 Hello. Hello everyone out there. I'm Stephen Ginsberg. I'm a GP in Northern Sydney, and I'm your facilitator for tonight. And welcome to the about 1,800 participants or registrants who will be joining us for tonight's webinar, culturally responsive healthcare for older Australians. And there will be viewers, as I say, who will be watching the recording because they can't be with us here tonight. I'd also like to say a special welcome to the members of the Sydney North older persons mental health network of which I'm a co-coordinator and to other networks around Australia who are meeting tonight with us to watch this broadcast. MHPN currently supports five older persons mental health networks across the country, and I'm pleased to report that a sixth network will launch in South Australia next month. And details of these networks and how to join them will come to in the closing slides. And as we're meeting by webinar, we can't greet the person sitting next to us as we usually would. So while we wait a few moments for others to join us, we might like to find the chat box and I'll find that for you. I'll show you the. Move that slide across. There we go. Open the chat box. Find that chat box and say whatever you want can just be hello. And where we're from. And I'll just say, because I don't have access to that particular chat box that I'm in North Sydney on gamma regal country. So you've got the navigation buttons there for the functions, which are pretty selfish planetary. The exit survey is accessible by way of the yellow icon, or as a pop up at the end of the webinar. So we'll come to that. When we come to it by registering, I have to tell you that you've automatically agreed to the ground rules, which can also be found in the supporting resources tab. By way of registration. Participants will ask to submit a question. And we've had lots of them. That you'd like the panel to consider. And some of these questions we've put together and have included in the question and answer section of the webinar. We'll also use the chat room and we'll monitor it and raise any issues during the webinar if we can. Time is our friend and also some degree limiter in how many questions we can get to answer, but our panelists have sworn to short answers. Hopefully, short and petty answers. This webinar is a little unusual because it's the result of a unique partnership between the 31 Australian primary care networks and the mental health professionals network. MHPN and in a first in their history. The 31 pH ends performed a consortium and engaged MHPN to plan, produce and broadcast webinars focusing on older persons in Australia and their mental health. And tonight's webinar is the third of the first series. We've facilitated the previous two and they are available on the MHPN website. And the pH ends have agreed to continue the series due to its success. So I think for one of the webinars we had 3000 registrants. More webinars will be delivered in the coming 18 months. Please use the chat box. Let us know what topics you might like to be covered in previous ones. We've focused on a single case. Which is the normal format, but we felt it more appropriate to address the issue of culture in general for this one and respond to your questions for much of the webinar. So that's the sort of housekeeping. And I'd like to begin by handing over to Susan for an acknowledgement of country. Thank you, Susan. Thank you, Steven. I'd like to start by saying Waramy, Nagaia Susan, Nagaia Brindji Wawonga, Gumi Dabiyanga, Gumi Dabiyanga, Matamorong Tianaga, Matamorong Bialia, Gamarigal Guri Pemmel. Hello, I'm Susan. I ask with respect and honour to speak to the male spirits, the female spirits, to be able to walk and talk on the land of the Gamarigal. I'd also like to acknowledge all of you online, wherever you are within Australia, that you are beaming in from different nations and homeland across the country. And I'd like to acknowledge all of you for being here this evening, and also acknowledge the different homelands that you are coming from. Thank you. Thank you very much, Susan. And by way of introduction to our topic tonight, I'd like to share with you questions that I often ask myself. I don't have an easy answer to them. What is the legacy for older people's emotional, social and physical well-being when they perhaps experience cultural disrespect and racism from our healthcare system? And how do we raise our level of awareness for the diversity of our fellow citizens and respect for their cultures and feelings? And these are questions that may frame our discussion tonight. Now, everyone's bios were on the invitation, so I will now bring you to a picture of everyone. There we go. There we have Susan and Samira and Ming and me. And we're very lucky to have you all. Thank you very much for coming tonight. So I might go back to Susan for the first answer to two broad questions. How do you engage with older people from First Nations and culturally diverse backgrounds? Are there specific issues for older people of diverse cultures? I guess, thank you, Steven. I guess in terms of the very multicultural nature of the original people of this land, First Nations people and in particular older people, I think that the history has not been so kind to us. As we engage in the Western health system, as you were talking about, there is racism and discrimination. It's about how we can support people through the system to engage to get a better health service when there has been a history where we have been denied even our own right and our identity to be seen in this country. And when we look at history in the 67 referendum and where that has brought us to, there is still a lot of healing to be done. There's a lot of creating a greater understanding between Indigenous, non-Indigenous people. We need to look at, respect and honour that we are a very multicultural nation in 2021. So how can we be more accepting and provide a service that's an honest service and sees all people? That's great. Thank you very much. Samira, your turn next, if you'd like to introduce yourself and put your perspective onto those two broad starting questions. Thanks, Steven, and thank you, Susan, for that acknowledgement of country. I want to acknowledge that I am on the land of the Yagura and Terrible people, land that has always been face of learning, and I owe great respect to our past and current and emerging leaders of our First Nations people. And I think, for me, it's very important to make that distinction when we talk about multicultural because I think it's very important that when we talk about multicultural, we give a special place, a prioritised place for our First Nations people because the experiences of colonisation, exclusion and racism are different to that of the broader multicultural population. So my experience has been primarily working with people who are migrant asylum seekers and refugee populations, so a lot of stories that I'll share