 Good evening everyone. My name is Lou Hess. I will be facilitating this evening's conversation. And it's my pleasure to welcome in excess of around about 2,000 registrants who have joined for tonight's session, for tonight's webinar, an interdisciplinary cross-cultural conversation exploring the meaning of healing and recovery. I also want to acknowledge those people who will view the recording subsequent to tonight's webinar. At the beginning, I'd like to begin by acknowledging the traditional owners of the lands on which this webinar, on which our webinar presenters and participants are located. I'd also like to pay my respect to elders past and present. This partnership is a partnership between Northwestern Melbourne and Eastern Melbourne PHN, who have contracted the Mental Health Professionals Network to deliver two webinars. The first one took place on March the 2nd and was an opportunity to engage with some of the complexities around support for people from culturally and linguistically diverse backgrounds during the pandemic and beyond. Tonight's second webinar is entitled an interdisciplinary cross-cultural conversation exploring the meaning of healing and recovery and will build on the conversations that occurred in webinar one but also clearly stands alone. We are of course interested to hear your feedback and you're invited to use the chat box. I'd like to make some comments on our ethos with appropriate acknowledgement and blessings to the technological gods who make tonight's connection possible or conversation possible. We want to make some comments on the ethos or what we hope to co-create in regards to this process tonight. Clearly I guess our hope is that it will be experienced not as a case conference, not as a supervision group, but rather a conversation between mates from different human service professions and disciplines musing on, yarning about professional practice with people from culturally and linguistically diverse backgrounds, many of whom will not have a cultural frame of reference for the presence of or involvement of outsiders in matters on personal matters. So try and embrace this experience as a conversation and it may well be that that conversation will be lubricated by a red wine or a hot chocolate. The other thing that we would say in terms of ethos as well is that conversations by virtue of their very nature will remain incomplete and our hope and our expectation is that our conversations tonight will create more questions and invite more depth than we're able to actually engage with in the context of just over an hour. So that's a summary of our ethos. We welcome your participation very much. To introduce the panelists, clearly you've seen the biodatas that Joanne, Guy and Steph have presented. I'm not going, clearly those biodatas positioned them eminently to discuss cross-cultural conversations, to discuss culturally responsive practice. Rather than speak to their biodatas again, I'm going to pose a warm-up question that is complementary to the biodatas that have been provided and will invite really some knowledge of self in regards to our own culture and our nascent learning about cultural difference and this is an important component to our experience of cross-cultural conversation, both personally and professionally. And hopefully this warm-up will lightly but importantly set the scene for our engagement with cross-cultural conversations per se. So I'm going to ask Joanne, Guy and Steph to make brief comments on their learnings about ethnic and cultural diversity in their families or communities of origin during their formative years. So Joanne, what do you remember about what you learned or were taught about culture, cultural diversity, about the other, about people not from your tribe during your childhood or your adolescence? Lou, it's a wonderful question and brings back a flood of very happy memories but the one story that I will share that made me realise how big and vast the world is is when I and my family and I arrived in Kuala Lumpur to start five years of living in Malaysia when my father was working. We arrived at the time of Chinese New Year and I was blown away to find that there were many, many, many different Chinese dialects and that I could learn to count ten in quite a few of them if I tried really hard and that one of the Chinese New Year dishes was the delicious looking jelly was made of seaweed. I've never forgotten that. I realised, wow, this world is amazing. Thanks Joanne. Guy, your early memories of what you learned about your tribe and cultural people that were different to you? Well, thanks Lou. I think my experiences were somewhat less delicious or happy compared to Joanne's. I think very often my cross-cultural encounters were a source of some discomfort. I grew up as an Anglo-Australian boy and I remember, for example, my mate at school had a Polish Jewish mum who served me up soup. I found in Edderball and that was discourse discomfort. I had a mate at school who told me that Russian soldiers were killing family members in his country town in Czechoslovakia. I had an Italian music teacher whose accent I couldn't understand and once more thought I was pretty unmusical, which was probably accurate. So I think these experiences of unfamiliarity weren't always comfortable ones and I probably didn't make it take up the opportunity to learn something that I could have and I think that's really an ongoing battle we have to not turn away from the unfamiliar but actually learn from it. So I've taken that lesson into my work and hopefully I applied it. Starting psychology as a young man didn't really enlighten me. I think the patient or the client that was envisaged was a generic western person so I really had to learn on the job. Thanks Guy. Steph? My memories of cross-cultural living I guess is pretty clear. We were taught and told by my parents to be as white as possible at all times. So some of you out there in webinar land will know exactly what I'm talking about and for those of you looking at the webinar going well that didn't work. She's not white, you're right. But I guess what I'll encourage you to do is lean into what that means. My family came from a country of strong colonisation where whiteness was right and we arrived in Australia in the 18s where migrants were welcome but as long as you behave well and if you assimilate. So by George we assimilated, we went to barbecues, we ate casserole, we were as white as possible at all times. I guess there's a challenge and a gift with that. The challenge is I guess the disconnect that colonisation breeds in people, the disconnect is painful and it's