|
by Patricia Nesci and Silvio Iadarola
According to the Mental
Health Council of Australia and Carers Association of Australia (2000),
approximately 40 percent of Australians were either born overseas or have
a parent from a non-English speaking background.
Twenty percent of Australians were born in a non-English speaking
country. Although the rate of
mental illness is similar to Australian born people, there is
under-utilisation of mental health services by non English speaking
background (NESB) communities. The
reasons for this according to the report include a range of complex
factors: high levels of stigma associated with mental illness for those
from a NESB; inadequate information in regard to services and how to
access them; lack of cultural appropriateness of services; and shortages
of bilingual and bicultural workers within the mental health services
together with a shortage of interpreters. This has major implications on carers for individuals with
mental health issues as it suggests inadequate treatment for NESB.
There is a range of services within the mental health settings that
people from a NESB cannot adequately access.
Another major deficiency, according to the report, is the lack of
carer packages in various languages which take into account specific
cultural beliefs about mental illness and treatment.
Caring for the elderly or older person who suffers from a mental illness
presents itself with a complex set of problems.
The Eastern Mental Health Services for Older People in South
Australia is a service which provides a comprehensive assessment and case
management approach for individuals 65 years and over who suffer from a
mental illness. During the
course of our work, it has become increasingly apparent that carers of our
clients, in particular for the Italian speaking community, are being
confronted with a range of complex problems in relation to caring for
their elderly parents or siblings.
Carers who were interviewed for the purpose of this report expressed their
sense of frustration in accessing information on services due to language
barriers. Further, these same
carers also referred to a sense of helplessness due to power imbalances
when contacting professionals from appropriate services.
Carers expressed disappointment at having to cope with complex
needs and demands in particular when their loved ones were suffering an
acute phase of their illness. They
also expressed concern about not having access to services or being given
culturally inappropriate responses. They
reported that at times what was most required was advice on how to manage
the behaviour in order to continue providing the required level of
support. Carers also
expressed a need to be provided with more education with regard to mental
illness.
The issue of respite was also a largely expressed need by carers of the
Eastern Mental Health Services for Older People, which to date has not
been adequately met. Findings
from a community consultation, “Strategic Directions for Older People of
Culturally and Linguistically Diverse Backgrounds” conducted by the
Department of Human Services, aimed to “act as a catalyst to develop the
final strategic directions and recommendations for whole of Government to
address the needs of older people from culturally and linguistically
diverse backgrounds”. With
regard to the Italian focus group, carers reported aversive experience
with respite services as there was inflexibility and lack of continuity of
care. “Carers need a
respite centre that is user friendly, not hospital/nursing home like and
flexible, a place where there would be no guilt in leaving their spouse, a
drop in centre” (Italian focus group). Carers referred to a need for
ethno-specific respite services. Further,
in regard to carers and relinquishing care, more home help was preferred
as a solution rather than nursing home care.
Nursing home care was only viewed as a solution if carers were
unable to cope.
A significant issue is that of the competing demands of family life and
caring for their elderly parent. Millward (1999) conducted a study, which reported the strain
on carers with regard to competing family priorities, gender roles, work
commitments and use of public services.
She also reported this to have an “impact of wider family
dynamics upon helping behaviour”. In
particular for women, it was noted that middle aged daughters working part
time or not in the work force were more likely than their sons to be
elderly carers (Millward, 1999). However,
what Millward also reported in his findings was that carers having support
from other family members, and having choices, contributed positively to
carers. Further, as one carer
expressed to our service when interviewed, having support from community
supports has been an enormous assistance.
“I would no longer be able to care for my elderly brother if he
did not have access to community supports”.
This particular carer referred to a long history of complex needs
with regard to her brother suffering from a mental illness and the strain
on herself and the family over many years.
She also referred to not having a voice when she attempted to
access service on behalf of her brother during acute phases of his
illness. She reported the
frustration and humiliation of approaching various professionals and not
“being heard”. However,
she now says that she “does what she can”.
“Carer burnout” was also identified to be a major issue with carers of
clients of Eastern Mental Health Services for Older People.
Individual carers reported experiencing periods where they felt
physically and emotionally unable to cope with the care of their elderly
parents or siblings. This is often referred to as “carer burnout”.
They reported the strain of constant supervision had taken its toll
on various occasions. According
to Minichiello and Coulson (1999), there have been reported short-term and
long-term effects on the health of older women carers in relation to their
physical and emotional health. Stress
has been identified as a major predictor of health problems such as
headaches, tension and nervousness and symptoms associated with the
musculoskeletal system (Rosenman et al, 1994, in Minichiello and Coulson
1999).
Directly related to carer burden is the hidden issue of elder abuse.
Minichiello and Coulson (1999) maintain that elder abuse may be
directly linked to insufficient support for carers.
The same authors refer to findings of a study (Kurle et al. 1992)
which revealed that 46 per 1000 of geriatric and rehabilitation service
community patient population for individuals aged 65 and over suffered
from elder abuse. One of the
major causes of elder abuse identified in this report was that of carer
stress. Further studies have revealed that violence does occur with
relation to the provision of care with reported verbal, physical and
sexual aggression (Cahill and Shapiro, 1993, in Minichiello and Coulson,
1999). Secondly, the above
researchers have argued that the legislation with regard to domestic
violence is inappropriate with elder abuse.
Directly related to the above is the significance of findings which
have indicated that “providing support and resources to caregivers has
emerged as an important factor in predicting more functional and
beneficial caregiving relationships”(Minichiello and Coulson, 1999).
In summary, caring for the older person with mental health issues presents
itself with major difficulties. There are major effects on the carer’s physical and
emotional health. Further to
this, the carers of clients of the Eastern Mental Health Services for
Older People from the Italian community reported major barriers in
accessing services and being provided with culturally appropriate
responses. More respite and a
more “humane” approach which takes into account the individual within
the context of their culture is required. This presents challenges for the mental health services to
provide more bilingual and bicultural workers in addition to further
transcultural training to staff within the services.
References
Mental Health Council of Australia and Carers Association of Australia
(2000). “Carers of People
with a Mental Illness- Final Report.
Canberra, ACT, Commonwealth Department of Health and Aged Care”.
Millward, C., “Caring for Elderly Parents”, Australian Institute of
Family Studies, Family Matters, No.52, Autumn 1999.
Minichiello, V., and
Coulson, I., “Family Support and Community in an Ageing Society”,
Australian Institute of Family Studies, Family Matters, No.52, Autumn
1999.
Department of Human
Services, “Strategic Directions for Older People of Culturally and
Linguistically Diverse Backgrounds, Community Consultation, Summary of
Findings”, November 2000.
|