Abstract
Between July 2002 and June 2007, the catchment area of Mercy Mental Health was the place of residence for 8% of Victoria's total adult humanitarian arrivals originating from the Horn of Africa [1].
The Consultation and Partnerships team of Mercy Mental Health, who provide a consultation-liaison service to general practitioners within the catchment area, became aware that few referrals were individuals from the Horn of Africa. The team acknowledged that the first contact with mental health services for many is via acute services. To explore this further, and in an attempt to identify possible barriers to these individuals getting effective treatment for mental health issues in the primary care setting, a project team was developed. The Mercy Mental Health bilingual (African) case manager provided a general overview of this community and existing issues. Initial ideas to target this community ranged from a structured group for African men, to providing education sessions to GPs. A structured data collection tool was developed, and several months in 2009 were spent meeting with African community leaders and agencies.
Acceptance/stigma regarding mental health issues among this community was significant. Community education was needed regarding mental health/illness, but the focus needed to be directed towards ‘physical health and healthy living’. Preventative services were lacking, and GPs and mental health workers needed to be aware of the African culture and experiences to be able to deliver culturally sensitive care. A lack of recognition of symptoms of mental illness by GPs, meant physical symptoms were often misdiagnosed. Communication was difficult, with a lack of interpreter availability/use, and limited translated written material. Establishing rapport and trust, and providing support, initially one-to-one, was important. A strong sense of ‘community’ within this culture was highlighted, with the feeling of ‘disconnectedness’ significant. The need for practical activities/support was reinforced, and partnering with existing agencies/services was deemed important. The idea of a group for African men was posed to the leaders and service providers; however, this was not the recommended starting point as it was necessary to develop trust and rapport one-to-one initially, and a structured approach was unlikely to succeed as regular attendance could not be expected. Practical support and flexibility was deemed very important.
In discussing the most effective and feasible methods of beginning to address the identified gaps, initial plans seemed unrealistic, utilizing existing resources, and the team wanted to be involved in something sustainable. Initial ideas of a group or provision of education sessions to GPs, did not appear realistic or feasible. Ultimately the team opted for a sustainable means of beginning to address the identified gaps, which included developing partnerships with existing services, through promotion of mental health assessment and a user-friendly referral process, and an increased presence in local forums.
Although the project team felt initial ‘grand plans’ had been down-graded, there was acknowledgement that what was perhaps a simpler intervention was indeed the most sustainable and feasible considering existing resources. The process is ongoing but remains challenging.
Actively investigating the needs of a newly emerging community is a novel approach for a primary mental health team. The findings of this small scale project suggest that the mental health needs of individuals from newly emerging communities could potentially be neglected in the primary care setting, warranting larger scale research to investigate further.
Also, there are perhaps untapped support services available via primary care. Bassilios [2] explored the impact of the Access to Allied Psychological Services projects (ATAPS) introduced in 2001, and the Better Access to Psychiatrists, Psychologists and GPs, introduced in 2006, via the Medicare Benefits Schedule, finding that these two Australian government reforms in primary mental health were complementing each other in meeting the need for mental health care in the primary care setting. Perhaps implementing additional Medicare funded services targeted specifically at newly emerging communities, experiencing acculturation issues is warranted. However, as identified, accessing support remains an issue to be addressed along side the availability of appropriate targeted support.