hard. It's hard to live with, it's hard to decolonise. But I guess the gift is that I've survived in Australia so I'm not going to say how long, but a long time. And most importantly I guess I've survived in community services organisations which I think really require people to be white. Thanks Steph. My own experience as a working class boy growing up in the southern suburbs of Melbourne I inculcated values that where I learned or was taught that I didn't actually have an ethnicity. The Greeks and the Italians who lived as neighbours to my grandma in West Brunswick they had an ethnicity but I certainly didn't. As an adult I've become more sensitive to my whiteness as an identifier and to the unexamined advantages that are accrued to me or often accrued to me as a white bloke. So thanks everybody. Those insights will be a backdrop to the conversations that we have later tonight. So some other housekeeping matters. The webinar platform you'll note that there is a help button if you need assistance or you can message red back directly or ring the number listed 1800 733416. We encourage you also to complete the exit survey and you can do that via the yellow icon. In terms of our format, each of the panellists will give a brief three to four minute discipline specific overview of what they believe to be the key ingredients to authentic cross-cultural conversation, cross-cultural responsiveness in regards to recovery and healing. This will be followed by a panel discussion of three vignettes. The discussion will address the aims of the webinar in regards to cross-cultural recovery and learning. The learning outcomes are listed in this slide but in summary tonight's webinar aims to explore the experience of healing and recovery for clients of culturally and linguistically diverse backgrounds. So that's really the housekeeping matters. Now I want to move on to an interdisciplinary perspective on culturally responsive practice. So Joanne, if you could please start by commenting on what informs your practice, the ingredients and the challenges, etc. Thanks Joanne. Okay, thanks Lou. For me, my culturally responsive practice is really informed by my experience of caring for many years now for refugees and asylum-seeker clients and I find them incredibly inspiring and extremely rewarding to be involved in their care and to know them and to learn from them. In terms of the other things, I alluded to very formative years in Malaysia in a multicultural school where some of those people I'm still friends with today and that was very, very challenging for a girl from a Catholic primary school in Frankston and then finally, in terms of what informs my practice, I have a Chinese-born daughter through adoption and going through that process of inter-country adoption required us to think long and deeply about our culture and how we would raise a child who was born into a different culture and the joy of living with my beautiful daughter and experiencing my culture and her culture on trips back has been very rich and very deep and we celebrate Chinese New Year every year the best that I can and it's great, it's great. So I am so blessed by having these experiences. This has really enriched my life and I bring it into my practice. I told the story today to one of my patients who was of African background whose son was struggling at school and I told her the story of trying to take my daughter to a Chinese language school and not being able to read any of the notices because they all came back in Mandarin so my patient and I both laughed about that. Anyway, thank you. And the four ingredients, please, Joanne. The four ingredients. The most important thing I think is to build a therapeutic relationship with the client so you allow time and regular review. You take responsibility for the client so you become their doctor and re-book them so that you see them regularly and you get to know them. Sometimes you might be the only constant in their life amidst the changing maelstrom of different case workers and so forth. So as a GP, the GP can be a constant. And then the other thing is to think about how you enable them to access your care if they find it difficult to go through the normal reception process and making phone calls and they may not know how to access care that's difficult in the middle of the night or as an emergency. So these things actually take a conversation. Also it's important where possible to use a professionally trained interpreter not a family member or a community member or even a case worker who speaks the same language. It's always best to use an interpreter and I can talk later about how we can enhance confidentiality and use interpreters more effectively. And then just to be curious, respectful curiosity about my clients' experiences and beliefs and the other thing I find very helpful is building a support team. So getting the details of all the people involved in the client's care and making sure we are all on the same team and all working clearly to support the client and then the client knows it and feels supported and cared for. Thanks Joanne. A myth? A myth is that cross-cultural care is hard. No, I don't think it's hard. I think it's actually many easier than some of the other sorts of work we can do in general practice and it's very stimulating and rewarding. And the challenge? For me the biggest challenge is trying to care for patients for whom English is not their first language in our very very fragmented healthcare system where people can attend three different hospitals for three different things wrong with three different parts of their body and neither hospital or GP will talk to each other and mental health systems don't communicate well with GPs at all. It's just terrible. And the patient often struggles to tell you what medication they're on or what's been done to them. So I find that quite difficult and a lot of time is spent on the logistics of finding out where people have been and what's been done and explaining things to people so that they understand what's been done to them. Thanks Joanne. We won't make any particular responsive comments to this section but clearly we'll pick up some of these themes in our discussion of the vignettes. But Guy can I hand over to you what informs your practice? You're on mute Guy. Yes, so I suppose the curiosity about culture something perhaps as I mentioned I turned away from as a child so being open to the life experience and worldview of our clients and learning from them and being aware of our own values and biases and selective sources of experience and knowledge and then experience from doing the work. So I