with you today are working in that multicultural context. And I think what Susan shared about discrimination and access issues is very much relevant as well to people who have travelled here from a broad range of different countries. Our health system is very complex in Australia. We have federal health system, state health system, local health system, and it's really important that we take time to talk about systems, advocate within the system and support people to understand how to receive health services. And we also work with health providers to support them to understand some of the journeys in healthcare that people have experienced as well. Thank you, Samiri. I think you raised that really important point of navigation of the system. We have to have the rudder and help people have the rudder so that they can navigate a very complex and often very user unfriendly system, particularly for multicultural citizens. So, Ming, your little bit about yourself and your thoughts on those two questions. Thank you, Stephen, following on from Susan and Samiri's comments. I would just highlight what Samiri said about the factured healthcare system, certainly from the consumer and the ethnic populations point of view. Healthcare, dementia management has a lot of challenges, even for people of non-ethnic backgrounds. There's obviously the issue in terms of engagement, reassurance, the diagnosis, and then actually providing that support. And all of these steps, if you look at the system as it is, be it between the state issues and the federal issues and all the funding, splintering, if I can call it in between, it is an incredibly complex system for anyone to navigate. And then to actually provide the specific insurance, because dementia is not one experience for one person. There's a multitude of different layers to it, and every family goes through it in different ways, which makes it interesting but challenging work. How do you maintain the communication engagement whilst providing the reassurance is a major challenge. And it would be trite to say that it's really about having experience and an open mind. So I think it's important to ask the specific skill sets that we should talk about here amongst the panel, the kind of things that would be relevant to help ethnic communities and ethnic families navigate the terrain. Let's keep the conversation going. Would you like to start us off there while that idea is fresh in our minds of the skill sets of what to expand on that a little bit more? Absolutely. Anyone who's been involved in dementia care, and I'm sure my co-panelists will comment on this as well, know that dementia management and for people who are going through this disease process need multiple teams to be involved. And that coordination of all your healthcare providers, some families can do it well and others struggle to do that. It's not a natural skill for anyone's background. And if you're from an ethnic community where language is a major issue, perhaps your understanding of dementia comes with stigma or comes with other preconceptions. It's very hard to engage services. And on the same token, every people of different ethnic backgrounds quite understandably would feel more comfortable with people of their own backgrounds. And so to engage a system where there's a multiplicity of personnel, of different professional backgrounds or different personal backgrounds, it can be overwhelming. So one approach would be this idea of care coordination. Who ends up being the care coordinator? And I would say very often it's the GP who does it very well. But then that coordination of all the other services and explanation on how to use those services. For example, with no disrespect to Samira, it's often quite difficult for families to understand what is an occupational therapist despite their very vital role. And so these are the kind of things where it becomes about media, but even just straightforward conversation and pre-emphasizing if you like to know where the potential gaps may be to guide people along this journey. Yep. That leads straight to you, Samira. Well, no offense taken, because I think one of the things we need to do as occupational therapists is really support people to understand what we do. Because a lot of migrants and people new to Australia are coming from countries where the role of occupational therapy is not yet established. And I think as an OT, my first session is usually about getting to know someone, understand their family, understand the family dynamics and what health beliefs exist in the family. And then also setting up some agreements of how we are going to work together. And part of that is explaining what I can and can't do as an occupational therapist. So, you know, usually people are familiar with the role of the video therapist, the role of the doctor, the role of the nursing team. However, it takes a little bit of work and explanation and some concrete examples to provide to the family of what an occupational therapist can do. And I think being the OT in the multidisciplinary team for me is really important because we have a role around not only supporting the person's ability to do the things they won't even have to do, but it's really important to understand from a cultural perspective what happens in your family when someone has dementia. How do we care for the older people in this culture? What are the social norms? And it's important to really start from that point of curiosity to build your understanding of how that particular family is working, who are the different family dynamics, who are the doers, who are the talkers, who's going to be the person that you can work with to help the family develop some self-advocacy skills as well. And, you know, I think that wraparound support kind of model is very helpful when we're working with people from multicultural backgrounds because it allows us to start to understand what natural thoughts exist in that person's life as well. And once we're engaging natural thoughts, we're able to start to build a real in-depth understanding of that family's unique culture. And I'd like to just add in terms of the importance of language and for us as First Nations people, you know, there were 100 of different nations and languages. And when a system comes in and has its own way of describing disease, and we're looking at dementia, what is dementia to First Nations communities? Like, we potentially would have had different ways of describing that. And it's interesting when you start to go into communities and talk about the different diseases. And I was working on a project in and around dementia within New South Wales and how people, you know, out there in the broader community view dementia or even thought of what this was when, you know, Auntie or Uncle or Nana or Pop just started to not remember things. And so it gets described as dementia in the Western system. But we would have other words for it and just care for