Submission to the Royal Commission into Victoria’s Mental Health System

Submission to the Royal Commission into Victoria’s Mental Health System

18 July 2019

Foundation House has urged the Royal Commission into Victoria’s Mental Health System to address the significant barriers preventing people from refugee backgrounds from accessing culturally responsive, holistic, trauma-informed mental health care.

Our CEO, Paris Aristotle AO, said, ‘People of refugee backgrounds have survived the horrors of war, persecution, torture and trauma. Just as would be the case for any person that had lived through such experiences, refugees and asylum seekers are likely to have a higher prevalence of mental health issues than the general population. In spite of this, their hopes and aspirations are to become positive and productive members of Australian society.’

‘The Royal Commission provides an extraordinary opportunity to ensure that refugees and asylum seekers, who have made Victoria their home, will receive the mental health care they need to rebuild their lives in safety and with dignity,’ Mr Aristotle explained.

Foundation House’s formal submission to the Royal Commission into Victoria’s Mental Health System highlights the barriers faced by refugee communities and calls for the Royal Commission and the Victorian Government to prioritise:

  • Recurrent funding to train, employ and build capacity of people from refugee communities to develop and deliver programs that reduce mental health stigma and improve mental health literacy.
  • The development of a standard for mental health services on trauma-informed care and practice including guidelines for implementation and an independent process for assessing compliance.
  • The preparation of an overarching intersectionality framework for mental health services that promotes responsiveness to the diversities of the Victorian population and takes into account the social determinants of health.
  • Culturally competent and responsive services that includes easy and timely access to professional interpreters and translations when required.
  • Funding for Victoria’s mental health services system that explicitly supports the roles of specialist services in complementing the work of mainstream services.
  • Significantly strengthened data, monitoring, reporting and governance to ensure effective implementation and transparency.
  • The establishment of a research fund for issues critical to assessing continuity of care and the impact of reforms.

Kylie Scoullar, Foundation House’s General Manager of Direct Services, gave evidence at today’s hearing of the Royal Commission into Victoria’s Mental Health System.

Ms Scoullar stated, ‘Stigma is a significant barrier that is widely reported in comprehensive consultations with members of refugee communities. For example, if the words “mental health” are included in the name of a service provider, a person of refugee background will often be reluctant to use that service.’

‘Another element of stigma involves feelings of shame, which cause barriers to engagement. Particularly with respect to young children as parents will often blame themselves for their child’s problems,’ Ms Scoullar explained.

Ms Scoullar said, ‘Fear and issues of trust associated with traumatic experiences involving doctors or authority figures can also be barriers as doctors, in some cases, have been a part of the torture or trauma perpetrated upon the person in their country of origin.’

‘Other contributing factors include a lack of knowledge about mental health services, previous negative experiences with health care professionals and an inflexibility of approach with mainstream services in terms of appointment times and locations, for example if a person is unable to travel,’ Ms Scoullar explained.

Ms Scoullar stated, ‘A number of Foundation House’s proposed recommendations will benefit not only people of refugee backgrounds but many other Victorians who, for example, might not speak English well or whose mental health has been seriously affected by other kinds of traumatic events.’

‘Some of the language used in Foundation House’s recommendations, such as “trauma-informed care” and “cultural responsiveness,” is not new. These terms are well known across the mental health landscape. However, from my experience working from both within mainstream mental health and my observations of our clients’ interactions with it, these terms or practices are not always fully embedded in the culture, processes and systems. Too often, these practices rely on the leadership of particular individuals rather than being a state-wide, systematic requirement,’ Ms Scoullar explained.

Ms Scoullar said, ‘One of the keys to the effectiveness of the work of this Royal Commission will be to what extent the implementation of its recommendations are fully embedded in routine practice and how this is ensured.’

For more than 30 years, Foundation House has provided specialist services to advance the health, wellbeing and human rights of people of refugee backgrounds in Victoria who have experienced torture or other traumatic events in their country of origin or while fleeing those countries. Our work is guided by an understanding that recovery and wellbeing are affected by a complex interplay of pre-arrival experiences and the risk and protective factors encountered by people from refugee backgrounds in Australia.


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