started working in the west of Melbourne and got thrown into a situation where most of my clients were immigrants and of non-English speaking backgrounds. Guy, so the ingredients. Next slide. Yeah. So we're still with the what inform is. So reading a relevant search and I think it's important to acknowledge that every psychotherapeutic relationship is cross-cultured to some degree. It varies in extent it is but there's always some cultural difference between the clinician and client. Okay, so I've got a quote from Laurence Kermit which I commend but really getting to know the client's beliefs and practices insofar as it's relevant to understanding and addressing the presenting problems. So you know there are rituals around grief and loss, child rearing, birth, help seed and behave and so on in their own culture. We need to know about those things. And subject education which is so important needs to be two ways straight. We need to give an accessible version of our therapeutic models that we need to know what healing means to our clients and what kind of help they seek out. And this concept of explanatory models. So the presenting problem, what do they call in their own culture? What kind of help would they normally get? Or its causes. So it might not have a psychological cause in their view or a medical cause. It might have a supernatural or spiritual cause or some other culture-related cause. We need to know those things. If we don't know them then there might be a mismatch between what we're offering and what the expectation is. And we need to assemble a care team which often should include people from the client's community. So not only family but informants perhaps but bi-cultural workers and counsellors and case workers. So a few myths. I was only meant to give you one but I've been delinquent here. So let's run through this very quickly. So the notion that psychological treatments aren't affected with non-western populations, we know that's empirically incorrect now. There's plenty of research saying they can be effective as long as they're appropriately tailored. But you can't do psychotherapy through interpreters for very valuable work. It is done through interpreters all the time. It slows things down but it's very possible. I like it being slowed down. Actually I'm very accustomed to that now and I think it's actually got its advantages. It adds complexity which we can talk about but it's certainly very possible. It's not a good guide to a person's important base and cultural beliefs just to say they belong to a particular ethnic group. People are much more diverse and heterogeneous than just saying they belong to a particular ethnic group therefore we understand it. So we have to be cautious about that. We also need to recognise that both, this is particularly true with refugee groups, that both pre-migration trauma and current adversities are very significant in contributing to mental status. So we don't just focus on what's happened in the past but what's actually happening now in terms of providing psychological care. So it is challenging to assemble a care team that has addressed the breadth of person's needs and includes bilingual workers and people from the involvement of the person's own community. It's challenging to tailor treatments to meet cultural needs and this is still more an art than a science. We've got empirically based treatments but they need to be tailored. How we do that is still being developed. In the face of not knowing and understanding having confidence about what we do know so we know about mental health and humility about initially not knowing a lot of things. So the clients in a life, their experiences and needs. Reading emotions of people from various cultures maybe expressionists, you know, idiots of distress as they're called may be different from how we're accustomed to emotions being expressed. So that takes a little time sometimes to get used to so we shouldn't rush to decisions about what a person's feeling. And also particularly, and Joanne mentioned this, working with Assigned Seekers and Refugees in particular when their material and social circumstances often based on a product of government policy are inimical to their psychological well-being. So you really feel, you know, systemic issues are pushing in the wrong direction and that can be frustrating and difficult at times. Okay, thanks Guy. Steph? I'm not going to say anything wildly unusual that Joanne and Guy haven't already said, but I guess my first controversial idea is that culturally responsive practice is just good social work practice. So I think some people freak out and think they've got to have this special culturally responsive tool in their toolbox. I think as social workers if we are genuinely curious, if we're positioning the other person as the expert, if we're collaborating, if we're using all of our normal social work values and frameworks, if we're starting where the client is, then we're already doing culturally responsive practice. If we're open to getting a critique of ourselves from the other person being told that what you're doing isn't working, then we're already doing culturally responsive practice. The second point is it's easy to say but hard to do, which is to hold that we're actually no different from our clients. So I think it's really easy to fall into this idea that our clients are special or our clients are damaged or our clients are marginalised. And I just think if someone saw me making bad decisions on a bad day, they would think all of those things for me. So I think our clients are exactly the same as us. We're all on a journey to reach our potential. We're all just kind of lost trying to make meaning. So profoundly treat your clients as you'd like to be treated. The other thing that I would say is that people can do anything if they have enough support to do it. So I often think clients often come to us when something's gone wrong or they're stuck with something and they can't figure it out. Or they've been told by someone else that what they're doing is not okay and they've been mandated to see us. So if the solution was really easy, if you know it already, then you're wrong. Because as both ex-Joanne and Guy have said, clients are the expert in their lives. They live their lives 24 hours a day, seven days a week. You see them one hour a week, one hour of fortnight. You don't know the answer. You don't know them. So always, I guess, just keep reminding myself that my job is to provide support even if it's not always an answer because the client will find their own answer. And our clients have infinite capacity, just like we