people. Like caring for older people, caring for elders was a part of our culture. And I think the other interesting thing about dementia and our communities is the work that Professor Tony Bro has been doing and looking at dementia within our communities. And he was very excited about the fact that, you know, they were able to track it back to, I can't think of the word, but incidences in early childhood and the delays in development which then meant at the other end of a person's life in older age that we are more susceptible and more likely to get dementia. Now, whilst he was excited about his research, I was actually devastated at that thought that, you know, a lot of our older people will end up with dementia in later lives. So I wasn't so excited, but the research was interesting in how there was the interface of what our communities were, how they were viewing this disease called dementia through the Western lens when we potentially have different ways of describing what is going on for our older people. Susan, if I can pick you up on that, because I know Tony and I understand and this brings me to an interesting point. When we communicate in dementia circles in this Western medical kind of field, if I can call it that, we tend to be very verbal, very specific in our language. When we talk about education, our families, if you look at the Alzheimer's Australia website, it's all about text. And it's not really about body language. It's not really about comforting. It's not even about, what can I call it, mirroring, because I know that's certainly part of the engagement when you talk to First Nations. You've got to come and mirror the body language and the temper and the tone and set the scene more comfortably. Whereas communication for us as doctors and then Western medicine, tends to be very discursive and precise. And in some ways, that's even condescending, right? In some circumstances, it comes off as condescending. But what do you think of that? These non-verbal communications in education and providing support, can we talk about that a little bit perhaps? Yeah, and I think that, given all of the different hundreds of languages of First Nations people, that even communicating between our nations, there sometimes can be a language barrier. And when we are responding to people who might have a diagnosis of dementia, I mean, I agree with you. It is all the non-verbal communication which is really important. I mean, my mum had Alzheimer's and it was devastating for us to see the decline in her, but also trying to still communicate with her in different ways. So yes, it is touch and it's just the facial features and the way in which you try to do things that were familiar for her. And it was interesting that it's the non-verbal communication and the fact that there were moments where she was quite cognizant of what was going on, and then she would just be in a different dimension. And watching her decline, watching the engagement with doctors and we were lucky, Tony was her doctor because he ended up at school with my dad, at university with my dad. So it was interesting to have that engagement with Professor Brode and the research that he was doing and then being my mum's doctor and him sometimes being surprised that what she could do when in a Western medical sense she shouldn't be able to do things. So that was fascinating for us and fascinating for me as a daughter. But really, I think that the non-verbal is really important, the way in which we respond, the way in which we communicate with each other as family members and all of the support staff that go into caring for a loved one. We need to remember the humanity. We need to remember to care and to love and to express that even though sometimes they might not fully be present. But it's the way that we've always done it. You care for your older people, you care for elders. Yeah, absolutely. Samira, I mean you've been, when we all spoke before the webinar a week or so ago, you work very much in team. So can you just tell us a little bit about multicultural health workers as part of that team? Yeah, so I work at World Wellness Group based in Brisbane and we have a team of multicultural peer support workers and they come from, we have about 60 in our team, all of whom come from different linguistic and cultural backgrounds and who have had different migratory experiences coming to Australia. So we have a model in our Psychological Therapies Program called the Co-therapy Model where a practitioner is having the support of the multicultural peer support worker to provide a level of cultural interpretation and their expertise in supporting the practitioner to understand some of the cultural issues and the impact of the migration experience and how that affects mental health. So we are very lucky that we have a pool of experts in a lot of different cultures because you can't know everything about a culture. We can't always understand the right type of language to describe dementia in a way that is non-stigmatizing. We don't understand what phrases mean but it's always easy to translate. So we have a beautiful Co-therapy Model that has been very successful and working with the expertise of our multicultural peer support workers has helped build our cultural capability within the organization but I really want to come back to what Susan is talking about around care and showing of empathy and being engaged from a place of what I like to call revolutionary love because that is really protective for us against, you know, experiencing vicarious trauma and it helps us in that whole process of supporting justice within the health system. So if we are truly into our jobs we're having fun, we're having a good time, we're caring for the people we're working with I think we're less likely to experience some of that compassion, fatigue and burnout and Vicki Reynolds has done amazing work around this so I encourage you to look her up because she talks about justice doing. And for me I can never know enough about different cultures in order to be able to provide a great level of care for everyone that I meet. However people know when you care people can feel that translates across cultures, across languages. So I think the most important thing is care for the people you're working with and have fun at work I think being positive about the work and the impact that you're bringing is so valuable to that therapeutic relationship. Yeah, I wondered when someone was going to raise trauma. Yeah. And looking at, I'd like to also reiterate that, but people know when you care people feel it they can see it in your eyes they can pick up on the energy and it's really important that, you know, when within the health system and all the allied health that people who are vulnerable, people who are not well look to the professionals for that support. And I know time is of essence and time is money to get patients through but really it's about taking the time to be present