to offer an interpreter is we may assume that if someone just speaks conversational English, we don’t need to book an interpreter. We’ll just wing it. But sometimes we may think that people understand what we are saying. And but it’s sometimes you know, in some cultures, nodding people may not and we think, oh, yeah, they’re understanding what I’m saying. But it’s just a sign of respect, they may not be getting what we are saying, and from a health system looking at a lot of jargon that is used in the health sector as well. And if you are going to
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use that jargon with people who have English as their second language, it’s also going to create barriers. So it’s important to make sure that even
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even when people speak
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English as their second language, just offering them that interpreter so that they they’re able to express themselves, clearly and comfortably in their own languages as well. And also, when we are assessing, it’s important to understand the explanatory model of the people we’re working with. So what do they think is going on for them? Also, maybe looking from a mental health perspective, okay, we may you may have been diagnosed with depression or with anxiety, or with schizophrenia, but that’s our biomedical model, a diagnosis but according to you, what is so giving them that power to share what they think is going on to them? And so what also what do you think is going on for you? Has that ever happened to you before or to anyone within your community?
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to your family, and if it has, what kind of help or treatment worked, it can be traditional, it can be religious, and it can be cultural, what helped, and if some, if they believe that, okay, maybe prayers from an Imam, or maybe prayer, prayers from a priest help, is that something that we can also incorporate in their care alongside, you know, some of the care and treatment that we’re providing them. And to make sure that, you know, our care plants, or our treatment plants are holistic, and they have those cultural considerations put in place.
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Ri and Millie now share some practical tips for care workers who work with culturally and linguistically diverse communities.
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I’ll start, I’m thinking about how care workers could potentially just understand which culture the persons coming from that they’re visiting. And perhaps they could learn a greeting from that language. Yes, another important thing is offering an interpreter or exploring interpreter use and even for the clients also to be aware that they know that they can also access that translating and interpreting services for free and a practical tip for coworkers is around religion exploring the religion of the people that they work with, because it helped the consumers navigate the times that were appropriate for them that didn’t interfere with their prayers or with their, like religious customs that they do during the day to resources that might be useful. Also, there are a number of multicultural calendars available and we can pop those in the show notes. In the others, the ethnic communities Queensland, in the multicultural advisory service has a resource available, we can pop in the show notes as well called The Little Book of cultural tips. And in that book, it gives a couple of examples of going into the home, preparing to go into the home, how you might conduct yourself while you’re there, from a really multicultural supportive way, and also follow up and anything else you might need to think about when you’re going in and out of different people’s homes.
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We have just heard about why it matters to be curious and ways to be respectfully curious when dealing with mental health of culturally diverse Eneas. Respectful curiosity is asking and knowing about the consumers cultural, spiritual, and religious values and how they would like to be helped and cared for.
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care workers could also offer professional interpreter services when needed, and holistic support involving clients family, community and religious organizations. During the episode read refer to the little book of cultural tips which is a resource produced by ECC Q’s multicultural advisory service, and it has tips on how to provide a culturally appropriate service.
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The link to this resource, as well as other resources relevant to this episode are included in the show notes.
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Join us for the next episode of snack to hear more about caring for culturally and linguistically diverse people.
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Funding for this podcast has been provided by the Council on the aging Queensland homecare workforce Support Consortium as part of the homecare workforce Support Program, which is funded through grant funding from the Australian Government