do if we have enough support to do it, which is really kind of mixed into that be respectful, be useful, be humble. For me, culturally responsive practice is of course you might get to know someone and you might share your opinions and your professional expertise. But ask first. Ask if that's what someone wants from you. That's not what they might want from you. I always think just, again, treat someone the way you'd like to be treated. Not just be open to getting a critique of yourself but invite a critique of yourself, invite feedback. Be useful. You should not show if you're being useful. Ask. And most importantly, be humble in the things that you're offering and the ways that you get your feedback. My four ingredients for culturally responsive practice is to know yourself. I mean knowing yourself is lifelong learning but I guess lean into it. So that's not for me not just thinking I know what I'm like and what I'd like to be like but trying to get a sense of how other people actually see you and that could be anything from filming yourself and realizing that your face does crazy things in an assessment or getting your friends and colleagues to provide a critique of you or asking a client. I've attached in the resources section something called an oppression and privilege wheel. It's kind of this way of looking at things intersectionally and knowing that really when your client and you come into a room you're not some, as Mr. Lou said, some benign blank canvas with no culture. You are a cultural being. You're identifiably a cultural being and that other person, your client, is assessing you as fast as you're assessing them. So know yourself and know that your culture is present and ever changing in the same way that that person's culture is present and ever changing. And think about, I guess, what it means for you in that kind of intersectional idea of two people coming together in a room and what role you can play in, I guess, challenging or even reinforcing some of those, I guess, intersectional things. The second thing I'll say is culture is constructed. So if we talk about race, we talk about ethnicity, we talk about a range of things, none of that's actually real. It's all made up. So when we think about culture, I guess our job as social workers is to think about how is culture being constructed right now? Who is constructing it? Who has the power to construct it? Who's benefiting from this construction? Who's not benefiting from it? As workers, we hold power. We write the case notes. We do get to say what's being constructed. So use that kind of power with a responsibility. Work alongside your clients. And I'm not saying that, you know, in social work, our job is not to tell people what to do or tell people what is power and what isn't, but our job is to keep bringing this into people's awareness and increase people's capacity to make choices. And as we all know in this work, sometimes someone's choice isn't between something great and something not great. It's between something bad and something worse that our job as social workers is always to be kind of enhanced people's capacity to make those choices. And also around collaborate, I just think, and it goes really well with relationship, relationship, relationship is that when you are too culturally identifiable beings coming into a room together, now what? Ask. If you don't know if you're being useful, ask. If you don't know if you've offended someone, ask. If you don't know if something's working or not working, ask. In that, as the worker, you are responsible for the relationship. You don't leave the person to fix it or to wander. Help them out and name it. A myth and a challenge. A myth is also my challenge, which is, I think, again, people pick out their culture's responsive toolbox when someone walks in the door that doesn't look like them. I often think if I walked into your practice right now and you took me on face value as looking like a brown, shulunkin woman and you treated me as such, then you'd miss me. Because that's not how I identify myself in terms of my culture. It's not the only way I identify myself as culture. As Guy said, every single piece of work that you'll ever do with anyone is culturally responsive practice. So my examples are if you walk into high density public housing, that's a culture. If you walk into a safe injecting room, that's a culture. When you walk into a different, you know, even a restaurant, that's a culture. So I just think there's a myth that you only need culturally appropriate practice working with certain groups of people. As I said, I think you need to be responsible with all groups of people. Thanks, Steph, and thanks, everyone. Let's move on now to a more in-depth discussion of the vignettes. The vignettes are not case studies in the traditional term, but rather of being designed to provide the opportunity for the panellists to identify a range of poignant practice issues relevant to responsive mental health to people of culturally and linguistically diverse backgrounds. Abdul, Lian, and Ful make an appearance again. They featured in webinar number one. But to go to Abdul first, God's centeredness is a primary value of many who arrive in Australia as part of our refugee and special humanitarian program and or are of culturally and linguistically diverse backgrounds. This is sometimes expressed in the Islamic sentiment of Allah ul Akbar, God is greater. And sometimes in the Christian sentiment of regarding the presence of God, Emmanuel, God is with us. This value for many people of culturally and linguistically diverse backgrounds has the potential to be a significant protective factor in facilitating mental health and daily functioning. What I would like to do now, informed by the comments that our panellists have made, is to ask Joanne, you, Guy and Steph to make comments regarding, in reference to Abdul's comment, my God will prevail. And you've noted in your ingredients the importance of respectful curiosity, awareness of our own values, and knowing ourselves as key ingredients to culturally responsive practice. So I want to invite each of you, and I'll start with you Joanne, to comment on how your story, your cultural knowledge of self in regards to God, your own spirituality broadly defined or absent, shapes your response to cross-cultural conversations and your culturally responsive practice with clients for whom God's centeredness or faith is primary paramount to healing and to life. Does your cultural knowledge of self in regards to the spiritual, does it enable you to in fact get it? Do you actually get Abdul's narrative? And if you do, how do you