and to have a level of empathy with whoever you're supporting and providing a service to and I just also want to say that Dala asked the question about, you know how to learn about appropriate language and support for First Nations people. So I know that you're all coming in and tuning in from different places across the country and one of the things that for us, we are very you know, multi-culture we have a lot of nations and it's really about health systems and services in a different states and territories actually having a relationship with your community that live around the services and for persons and staff to actually have that relationship with community. So when you have events and things invite community in we have a different system of philosophies of health and wellbeing and we'll have different words across the country for different practices and it's really about trying to reveal and unearth the original health practices of this land to know all of the different nations and elders older people and then start to work out how you can actually do this together because here in Northern Sydney like I've known Stephen for a while and looking at how we've been able to embed some of the First Nations cultural practices of health and wellbeing in this area and start to use the language and start to embed some practices is actually what's important because when you start to use language and to incorporate our philosophies of wellbeing people are then validated they're seen in the landscape they're heard in the landscape and that's what's important because for a long time we just weren't so we're now getting to a point where there's a whole lot of funding in and around providing services to First Nations people how do some of these organisations, hospital personnel, staff do it well and it's about the relationship. So in a miraculous way you've all answered some of the questions that have been sent in of course because hopefully we're all on the same page here and we're all thinking about the problems and how we can solve them and perhaps not see them as problems even so being culturally humble and practising in a reflective way that was one question that I think you've gone a long way to answer. Ming I was going to ask you the hospital is often the interface that people come to and I'm wondering if you could give us a few insights into how hospital based practice differs from community practice and community practice is much more outreach at best than hospital and I'm wondering again the barriers to keeping appointments follow up continuity how you see that challenge in the hospital system. So a couple of points to start with I think everyone's been through the hospital system for themselves and can see it's very much beholden on the user or the patient to push themselves through it communication is the major problem in particular in the system which there is a hierarchy not the same as it used to be but every hospital has hierarchies within it and different lines of communication so for example something as simple as what is a registrar versus what is a consultant about your concerns which come very naturally to healthcare professionals because we live and breathe this situation when you think about incredibly foreign situation to people outside and then even the process of how do you support a patient with dementia and the myriad of issues that they present or the things that they require getting that information and keeping them in that stream getting support is incredibly difficult because the hospital system is geared towards efficiency the tendency is to come in for that brief moment and to be back out again and to lose contact to very much a down soft kind of phenomenon so the first thing I would say in terms of the differences that the hospital is geared for efficiency it doesn't in its natural form provide an easy environment for people to navigate the first word of advice I would give is to really describe to patients how they can advocate for themselves or to figure out a way that they can have advocacy be it either through the family member through some kind of service such as what Samira was describing or if it's even through the GP himself or herself you need to figure out who's going to be the co-sponsor to get them to navigate through and help them engage a very challenging communication system. And the issue of keeping is there any trick you found for making sure that people come back to their appointments because that's not an easy idea to grasp. It is a huge one isn't it? The trust and what the ladies were saying before about patients knowing if you care look like there's no getting around it, there's no point kind of workshop it, you either care or you don't and that comes down to healthcare professionals looking after ourselves I think if I can put the knife into the back of our own specialty Stephen we tend to work ourselves too hard and we've become a little bit focused and I know there have been times when I've come close to burnout you just don't have that then but you're not paying attention and the experience isn't quite as enjoyable. So looking after yourself and being a bit careful to know when you're in form and out of form is important. Something that we talked about previously when we were preparing for this talk was about the feedback loop. One of the challenges is we're all going to be meeting different ethnic groups and it's often hard to know whether you got it right or wrong and so if you can somehow develop something in your practice so you know how the experience has gone for that individual patient, particularly for a new ethnic group you've not been involved with or you can get some kind of feedback from the advocate or there I say people resources such as allied health MDTs or even the trans translation service. I think you've got to make sure that that process of feedback is somewhere available to you. We might take that lead to just discuss briefly the translation services or interpreting service its strengths and its weaknesses. Susan I'll jump in. I think that previously the system has not been responsive to First Nations needs and it caused a disconnect of our people going into the hospital system because that was a place that you would only go at the last resort and then people would die in the hospital and that was because of the racism that was happening and I've heard some really horrific stories of the way in history how our people were treated, there were things separated there were wards that were out the back and there were not such nice names written across the gowns and the cutlery and the crockery which is a bit horrifying but it's not that long ago that this stuff was happening. How that's turned around is that these days you have Aboriginal health units within local health districts so even here in Northern Sydney where we have quite a low population of people who identify whenever someone goes into the hospitals and identifies