Marginalised communities find it harder to get support
Marginalised communities find it harder to get support
Monash Life | Thriving Communities | So how are you really? | 2 minute read
Dr Anton Isaacs, Senior Lecturer at the School of Rural Health, says the first step is getting the messages through.
The key to understanding and tackling mental health issues, wherever and whoever you are, is information. Whether that’s recognising symptoms, getting help or accessing services, or simply understanding what mental health means, spreading the word is vital.
But in many marginalised communities, those messages don’t get through – with devastating results. The recent Mayi Kuwaya study found that one in three of Australia’s Aboriginal and Torres Strait Islander people have ‘high or very high’ levels of psychological distress.
Statistics show they are a shocking three times more likely to commit suicide than the non-Indigenous population – and a lack of knowledge and education about the issues in those communities may well be playing its part.
Dr Anton Isaacs, Senior Lecturer at Monash’s School of Rural Health, says: “People belonging to a marginalised community, whose culture and language is different, feel so far removed from mainstream society that anything that happens in that space is of little interest to them.
“When the government sends out health information through mainstream media, they might not really understand it or think it’s not relevant to them.” So the message needs to be targeted to the specific community.
Isaacs, who previously designed community mental health programs in his native India, initially came to Monash to undertake a PhD researching the mental health challenges faced by the Aboriginal community and the response of mental health services in the Latrobe Valley in Gippsland, Victoria.
Mindful of the community’s sensitivity to the intentions of outsiders, he first sought to establish trust before exploring the effects of marginalisation on mental health and how it might be addressed.
“When I started asking about depression, one man said: ‘What do you mean? No one’s pressing me down!’ They had no concept of what the word represented. When I mentioned mental health, they said: ‘Mental is those guys we see on the news murdering people. We don’t have those problems.’
“However, when I asked if they had crying spells, felt really down and couldn’t sleep, they’d say: ‘Oh yes, we have all those’, but they believed that was down to diabetes or hypertension. When I explained what depression was, they said: ‘We’ve all got that.’”
Isaacs found that the fact that these issues were so prevalent among Koori men (Koori is a term used for Aboriginal people of South Eastern Australia) was a barrier in itself. “It was accepted as common, so they didn’t make a big fuss about it, and if you did, you’d be told: ‘Come on, you have to be a strong Koori man’, so they’d stop sharing.”
In many cases, their partners would make them go to the GP, but when the doctor referred them to mental health services, that proved a further barrier. “They would find it hard to go, because they’d say: ‘Someone’s going to see you there and then the whole community will know’, says Isaacs.
“If you’re seen at the mental health clinic, it’s that association with the word ‘mental’ again; there’s the stigma attached and people start ostracising you. This stigma is a lot worse in marginalised communities than it is in the mainstream population.”
And even if they get beyond that, the clinic was too strange an environment for them to relax. “Koori men, particularly the Elders, would be very uncomfortable being seen by a female clinician because this is ‘men’s business’. But even with a male doctor, looking face to face at a medical professional in a sterile room, their anxiety goes through the roof.
“Given the history, they are scared the government will come and take them – or their children – away. A lot of Indigenous people are happier outside; they want to sit on a park bench or under a tree, side by side with someone, looking in the same direction and not making eye contact.
“But there’s a huge mismatch between the types of services Koori men are comfortable enough to access and the services available to them. Mental health professionals aren’t going to come and sit under a tree to do an assessment.”
Having gained the trust of the Koori community, Isaacs worked with them to develop a program called Koori Men’s Health Day. He facilitated the event, but the community organised it, setting up an all-male team consisting of a doctor, a mental health nurse and four leaders of the local Aboriginal community.
All participants underwent a medical examination, a blood test and a psychological assessment using the Kessler-10 scale – with a pointed absence anywhere of the word ‘mental’. Nearly half of those who attended scored significantly high in the tests to be offered a follow-up.
Isaacs says that breaking down the barriers will improve understanding and perceptions of mental health challenges and help marginalised communities, such as Aboriginal and Torres Strait Islander people, to better access services. But it will continue to be a challenge. Marginalised communities in general are typically left behind because they are considered as ‘not important’.
The government has since stipulated that Aboriginal research cannot be led by non-Aboriginal people, and Aboriginal male academics researching this topic are hard to find. “We’ve made a start to highlight some of these issues and hopefully this will help a few people,” says Isaacs. “But unless those barriers come down, the challenges are likely to remain.”
Dr Anton Isaacs is a public health physician and Senior Lecturer in the School of Rural Health.
So how are you really? Dr Isaac’s top tip:
- “My spirituality really helps me to preserve my mental health, so, I’d recommend that to anyone who’s willing to explore that side of things.”