manage that? And if you don't, how do you manage that? So Joanne, if you could comment on your cultural knowledge of self in regards to your spirituality and its relevance to your work with Abdul and others for whom God is primary. Thanks, Lou. Look, I was... I've been brought up in the Catholic Church, in the modern post-Vatican II Catholic Church. My theology is very, very post-Vatican II feminist and social justice informed. The presence of God is very strong and important in my life. My adherence to and practical participation in the church community has certainly waned over recent years due to things we don't need to discuss tonight, but I think everyone knows that. But my connection to God, I have always found actually very, very helpful strongly that God will prevail. And in terms of strength-based practice, it would frequently ask a client, what helps, what gives you strength, what gets you out of bed in the morning, what keeps you going, where did you find the strength to survive what you did in the detention centre or in the refugee camp? How does God help you? How does Allah help you? And the other thing that's beautiful is sharing the joy that clients have sometimes is religious traditions. So for example, we've got Ramadan coming up. Muslim people often say they really look forward to Ramadan. It's a great time of year for them. They love it. And just to see the joy on their faces and to share that joy with them, it's very precious. And I think it makes them feel validated and not understood necessarily. I wouldn't claim that. But to be sharing something with them at that level is great. To share the joy of a client who has spent a wonderful weekend at the Vietnamese temple, to share the joy of someone who is celebrating Easter in the Holy Week and who believes it very passionately and is very enriched by the church, that is something that helps to create that therapeutic relationship with that bond, that I think is very essential to our work. Thanks, Joanne. Guy, your response to my curious question. Well, Luan, my name is that likes to have God on your side. Now, I don't mean to be facetious. I mean, I find it very useful at times to have a client with a strong faith because it gives you an entree into a set of values that I can try and understand and see how they're operating to assist or perhaps not assist that person with respect to their current difficulties. So in regard to Abdul, I'd be very interested to know how his faith is operating his life beyond what we know and have been yet and establishing that very early in the therapeutic relationship. So, you know, is he part of a faith community? Is he attending, I assume, a mosque? But, you know, what are his religious practices? Is he maintaining them? Often it's a very useful, just in terms of mental state, knowing, you know, I always ask my clients about their prayer, and if they've stopped praying or if they're losing their train of thought of praying, I mean, this is important. It's a kind of cognitive test, as well as something telling you a lot about their morale and their capacity to maintain a tradition, their current circumstance. So these are very rich things to find out about. And I don't find... I don't find my own... I'd like to think my own position on religion is not any kind of barrier to having a genuine curiosity in terms of what my clients, you know, the role of religion in their own lives. Religion is often regarded as a protective factor, but we shouldn't start... We shouldn't presume that. We need to know actually how it's operating the person's life because it could... It can be protective insofar as it provides resilience or acceptance or brings the person into contact with other people of faith. They may be all very protective consequences of faith, but it may be, for example, imparting quite a self-punitive approach to what they perceive as their own shortcomings or failures. Or, you know, it's always going to be quite individualised. So we need to find that out. In Abble's case, we need to find that out early on. And this is going a bit beyond your question, but I suppose my concern is is how this is the trajectory of this vignette, as brief as it is, is that it seems to me that Abble's been arrived at a position where his feeling has to choose between Western psychiatry and his own faith. And that's not where we want our clients to arrive at. We want to be set up treatment relationships where the two can work in tandem. So the person's traditional views and also what we may have to offer to assist. Thanks, Guy, and I'm sorry to cut you off, but I've been so engaged with the conversation I haven't been on my game in terms of timekeeping. So, Steph, don't feel as though you've got to truncate your comments, but your response to your cultural knowledge of self. Well, firstly, I'll just say, Lou, with the three of us keeping track of time is possibly incredibly hard. Hard job you've got there. Look, when I read about poor old Abble, I guess what came up for me is questions of endurance and questions of what God expects of us. So, you know, I think your original question, Mr Lou, was to ask about what our faith and what our understandings of faith are. And for myself, I don't know. It depends on what day and time you ask me. It changes wildly as to what I believe and what I think I believe and how I make meaning. So I assume that that's what all people are like. So I guess with Abdul and social workers, we don't have medications. We don't have very much apart from ourselves as the tool. So I guess when I think of Abdul and the clients I've worked with like Abdul, I guess my job is to create a space where people can talk about and go to a hard place in talking about it. So I can think of clients who've absolutely had this space that God will prevail, but been able to talk about, well, I just don't understand why God expects this much of me. Or I don't know, God expects this of me, but I don't know how much endurance I've got. And to create a space where people can talk about that and people can create meaning about that and what is it like to disappoint God? What is it like if I don't make it? To have a safe place and a safe relationship where people can talk about the what if and make meaning of those. Thanks, Steph. And thanks, everyone. Let's move on to Leon. Leon's story highlights many factors of potential interest, the importance of relationship, the importance of significant others, the importance of extended family and the importance of community. Thank you for trying, Doctor, but Ong does not need to try. She just knows. Given Leon's decision to privilege her emergent