when they're going either through emergency or through other ways of getting services that the Aboriginal health unit gets notified and then they will come and be an advocate, a friendly face and kind of be the concierge through the system which I think for us going into and I think for a lot of people going into hospital systems it's frightening and I just think that when our young people and when our older people need to kind of interface with those services that they just need someone to just be there to shepherd them through what's necessary and it is frightening for our old people and our elders to go in and I think there's a lot of effort to really educate the system so there's not the discriminatory responses that have happened in the past that there is a change that's going on and I can see it and I've been a part of it and it's good to see because our people for a long time feared the hospital. I'll put in a little shout out to those who really are I think trying across the country to address these issues. Samira you probably have many different interpreters or translators people to work with what do you feel about the system? Yeah well I think you know we have the model where we have our multicultural peer support workers who can provide language support and then we also do have access to either two interpreters or the Queensland Health on-call interpreters and the key thing is to have an understanding of best practice when working with interpreters so it's important to understand the country that someone originates from and that will help you build your understanding of what dialect of that particular language that person speaks. So for example if you're working with someone from Sudan who says they speak Arabic they're going to need an Arabic interpreter which is a different accent, a different way of speaking to say Arabic speaker from Iraq so it's very important to have that contextual understanding of where someone is coming from and the language and the dialect that they prefer it's also really important to find out about what sort of gender match is appropriate for that person when you're working with the interpreter and it's important not to make an assumption about gender matching so some men are very comfortable, sometimes even more comfortable to work with a female interpreter because they're more comfortable to be vulnerable in that space and vice versa so every individual will have their own unique ideas about what sort of language they want. Some people may want to face to face interpreter other people may be more comfortable with one over the phone. When we're talking about sensitive mental health issues a lot of people that I have worked with have requested a phone interpreter outside of Queensland so outside of the state that they're living in just with that feeling of comfort and safety that it's not going to be someone that they may know from their community because ultimately our ethnic community are relatively small in Queensland so everyone knows one another and it's important that we provide that offering to people so that's the first thing. The other thing is that when you're working with the interpreter it's really important to remember to give them a very brief overview of what you aim to do during that session and have a bit of time to debrief afterwards if possible so you can understand how the conversation went particularly challenging working with interpreters when you're engaging with someone that may have cognitive impairment so it's important to brief the interpreter and to make sure the interpreter is letting you know if someone is having difficulty understanding what you're talking about or what they're saying is not making sense and it's important to really remain in control of the conversation so it's a conversation between you and the person you're working with and my key tip is to speak in simple English. Short clear one idea sentences at a time even break your sentences and ideas down further if you need to and ensure that you are addressing the person directly so instead of saying interpreter can you tell Steven that it's a hot day today you just speak as though you're speaking directly it's a hot day today or let the interpreter take over and it's really important for you to continue with that throughout the conversation so it's a conversation that feels more direct between you and that person in order to build the relationship otherwise what can happen is the interpreter can take control and start to do some of the work for you that's so interesting I mean you've probably been through the medical system more recently than me but this is not something that was ever taught in my medical school yeah just listening to Samira I was just thinking exactly the same thing even in western Sydney where I've been working for many years prior to moving to the beaches the communities would be surprised how small they are and even say Chinese communities the networks it's amazing how integrated they are so you've got to be careful about diagnosis who knows about it and quite often translators are quite important people within their own cultural groups so it can be a touchy-feely or challenging situation to know and talk about diagnosis I'm curious to see what all of you think in terms of this discussion because I very much agree with Samira that the conversations and that skill of engaging and looking at the patient directly talking to them and just using interpreter as the voice in the background the precision of what you say becomes a challenge and even this idea of briefing the interpreter before and debriefing because I think it's a very good one but sometimes I wonder about how explicit I should be to the patient there are some times when you can really come across a family to say even if it's dementia I don't want you to tell the family or the patient rather that they have this diagnosis and that product puts us as medical people as health practitioners in a bit of a bind because Western ethics is pretty clear that we have to be very transparent and very earnest and explicit in what we see and what we say and I'm just curious what the panel thinks about that the dementia diagnosis being a classic one because obviously there's a stigma for some cultures do you use alternative words or can we say it once or what do you think is how do you approach that problem that's huge yeah and I think it's one that's not necessarily unique to multicultural communities either so the way that I've handled situations like that is worked with the family to help understand why are you afraid and address some of those issues like taking a holistic approach and then also trying to find words that are appropriate and non-stigmatizing in that person understanding and using the level of health literacy to explain what's going on to them going on to them but yeah I think it's very much at an individual level where we need to find the language appropriate to support