In Australia, multicultural people are overrepresented in mental health inpatient facilities and are more likely to be on involuntary orders (Australian Bureau of Statistics, 2012; Warnock-Parks et al., 2010). This is partly attributable to the many cultural and language barriers limiting access to and effective utilisation of services (Queensland Health, 2012). In Australia, mental health services use a service delivery model that provides clinicians such as mental health nurses, psychologist, psychiatrist, social workers with interpreters to overcome language barriers which is important in producing accurate assessments and diagnosis but do not address cultural barriers (Scala, 2012). Overcoming cultural barriers is more complicated but understanding how culture impacts on mental health and help seeking behaviour can improve mental health outcomes for multicultural communities (Owiti et al. 2014; Scala, 2012). Typically an ethnic matching model of matching the ethnicity of the mental health professional and client has been used with some success (Cabral & Smith, 2011). One Australian study using ethnic matching reported reductions in crisis presentations and hospital admissions and an increase in contact with community mental health services (Ziguras et al., 2003). However, ethnic matching has limitations; in particular it is difficult to find a range of ethnically diverse mental health professionals to respond to the broad cultural diversity of clients/patients. Ethnic matching is particularly difficult in Australia when there is an increasing number of new and emerging communities, in which there are only a few or no mental health professionals within the population. To overcome this problem and to ensure mental health assessments are culturally appropriate, the co-assessment model which pairs a mental health clinician with a bicultural worker to jointly assess multicultural clients was used in an Australian mental health facility. It was envisaged that the use of the co-assessed model would help clinicians to better understand how cultural factors impact on clients’ understanding of mental health. The purpose of our study was to explore clinicians and bicultural workers’ views on using the co-assessment model.
Methods: Qualitative design was used with a purposeful sample of nine clinicians and nine bicultural workers drawn from a transcultural mental health facility. Using semi-structured open-ended questions, two focus group interviews, one with the clinicians and one with the bicultural workers were conducted. Information was sought from participants on the co-assessment process, perceived benefits and challenges, and how the model differed from the use of interpreters. Data were transcribed verbatim, coded and analysed using content analysis
Results: The findings indicate the model is effective in increasing cultural understanding and sensitivity in mental health assessments. Clinicians found bicultural workers provided the cultural lens to better assess and diagnose clients. Bi-cultural workers stated their cultural and personal experience in the assessment process facilitated a holistic approach. A common challenge for participants was time constraints and the blurring of role boundaries.
Conclusion: Our findings suggest the co-assessment model has applicability to mental health nurses and health professionals to enhance optimum assessment outcomes for multicultural communities.