Abstract
Between 1996 and 2000 the Transcultural Mental Health Centre at Parramatta published seven monographs in its superb series, Current issues in transcultural mental health. Diversity and mental health in challenging times, the eighth in this series, was published in 2001, and lives up to the standards set by its predecessors. The editors, Beverley Raphael and Abd Malak, have brought together an impressive array of contributors (34 in all) into this edited volume. A remarkably diverse group themselves, both in terms of their cultural background and professional training, the contributing authors may be taken as broadly representative of the leading figures in the field of transcultural mental health within Australia today. I anticipate that this book will attract a wide readership of people involved in mental health care; first, because of its interdisciplinary nature; and second, because it is organized in two parts, the first is concerned with broad scale issues of prevention and service development, the second focuses on clinical issues.
Raphael sets the scene by asking how prevention and early intervention can be tailored to the needs of a culturally diverse population. Her approach is developmental and the chapter serves as a useful review of the work that is being done in this field in relation to each developmental stage. A number of specialized areas of prevention are addressed within the first section. For example, there is an account of a multilingual community awareness campaign that was run on SBS. As impressive as the campaign itself was its careful evaluation, showing modest yet demonstrable effects. Suicide prevention receives attention in a chapter that reviews the evidence for the efficacy of prevention programmes in general, and then takes this forward to examine how we might develop such programmes in relation to young people from diverse backgrounds. There is a particularly interesting report on collaborative research undertaken with parents of Kmer, Vietnamese, and Spanish-speaking backgrounds. What makes it so interesting is that the authors not only look at mental illness in these three groups and the special needs that this illness generates, but also focuses on their capacity to parent their adolescent children, and the particular problems they face, mostly in the areas of discipline and authority.
Several contributions within the section are concerned with service delivery and development. One looks at ways to involve carers and consumers from diverse backgrounds, another reports on a very promising trial of the use of a bilingual/bicultural case worker, and the third is a particularly useful perspective on the disempowerment faced by people from non-English speaking backgrounds when dealing with the Mental Health Review Tribunal.
The clinical section of this book is rich in the areas of cultural identity, adaptation, grief, anxiety and, most notably, trauma. In the latter regard, there are contributions on depression in women who have been subjected to torture, suicide and suicide risk assessment among survivors of concentration camps, and the complex experiences and reactions of interpreters who work in this field. Two chapters examine specific therapeutic approaches to posttraumatic stress disorder (hypnosuggestive therapy and eye movement desensitization) and the acceptance of these treatments by people from diverse backgrounds. The clinical section will be of great interest to mental health professionals involved with the Spanish speaking community in Australia, with several contributions based on the authors' clinical experiences in working with this group. One of the most thought provoking contributions in the entire volume looks at child abuse against the background of cultural patterns of child rearing. It argues for the necessity for the sort of cultural competency in assessing child abuse that enables mental health professionals to move away from an ethnocentric stance, but at the same time avoid the risks of extreme cultural relativism.
Clinicians of every species, as well as those involved in service development and mental health policy, will find this volume a great resource, not only in terms of its content, but also as a guide to some of the principal people working in the field. The publication of Diversity and mental health in challenging times may be taken as an indication that transcultural mental health in Australia is robust indeed.