that person emotionally to understand what's happening with them and kind of normalize the experience even if we don't use clinical language and that normalizes the group you go ahead as the GP here Samira you and your group you obviously take a lot of time I'm not saying I or my colleagues don't try and take time but the time pressure in the clinic is so great and that's really where working in teams comes in is to know that you have a team that you can politely and respectfully suggest that they are brought in to help because this is a slow and considered process so yeah absolutely yeah and shout out to the Brisbane North and Brisbane South PHS for funding our capacity and to Queen's High Health that's about that you funded me here to watch that you have these you specialists have these long consultations you see yeah yeah now what I'm going to do now because we're just coming into the last third I think I'm just seeing where I can find the slide the beloved learning outcomes that all of these meetings enjoy so much setting up and we had part in setting these up so looking through it I think that we're not doing too badly in covering many of these many of these questions so I hope that will be reflected but maybe just take a moment to have a look at what we said you should as an audience be a little bit more comfortable with at the end of this so I'll take it off the screen because it's a bit prescriptive to come back to all of us so one question that came in how can religious faith be involved in counselling should I always refer people to their relevant religious or cultural leader when questions of faith or beliefs arise in the counselling room how issues of faith and spirituality addressed in your practice we've answered that to some degree but I think the fear of not approaching a client appropriately because we know nothing of their faith or spiritual beliefs and making a mistake that will damage the relationship right down the track so any thoughts on that so I'll jump in I think again because of the history of this country and the fact that our people are the the original people of this land the sovereign people of this land and a system came in and got put in over the top of what was here at the beginning there is an emerging awareness of our people, our culture and our practices which I think is great and previously there was the misunderstanding so there was the discrimination that happened because people didn't know where to go to I think now that there are there are more elder elder groups there is Aboriginal medical associations there are a whole lot of resources now where people can actually find out how to engage better with our older people, with people with dementia, mental illness and the other point I want to make is that in terms of mental health and I think it's the Australian Psychology Association a number of years but it actually did a formal apology to our people to say that our psychology, the western psychology doesn't work and has in fact made us even more unwell I think that to be aware that not one size fits all people that there is a cultural difference there is cultural context language is really important now the thing I was going to add before was that for some of our people and older people English could be a fourth or fifth language and people have to process what maybe a doctor or a counsellor or a health worker is saying to them and if they don't have someone who can interpret that for them which is the translation of the western diagnosis and a service then people just get really fearful because they don't understand what's going on and so they won't return back so it's how we can make the service more engaging but more responsive to someone's cultural spiritual background and if you don't know what that is then seek out how to educate yourself better in being able to respond to different communities and when I say communities I'm talking about First Nations communities the other thing I was going to say was that people are off country sometimes too so what makes us well as First Nations people is actually being on our own ancestral homeland we get strength we feel well when we're on country being off country can make us unwell so sometimes people will say I'm okay I might physically or spiritually or mentally cognitively be unwell psychologically be unwell I just need to go home to country and that is as good as any pill I can assure you being on your ancestral lands and being with your community makes you well and I would think that would be the same correctly if I'm wrong Samira and Ming for many many people it's sort of the elephant in the room sometimes just naming that before one goes into a complex psychological remedy and particularly medication just to acknowledge that you are not in your country and of course it may be impossible to go back to your country if you're a refugee so Samira you spoke when we were talking before this webinar about a cultural capacity ladder that you use in your that would be interesting to hear about yeah well it sort of it's not much talking about you know the cultural capacity ladder is how I see things in my mind and it's sort of about understanding that where am I and it's about reflective practice so the first step is on level of cultural awareness so okay I understand that my values, beliefs and understanding of mental health are different in this situation the next level up is building cultural capacities so you're starting to develop skills and strategies to be able to work culturally but the top rung of the ladder is cultural humility that's when you've reached a point that you understand you're not going to know everything you need people around you to support you to understand and build your capacity to be responsive and you've developed a framework of reflective practice that is grounded in a value of wanting to do justice in the work that you're doing so that's kind of how I like to think about building cultural capacity at both an individual active level and also at a semi-organizational level so when we think about how we are funded to do our work a lot of psychological therapies across the country are not funded to work with interpreters so this is something we need to advocate for we need to advocate for the basic language and advocate for doing things better I think as occupational therapists we are very lucky because our practice framework I'm specifically referring to the Canadian model of occupational therapy centre of that model is spirituality so what motivates someone what are their beliefs what are their ideas around health this is what we define spirituality not necessarily religion for everyone so it's an important conversation to have with people from multicultural backgrounds a lot of people who come from collectivist cultures and multicultural backgrounds are very comfortable to talk about religion I know in our mainstream Australian culture to things you don't talk about politics and