relationship with Ong, her friend from the church and her husband's interpreter, rather than continuing with a child-first referral, can you comment, and this time I'll ask Steph and Guy, on the notion of cultural humility that you noted as important to culturally responsive practice. How is cultural humility relevant to the client's apparent privileging of her values as to what is needed, what help she requires, her expertise in regards to her life? Can cultural humility co-exist with your knowledge, to use your words, Guy, that you are a Western, you have expertise from a Western perspective? And what do you do with it? Are there potential contradictions as to who knows best? So, Guy, if you could please respond, flesh out your comments about humility and how they might reply to Leon's decision. Look, I think this is in an uncommon scenario where we feel we're delivering something of, you know, scientific and technical expertise and the client will choose a more traditional and familiar source of support over what one's offering, and that does require humility. It's a moment to learn something. I think in this instance, again, and I think there's a theme running through these vignettes, that at the outset it would have been great to have had the humility or foresight to think, I need someone like Ng on the care team from the outset. I can't do all this. Ng is going to provide something that is impossible for me to provide. I'm providing something that's part of the ingredient of what needs to be offered, but it's not the full picture. And again, we see a little bit like in the first vignette where I think the system has worked in a way, unintentionally, to put Leon in a position where she has to make a choice that she shouldn't have to be making between a traditional source of knowledge and wisdom and support and the technical expertise of the clinician, whereas you want those things to factors working hand in glove ideally. So that's where I suppose the humility and foresight comes in. I should say also, I suppose connects to humility and that is we shouldn't assume our systems are in any way perfect. Now, this is a mother, a refugee mother, or one would assume refugee, of a six-month-old child. Now, we know about the experience of having a child in this country amongst refugees and immigrants that sometimes it can be very difficult in all sorts of ways. There's a terrific study you can find on the Foundation Health's website, which is in the resources called Having a Baby in a New Country is a study of Afghan families. And, you know, the anti-Natal and postnatal care, the lack of interpreters, the confusion, the inability to observe traditional rituals around childbirth and rearing children, it makes the whole experience extremely challenging. We need to know about those things. So we would need to know about Leon's experience as a mother over the first six months and how that's affected where she's arrived now. All that requires a kind of openness. Thanks, Guy. Steph, how is your notion or your experience of cultural humility relevant in your potential work with Leon? I think with Leon, when she says, I think that beautiful line that I think you delivered so well, Mr. Lou, around how her friend doesn't have to try and do a worker, you try too hard and it's painful. I think what a gift. What a gift for someone to give you. And I guess my take on being culturally humble is just to let Leon know that she nailed it. She was right. I was trying too hard and it was awful. And you saw it. And to apologise. And I think there's a line further up in the case study where, you know, she's talking to you about her child not really bonding with her and vice versa and how painful that is. And I think the next bit is, and as a worker, you arrange for a child's first referral and she thinks it's a wonderful idea. My cultural humility goes, that was us panicking. That was us as the worker going, good guy, we need to make a child's first referral. And I'm not saying that you might not. But just to check with Leon, did I lose you there? Is that the point that I did? Did I do something in that moment? Do I have power as workers? And we can say we're making the child's first referral. And of course our clients will say yes. But is it a yes? Is I just saying yes because we're in power? So we're responsible for that relationship. So my cultural humility would say a couple of things which is go back and fix the relationship where you need to because it's on you. Let her know that she nailed it in her feedback and she was correct and you apologise. Let her know that you will always be there if she needs to but at the end of the day this is her choice. And if Ang is a better worker than you, then that's completely appropriate. Thanks Steph. Mindful of time. Let's now move on to Fung, our last bin yet. Fung's story highlights amongst other things the relevance of cultural values as a protective factor and the potential for a resistance to or departure from cultural values of family of origin in response to a range of Australianising influences. The vignette notes that the clinician or you feel pitted between Fung and his mother and that Fung has communicated in exasperation that you are from here, you should understand. How come I feel like I'm talking to my mum? This is a waste of time. Joanne, you have noted in your earlier comments the critical importance of therapeutic relationship and you also noted at the myth that cross-cultural care is hard. So I want to ask you, invite you to comment on your knowledge of self, personal and professional and the relevance of this to your engagement with Fung's narrative that it feels like I'm talking to my mum. How might you, dear Joanne, build and transact both a therapeutic and a cross-cultural relationship with Fung and address his experience that it feels like you are his mum? Oh goodness me. Lou, you realise that this is a really difficult question to ask the mother of a 16-year-old, don't you? Yes. Because in terms of cross-cultural communication we are talking teenagers and TikTok and my generation with the rotary phone. Look, and I personally think that if I was looking after Fung, he would be the one that I would probably struggle with the most, perhaps as that doctor was doing. I think what you do in that space is you see Fung's frustration and you acknowledge his frustration and I would probably say something along the lines of you seem very angry now. I'm very sorry that I've said something that's made you feel very angry. Is it possible that you can tell me a bit more about how frustrated you're feeling? Is there something that we can work on