Mental Health in Multicultural Australia

Australia is a country of many cultures. During your time working here, it is inevitable that you will treat patients from culturally and linguistically diverse (CALD) backgrounds. In 2003, 23.4% of the population was born overseas (ABS, 2005), and one in three Australians has a culturally and/or linguistically diverse ancestry. People have come to Australia from 140 nations around the world, and more than two million Australians speak a language other than English at home (Ferguson, 1994). 

In Australia, doctors are also a culturally diverse group, adding to the rich interplay of cultures in interaction with patients (Bennett et al., 2005). Culture influences all aspects of mental health and mental illness, including how it is understood and explained, its experience and manifestation, its course and epidemiology, and its diagnosis and treatment.

Mental Health in Australia's indigenous populations

The Indigenous cultures of Australia are broadly divided into two main groups: 

• Aboriginal
• Torres Strait Islander

Aboriginal

Refers to any of the cultures and people from the Australian mainland. Although accepted as a general definition, this covers many distinct groups (e.g. Aranda, Warlpiri, Worimi, Yorta Yorta). 

Individual groups are usually referred to as “nations” rather than “tribes.” There are also a number of regional words that are used generically by Aboriginal people to indicate their ethnic identity. For example: Koori – Victoria / South-Eastern Australia Murri – Queensland Nyungar – West Australia Yolngu – Northern Territory These words are region-specific and can either refer to an Aboriginal person from that region or be used as an adjective (e.g. a Koori health worker). 

Torres Strait Islander 

Refers to cultures and people originating in the islands of the Torres Strait (e.g. Muralag, Saibai, Badu) and the northern tip of Cape York. Torres Strait Islander culture has similarities to those of Aboriginal Australia and Papua New Guinea. Because many Aboriginal people live in rural or remote areas, they often have difficulty accessing health services, particularly specialist services. 

Young men in custody are a particular concern. It is estimated that up to a quarter of young Aboriginal men have had direct involvement with the correctional services and young Aboriginal men currently represent 22% of the total Australian prisoner population (Krieg, 2006). Incarceration can be both a risk factor for, and a result of, psychological problems. People of all ethnic backgrounds are three times as likely to suicide if in custody (AIHW). For many Aboriginal people, naming the dead, or showing pictures of deceased people, may be deemed offensive if the family are still in mourning. 

You may notice that Australian films or television shows that include images of deceased Aboriginal people will have a warning that some viewers may be offended, in deference to this custom. It is not uncommon for people who share a name with a deceased person to use another name for the duration of mourning. 

Self-harm in Aboriginal clients In some traditional Aboriginal societies, initiation rituals can involve scarring and other activities which might be considered self harm. Presence of these scars should not necessarily be taken as a symptom of psychological morbidity, as they are associated with standard cultural practice.