religion but that's not the same across different cultures and contexts and in fact when you're working with older people from different backgrounds a lot of them love to talk about politics so that can be the currency that can be your buy-in and it's important to ask the people around what they like to talk about so really understanding that our framework is centered around spirituality because that is the motivation and volition I think that's really important I think we do like you on our team Samira well for the people a shout out to anyone from Queensland we've set up a service that was born out of the COVID pandemic funded by Queensland Health and it's called Multicultural Connect Line and we exist for the sole purpose to provide a pathway to culturally appropriate mental health support for people across the state and we are also able to talk to other providers and practitioners if they've got questions about social services and also mental health support so you can bring me on that 1300 number perhaps we can send that around later and I'm really happy to chat about that and Ming do you think any of these conversations go on a lot in the hospital of this nature yeah I think they do I think most people do try let's be clear the difficulty is the structure of the workflow around happens in the morning the family's not there the consultant who directs everything disappears and goes off site a lot of the communication to the allied health and the nursing unit management floor doesn't necessarily happen they don't know what's going on so if you spend the time and look at it it's just the way that we've structured our workflow and how our jobs work that's the issue but people are trying to engage with that I think what Susan was commenting on in terms of the Aboriginal Health Officer I had trade actually under Tony Bro for a while many years ago and had a very good experience about that it's really just about co-locating a buddy of the same culture who can navigate and be the concierge the tugboat through the stream I think it can sometimes be as simple as that the other thing there is I said the families and I guess maybe can we maybe exploit that a little bit more and discuss that because invariably where I've seen families who have the financial and the education and the experience to engage with a higher item so for example I've noticed between my experience in the western Sydney versus the beaches the clear difference is some of the families I'm meeting in the beaches are used to dealing with advocacy with a lawyer family or a business family they know how to advocate for their family they know how to talk firmly but not confrontingly and they know how to seek advice they know how to pick who they have met is the person with the information when you've not come from the same background in western sort of culture if you like or you're not used to big organisations and systems it's very different and I think a lot of hospitals are trying to engage with that in different ways be it the size of the hospital what kind of person engages with the family and even the basic communication tools like do you give brochures do you plug in Manny with the GP or do you go specifically to the patient with some kind of care provider be it a specific allied health worker invariably the social worker so I think hospitals are trying but this is the kind of thing that we are talking about today so it's almost time to sum up in a sort of one-liner we did have a question which is far from a one-liner and that's about stigma so I'm going to set you a really hard hard task here but I think stigma is central to what we're talking about and the feelings of people coming into our health system especially with psychological what we call mental health issues social and emotional non not feeling well so big challenge but you've got about one minute each to sum up the challenges I mean you've all really covered as much as one can in three-quarters an hour the the field we've had a conversation which is so important but maybe just a word or two on stigma oh that's something on that one oh well we're all human that's good well it's not a stigma if you don't make it a stigma in the office when you're talking to them it's really about showing that it isn't a stigma this stuff about say Chinese culture about seeing dementia as maybe being normal and healthy normal expected aging versus other cultures say for example Eastern Europe but maybe the patients malingering I'm not sure that's entirely true I think families and cultures are more heterogeneous than that but obviously we have to be aware there can be some trends but look, stigmas aren't stigmas if you make sure that you show the patient you care and it's not a problem they're less a person for what they're going through the only other comment I would say in terms of living a particularly stigmatizing diagnosis is you don't have to necessarily deliver it right at the point of contact I've in my younger career often done a very hefty cognitive examination because I thought I was being a smart doctor that's a very confronting experience for most patients when they have to be exposed to a cognitive assessment it's like confronting and demeaning and then to deliver them a diagnosis at the end of that in such a very taught situation it's not the way to go it's better to spread out the consultations and see them iteratively and introduce the idea in a more comforting manner yeah if there's a word stigma in other languages Samira I don't know because I only speak English but what I can speak to is that in our organization at world wellness group we've done a lot of work to understand how to explain mental health in a way that's not stigmatizing so if you look at our promotional materials for example for the helpline you'll see words like stress and worry or concern that gets translated into different languages we know we're talking about mental health issues but we don't put it across that way because then once it becomes illness issue it becomes inaccessible to a lot of people that may need health and what we've done on our helpline is we've structured in psychosocial support and practical support and what we find is that once we're able to offer someone a solution to a practical issue causing stress we've built a relationship and then that's when conversations about mental health issues start in a more natural way so it's really about investing time to build rapport assess someone's mental health literacy and find the right language to describe what's going on and find the right person in that person's life to talk to as well particularly with older people and I think in the public chat somebody mentioned that in a lot of ethnic communities in Australia I'm referring mainly to our collectivist cultures that reside within Australia there is a reverence for older people and a lot of respect and a desire for younger people to be caring for older people so it's usually very