together to make you feel a little bit more supported or a little bit less frustrated? That's probably where I'd go initially and then I'd see... I'd try to continue to offer my support. I'd probably back away a little bit although I would be very concerned about the drug use also and the COVID-breaking rules, but I would just try to maintain a therapeutic holding, a willingness to listen rather than to speak and be perceived to be judging. Thanks, Joanne. Steph, you've heard what Joanne has said. Any response from you? This probably says more about me than anything else but I'm not that concerned about his drug use or his risk-taking. I might have a harm minimisation conversation with him, but young people take drugs because they want to belong and it's fun. Yes, if I was to bang on to him about how worried I am about that, then I did just turn into his mum and he clearly said that's not what he needs. So I guess, again, I come back to that idea of what's the relationship, what's useful, how is me being worried useful to him and I think he's pretty well-saying it's not. So I would want to create a space where he's safe to talk about his harm minimisation, where does he get his drugs from, are they using at the same time, are they keeping an eye on each other, leave no one behind, stick together with your mates, all of that kind of stuff to reduce harm. But I feel like it's a process he's going through around belonging and a phase that he's going through his life. So I kind of think, how do I be useful in my relationship around that and giving him a space where he can talk about that? And, Seth, how might you address you sound like my mum? Would you directly address that? My hope is that in my work with him, because I'm not that worried about his drug use, I might not have got that far to standing like his mum. But if I had, if I'd made a whatever and said it, I'd own up to it and go, oh my God, I did just sound like your mum. So sorry, that's not my job and you've clearly said that that's not useful. How can we get back from this? How can we get the conversation back onto something that's useful to you? But my thing is if a client is feeling safe enough to tell you to go shove it, take it as a gift. Seth Guy, you sound like my mum. Yes, look, I hope Lou, I wouldn't take a very different approach to what John's step has already spoken about, but if I could just step back a little bit from that in terms of how we arrived at that point, because I do think it's appropriate to have a talk about, you know, that at some point in some way the dangers of methamphetamine, I think that's a connection with this person in their care. We'll have to get to that point at some stage. Now, a consideration that doesn't come out strongly in the then yet or in terms of it having been looked at is where Form is positioning himself in relationship to his traditional Vietnamese culture and what his view is on what Australian values and culture are. Now, he seems to at this point be in a position where he sees them as totally incompatible, mutually incompatible, and he's having to make a choice. And he seems to have a slightly caricatured view of both. I must say that I've never met a young person of immigrant background who completely rejects their culture of origin. There will be things there that he will want to celebrate and hold on to, but at the moment he's not able to because he's seeing that just in terms of the struggle with his mum over his own individuation. So I think we do have to, and then that gets acted out in a kind of transference way in the therapeutic relationship. So I think we do need to get to that, how he's positioning himself culturally and I'd be interested in what he values in his Vietnamese heritage, what he takes from that and how that's compatible with his drug use. I wouldn't say it in that kind of blunt way, but I'm interested in terms of what he wants to achieve in terms of a young man who's born in Australia with Vietnamese background and he's starting to use illicit substances. How's all that fit together? I think a broader conversation like that might lead to him actually being able to say, well, perhaps I am a bit worried about my drug use. Perhaps I am a bit worried about alienating my mum, but you won't get there simply by giving me a lecture on illicit substances. But I think that broader conversation will get to a point where he's made able to reflect a bit more about what he actually wants from his life and what he wants from his own heritage. And Guy, using the language of therapeutic relationship, what would you be hoping to achieve in terms of your therapeutic relationship with him? Well, see, I think one thing, presenting problems a bit unclear with his time has come along and pleaded for his freedom. So I'd hope I'd be starting off on a shore of forking he's represented in the vine yet, because I don't know what he's actually been agreed upon to work upon. But I think there is a complex psychological and cultural issue around his relationship with his mum and his own individuation. At the moment, he's seeing it in very black and white terms. So I'd hope he'd be able to arrive at a much more integrated position where he chooses from both cultures and feels comfortable in his own scheme regarding that. And the therapeutic relationship would be working through that. This is a bit speculative, but we also see often children of refugees where the parents have a trauma background actually being quite overbearing at times, and that reflects their own losses and having difficulty actually individuating themselves or letting their kids go. So I think there's, you know, that's speculative. There's lots of dimensions to this, and I'd be wanting to explore that. It can only be done by ensuring the therapeutic relationship doesn't break down. So I wouldn't be getting to a point where he was having to choose between me and Druggies, for example. We don't want to arrive at that point. Thanks, Guy. Steph or Joanne, any further comments on either what Guy has said or the conversation that's unfolded thus far? Steph? Not really. I mean, other than, you know, I think of all those vignettes, Fung stands out to me the strongest. It would certainly be, look, you know, he's a young man born to parents who weren't born in Australia. And I have some resonance with that. I have some resonance with Fung's feelings. And I get what you're saying, Guy, around you've never met clients who reject it totally. But I can tell you, for a good decade, there I did. And I want... And it felt really important. I think that's, I guess, what I was also getting at around this, the damage