For culturally and linguistically diverse (CALD) people, the risk of mental health conditions is compounded by isolating factors such as cultural differences, language barriers and the effects of migration. As a result, accessing services that are culturally and linguistically sensitive is essential to providing appropriate support. Being aware of the barriers to care and the services available is important for pharmacy assistants in helping to deliver effective care.
The World Health Organisation defines health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”.1 This means that health doesn’t just include physical health but also needs to be inclusive of mental health and social wellbeing.
Pharmacists and pharmacy assistants are responsible for caring for individuals of diverse ages, gender, ethnicity, socioeconomic status, sexual orientation and health beliefs. Health disparities within different cultures have been documented, demonstrating the need for healthcare providers, including pharmacists and pharmacy assistants, to help increase cultural safety.2 Understanding and cultural respect are essential to providing proficient pharmaceutical care.
In December 2020, the National Suicide Prevention Taskforce produced the ‘CALD Lived Experience Research Final Report’, which found that while it’s important not to group CALD people into the same category, issues of employment, housing, and stigma around mental illness and suicide as cultural taboos were found to be contributing factors towards mental health issues.3
In the absence of culturally appropriate services, members of CALD communities can miss out on suicide prevention services. Further, services can be difficult and confusing to use, because of cultural and language barriers, and awareness may be lacking that services even exist.4
The federal government’s Mental Health in Multicultural Australia (MHiMA) project, ‘Framework for Mental Health in Multicultural Australia’, provides that being culturally responsive must form an integral part of mental health service delivery.5
Data from Mental Health Australia’s (MHA’s) ‘Embrace Multicultural Mental Health’ project shows that:
- Barriers include stigma about mental illness, language barriers, limited knowledge of mental health and the services available.
- Immigrants, refugees, and asylum seekers have lower rates of mental health service utilisation.
- People from CALD backgrounds are over-represented in involuntary admissions and more likely to be exposed to quality in safety risks in care.
Low English proficiency, loss of family bond, racism and discrimination stress of migration and the stress of adapting to a new country, trauma, and limited opportunity to utilise occupational skills contribute to an increased risk of mental health issues in CALD communities.6
The Embrace Multicultural Mental Health project provides access to resources about suicide prevention and mental health for CALD communities.
“Embrace Multicultural Mental Health aims to engage people in CALD communities in a conversation and provide information about what comprises good mental health and where to seek support if needed,” MHA CEO Frank Quinlan said, adding that the project also works with mental health services “to ensure services provide assistance and support that is responsive to the cultural needs of individuals, families and communities”
MHA has partnered with the Federation of Ethnic Communities’ Councils of Australia (FECCA), and the National Ethnic Disability Alliance (NEDA) to deliver the project.
“As in all parts of our society, mental health is a major issue in ethnically diverse communities, which desperately need greater attention,” FECCA CEO, Mohammad Al-Khafaji said, adding that the partnership with MHA and NEDA was launched to deliver the ‘Embrace’ project.
NEDA CEO Dwayne Cranfield says the Embrace project is an important collaboration for many areas of the sector, and “an important addition to our core business of advocating for people with a disability, and their families, from culturally and linguistically diverse and non-English speaking backgrounds”.6
Cultural safety in pharmacy
Pharmacies need to foster a culturally capable and sensitive workforce to promote an environment where customers are comfortable seeking support. Research increasingly supports the facilitation of cultural safety in healthcare settings.
Cultural safety goes beyond cultural competency, as it encourages confronting bias and the inherent power structure integrated within our health systems, according to an article published in the International Journal for Equity in Health. “It seeks for health professionals to challenge their own culture and cultural systems rather than only becoming ‘competent’ in the cultures of others”.7
The Australia Pharmacy Council offers podcasts and webinars aimed at increasing cultural safety in pharmacy education to open up the conversation as to how cultural safety can be embedded within pharmacy.
When spaces are culturally safe, they’re more welcoming. In the pharmacy setting, this means people are more likely to communicate how they’re feeling, disclose mental health struggles, and feel more comfortable accessing mental health medications and asking about their safe and proper use.
- World Health Organisation. ‘Constitution’. 1946. int/about/governance/constitution.
- O’Connell MB, et al. ‘Cultural competence in health care and its implication for pharmacy’. Pharmacotherapy, 2007; 27 (7): 1062-79. net/publication/6243698_Cultural_Competence_in_Health_Care_and_Its_Implications_for_Pharmacy_Part_1_Overview_of_Key_Concepts_in_Multicultural_Health_Care.
- National Suicide Prevention Taskforce. ‘CALD Lived Experience Research Final Report’. 2020. imgix.net/assets/src/uploads/Final-Advice-CALD-Suicide-Prevention.pdf.
- Australian government. ‘Fact Sheet’. 2020. gov.au/sites/default/files/documents/2020/11/mental-health-services-for-people-of-culturally-and-linguistically-diverse-cald-backgrounds.pdf.
- Mental Health in Multicultural Australia (MHiMA). ‘Framework for Mental Health in Multicultural Australia’. 2014. gov.au/getmedia/59a020c5-ac1e-43d5-b46e-027c44b94654/Framework-for-Mental-Health-in-Multicultural-Australia.
- Mental Health Australia. ‘Embrace Multicultural Mental Health project launches’. 2019. org/media-releases/embrace-multicultural-mental-health-project-launches.
- Curtis E, et al. ‘Why cultural safety rather than cultural competency is required to achieve health equity: A literature review and recommended definition’. <itals>International Journal for Equity in Health, 2019; 18:174. biomedcentral.com/articles/10.1186/s12939-019-1082-3.
First published in Retail Pharmacy October emagazine