easy to find people around an older person to talk to as well I guess my contribution to this is language is important and so when we're talking about the different health whether it's physical health or mental health from our perspective it's about social emotional well-being and what we would also say was that this is one organism and not to separate out the mental health and the physical health because there is such an interplay that happens so we look from a more holistic point of view of a person's connection and their identity and their whole social emotional well-being we also in terms of First Nations philosophies around well-being we look at the three worlds and we recognise the importance of the connections of the three worlds so there is the human world and it is about our physicality and our relationships with family and people and our behaviours and how we're meant to respond to different people there is the environment that we live in and there is also the sacred world so spirit being at the centre of everything and recognising that we are spiritual beings having a human existence and where we are born from and where we are born into is important in terms of being a human this lifetime but having a spiritual journey so it is about making sure that we care for all of it our humans, our physical and our spiritual cells and it's that what I call the triangular balance that if all of those are in balance then we're happy and we're healthy and we're well if something is not in balance then that three-legged milking really falls over so our desire to be on country to understand our connections as humans and also understand our cultural, spiritual ways that are important to us so social emotional wellbeing understanding who we are this lifetime and yeah that's what's important we have a lot to answer for don't we Ming for the over-medicalisation of growing older yeah obviously we have skills but we can sometimes not see the wood for the trees and I think that's one of the messages I hear from all of you and so we've certainly had a conversation tonight which is I think probably always helpful and if only we had more time for conversation in our daily work I sometimes like to think of the words that you've used during the webinar and there are always words that begin with COM the Latin for with think words like compassion and comfort so important it's always fun to go and google words beginning with COM and carry them into the day it's an interesting exercise now there are resources let me come to I think Samira wanted to say something oh there we go I'm not following my chat room I'm bad sorry I've got probably too much of an eye on the clock yeah just quickly Stephen I just wanted to pick up on what Susan was talking about around looking after people holistically and that is so something that we found really valuable and important is facilitating referral to other service providers in a way that you remain linked in with the person until you know they've engaged and they are well engaged with other service providers before you close them or exit them from your program and I think this is something I probably should have said earlier but this is central to a trauma informed model so we're not having a reliance on that person to repeat their story to every provider they come in contact with and I think from an OT perspective we want to provide that holistic care as well that is very much part of our framework and just a word of encouragement to our PHN funders and listeners out there is that let's get mental health programs outside of clinical spaces outside of the office into outdoor areas where people feel more comfortable more connected to nature to calming sensory environment. All right now I have to jump back in Stephen and talk briefly about Cabernonna which is exactly what you're talking about Samir so with the PHN mental health money that was in our region in Northern Sydney the Gamarago Group partnered with Relationships Australia to dovetail Indigenous philosophies with the Western system and it was exactly that take people outdoors do ceremony connect with nature and be with life-minded people and share time together and that just human connection and energy being in the environment just allows everything to fall away and you can just have those moments of respite from your life which makes such a difference so Cabernonna is a Gamarago word and it means resting the mind and it was just so wonderful that we're able to create something that brought the best of both systems together. No good and during COVID I set up a little outside working space that was appropriately distancing and the rest of it and people said I don't want to go back inside again can we always have consorts like this so I think this is a human desire to be out outside and the medical system of course for obviously good reasons has become like a fortress and let's see how we can help people so if I can move on to that there's one which I didn't put in there which is Council on the Aging Australia COTA if you Google COTA they have a particular site which is culturally inclusive aged care which is full of good information you'll all receive follow-up communication from MHPN with the recording of the activity so maybe in your workplaces play it to a small group and further the conversation is how things move along and how we can advocate better for change MHPN supports engagement and ongoing maintenance practitioner networks where clinicians from different disciplines meet regularly with other mental health practitioners share tips, resources build local referral pathways and engage in CPD so there's a list of some of the networks our one in North Sydney has meetings on a wide range of topics including art and music therapy multicultural issues drug, alcohol issues First Nations health geriatrics, psycho-geriatrics and even film screening so to all of those who are in that network I think we've built up a good group and look forward to meeting face to face if we can clear COVID out of the way so if you're interested please make contact with the MHPN I think this is really important and I'll use that word political work is to meet in groups and promote the ideas that we're talking about here and spread the word and that's best done in small groups and community it's a very inclusive network so you don't really have to have a formal qualification in one of the six allied health categories or eight allied health categories that Medicare recognizes as I said you can be someone involved in art or music therapy or community leader and they're going to be more webinars and more so this was the third and there'll be more webinars as I said at the beginning by way of partnership between the 31PHN and MHPN keep an eye out for future communications please fill out the exit survey I'm not sure if that's another slide here there we go yes that's thank you we're not quite thanking you yet but we'll be thanking you in a moment