that colonisation brings and the damage that... of wanting to, when you're already othered and you just want to belong when you're a teenager, you will other your otherness, if that makes sense. And it feels so important to be one like everyone else, even if it means doing things that you might not normally do. So I guess that's what I meant around... Fung doesn't need another Asian woman worrying about him. He needs someone he can talk to about, you know, how does taking drugs and belonging go together? Why do you want to belong to one group over another? Like, what does that mean? You know, that caricature of your Vietnamese parents, where does that come from? Who benefits from that construction? Because it is a construction. It's out there in our, you know, in our mainstream media. So when you want to belong, who's benefiting from that? Thanks, Steph. Joanne, any final comment on... or anything else you'd like to add in regards to Fung and your therapeutic and cross-cultural relationship or what you'd be aiming for? Oh, I think I and Steph have really nailed it, to be honest. And I'm enjoying sitting back and listening to these masters speak. And what a pity we have to finish in a little while, because really we could go on for another couple of hours. I could just sit here and drink in their wisdom. I'd really enjoy it. Anyway. Well, thanks, Joanne. I appreciate those comments, but clearly the practice wisdom has been very broadly based tonight. But so thanks, everyone. I mean, what we need to do now in terms of time, I want to provide you with an opportunity acknowledging the richness of the conversations that we've had and the time constraints and the fact that many of our conversations, as you've just said, Joanne, invite greater depth. I want to invite each of you to identify in a very few words a key take-home message regarding culturally responsive mental health care, regarding cross-cultural conversations. So, Joanne, your key message? My key message would be if I had to distill it down to one thing, it would be the importance of the therapeutic relationship of being respectfully curious about your client and being kind, being warm, being welcoming. One of the most important things people need, we've been talking about full needing to belong. Our clients often need to feel welcomed. They're often living in a climate of suspicion and political distrust. And the role of the clinician to support and to welcome and to care is huge. So that's my take-home. Thanks, Joanne. Guy, your take-home message. Okay, so what I'm going to say is a footnote to Joanne's comments because she said they are the most important things. But those footnotes are these. So you don't know until you find out. That's a motto I'd take. You have to inquire. Don't trust intuition solely. Intuition becomes increasingly unreliable with cultural difference. It's always a bit suspect that, you know, so find out the inquiry can be humble about what we don't know. We shouldn't nonetheless lose faith in the therapeutic approaches, but they must be adapted. And they need to be adapted and negotiated with our clients and their expectations and needs. And we need to read research. There's lots of research using, working with our own, you know, Western therapeutic methods in other settings now, and we need to know about their effectiveness and how we adapt them so they're more effective. And then finally, we need a network of advice to draw on the knowledge of people from the communities from which our clients come and involve them in the care. They're my main messages. Thanks, Guy. And Steph, your takeaway message. Pretty much what Guy and Joanne have already said, which for me, I always think what's happening for me, what's happening for the other person, and what's happening between us. And you have a go at that, reflecting on that, but as Guy said, if you don't know us, and really kind of always just being mindful of how is this useful and who is it useful to. And just to be cheeky, my final social work nerdiness always says, and how will I document this? Because for me, good documentation is a really important way of being accountable to your clients so that when they come back to this, like, you know, they don't have to start all over again. Thanks, Steph, and everyone. So as Chair, my summary is that tonight's conversation has provided us with some really rich and important glimpses into both the opportunities and the complexities involved in cross-cultural conversations and culturally responsive mental health. Our conversations have, of course, invited greater depth than was possible within an hour and 15 minutes, but hopefully these conversations and your participation from your lounge rooms, from your offices, et cetera, has created and stimulated a raft of other questions. As you said before, Joanne, I mean, in some respects we could listen to one another and we could discern and distill practice wisdom from the responses that all of us have. So hopefully the conversations have invited or clearly the conversations have invited greater depth. Hopefully it's stimulated a raft of questions that can be reflected on in an ongoing way. The supporting resources that are posted in the Support tab are very comprehensive. Guy has referred to some of those resources in his comments as has Steph. Joanne has contributed a number of very useful resources and those resources are clearly going to provide more depth and more rigor to the conversations that we've had tonight, so please immerse yourself in those resources. You will also receive follow-up communication from the Mental Health Practitioners Network about, in response to this seminar or webinar, MHPN also supports the encouragement, sorry, the engagement and ongoing maintenance of practitioner networks. Please contact the Mental Health Professionals Network if this is an interest or indicate via the exit survey, which we, of course, encourage you to complete if you have an interest in further conversations and being a part of various networks. Thanks again to all of our panellists for inviting us into a very interesting and rich space. I've been stimulated, I've been inspired, I've been humbled by what I've been able to listen to. Thanks to all those involved in technical, admin and production roles, which have made this webinar possible. And thanks to all of you for your participation in the webinar. We look forward to receiving via the exit survey your comments and your comments will be taken seriously in terms of enhancing, enriching this process that is offered in regards to various practice issues. So thanks one and all. Good evening to everyone.