According to the “Provincial Diversity Needs Assessment Report, Centre for Addiction and Mental Health, CAMH, 2004 report, service providers across the province indicated that many clients do not receive the health care they need, this problem is even worse for diverse communities, because of their unique needs and the additional systematic barriers they face in accessing services… most agencies that provide settlement services to new immigrants and refugees do not have the capacity to recognize and deal with clients’ mental health and/or addiction problems. In addition, service providers often have difficulty referring non-English speaking clients for treatment, because very few facilities provide interpreters and/or programs and services in languages other than English.
In the same report, the shortage of culturally competent health care professionals, as well a general lack of cross-cultural understanding as a significant barrier to accessing services was indicated, participants in focus groups pointed out that there is relatively few primary health care workers and professional trained in regards diversity and cultural differences. They also stated the need of appropriately trained doctors, nurses and other health care professionals. Members of ethno-racial and cultural diverse communities indicated that their cultural and linguistic needs are not acknowledged or taken into consideration in the provision of treatment or services. Most felt the need to express themselves, in their own language and in a culturally appropriate environment, to health professionals who could understand and respond in their language. Many focus groups viewed racism and homophobia not only as significant barriers to service access but also as major contributors to lack of care, to inappropriate and improper care, and indeed directly to an increase in addiction and mental health problems. Racism was identified as one of the barriers that prevent members of ethno-racial and cultural diverse populations from accessing mainstream services.
It was also noted in the above mention report by focus group participants, that in communities where casinos operate, there s an increased in mental health and addiction problems, with few new resources to address them. Participants also noted the lack of community leadership, cohesion and inclusiveness, lack of funding and low policy priority, as well as lack of attention to social determinants of mental health and addiction affecting diverse communities.
To reduce gaps in services, the following are some of the recommendations that most focus groups participants noted were more important:
- Provide culturally and linguistically appropriate programs and services and resources
- Development of more specific materials that are culturally appropriate, clearly written, removing clinical jargon, and in different languages, to inform diverse community about mental health and addiction education and services
- The use of community radio, videotapes, cable TV, churches and religious institutions, as important routes for education, health promotion and communication.
- Provide alternative approaches to mental health and addition services, such acupuncture, yoga, meditation, etc. vs too westernized and medication-focused existing programs
- Re-train and hire foreign-trained physicians and other professionals
- Share information among service providers that pertains to diversity, including inter-community best practices
- Develop public awareness and media campaigns to reduce stigma in diverse communities.
- Reach out and engage in partnerships with ethno-racial and cultural diverse populations
As A. Blaszczynski, concludes in his article “Gambling Problems in a Multicultural Society”, of a research done in Australia, “In order to achieve better outcomes for ethnic clients, therapists must accommodate cultural differences and specific cultural needs of ethnic clients. The cultural background of ethnic clients provides hem with a context for actions and interactions with other. This context will have embedded in it culturally based beliefs, values, attitudes and role requirements. Awareness of the influence of culture will allow therapists to gain more relevant information from ethnic clients by asking more appropriate questions and allow for more culturally appropriate interventions.”
These practices must include:
- Developing partnerships and/or coalitions
- Prevention and awareness programs
- Counselling in various languages
- Language- specific publications
- Increased collaboration with service agencies working specifically with ethno-cultural groups, especially with Multicultural Centres and/or settlement service agencies. Groups in Ontario
In my successful working experience with members of ethno-cultural communities and their families, I have learned that attitude is more important than knowledge. Our attitude can open the doors to connect and create a bond with our clients in receiving the message properly and engage in treatment, or it can block communication at both ends. It is essential to form an essential culturally competent relationship with our clients. Learn about your individual clients customs such as eye contact, greetings, what is permissible and what it is not, and how is the family decision making process. Working in partnership and/or very closely with ethno-cultural communities is a key element for developing effective and alternative mental health practices to address the issue of problem gambling. Building successful and lifetime alliances with ethno-cultural clubs and organizations, Multicultural Centres and other agencies serving newcomers are very important to build trust and be able to engage members of these communities
These are Tips that I used when working with members of ethno-cultural communities
- Have a map of the world
- Learn about your own culture and ethnicity
- Enhance your office space with poster/articles/ornaments from other cultures
- Speak with clear and simple language
- Be aware of your body language
- Be aware of your client’s body language
- Introduce yourself
- Place special attention to your client name
- Place strong emphasis on confidentiality
- Avoid gambling and/or medical lingo, abbreviations,
- Be aware about your own biases and fears
- Be respectful always
- Be flexible
- Show patience
- If need be, please allow the presence of another family member in the counselling session, just as a support party, not as an Interpreter
If there is need to use an Interpreter, always look for the Interpreter Services and or Cultural Interpreting Services in your community. These professionals are highly qualified, abide by a code of ethics, and most likely their particular language is their mother tongue, which will benefit the dynamics of the session. Their role is to facilitate accurate communication between people of different languages and cultures. Avoid using family members, friends, or people who work in your organization and that have the language but not the training, certification, competence, fidelity, and impartiality as a Certified Interpreter. This practice can cause confusion, waste of time, and extra stress for the client and service provider. Place strong emphasis in the confidentiality of the services.
Please follow the below guidelines when using an Interpreter
- Make sure you have your client’s permission to use and Interpreter
- Meet with Interpreter and/or Cultural Interpreter in advance to clarify roles
- Allow extra time for session
- Speak directly to your client
- Speak clearly and in shot sentences using plain language
- Avoid the use of jargon, Abbreviations or acronyms
- Provide clarification and explanation
- Make sure that the message that you intent to convey is understood
- Try to use alternative, inclusive holistic approaches to treatment
- When using assessment tools, remember that some people may have subjected in the past to interrogation methods, and being questioning may increase stress and fear
- Make sure that client understood time and date of next meeting
- At all times and circumstances be respectful
- Thank your Interpreter and client
- Debrief session with Interpreter after client is gone, if need be
- Evaluate your session
- Evaluate yourself
- Provide professional training and resources focusing in education in cultural competency anti-racism and diversity issues as part of in-service and professional development opportunities.