Our Mental Health Access Service (MHAS) has once again successfully met the National Standards for Mental Health Services (NSMHS). As per the accreditors, IHCA “MHAS provides an outstanding service with exceptional outcomes as a result of their advocacy and support with very complex caseloads of migrants and refugees with mental health concerns.”

Client feedback best demonstrates their appreciation of the service:

• “Brilliant service. I am going Okay now but they were a great support for me for several years with my mental health and housing problems. Sometimes I still ring them now to keep in contact or if I have a problem with something and they are always so welcoming and helpful.”
  
• “They have been working with my family for many years off and on, helping with practical support and referrals to other services for mental health and grief and loss, and a massive amount of emotional and mental health support. I don’t know what we would have done without them.”

Here’s a case study that highlights the extensive work undertaken to support our clients.

Background Information

‘Anne’ a high school student is the third oldest child in a family of 6 children. She lives with her single mother and four siblings live in a 3-bedroom private rental house.. She is estranged from her father.  Anne was born in a refugee camp.  The family arrived in Australia as humanitarian entrants.  They have moved house many times over the years, including interstate and regional areas.  They have often been at risk of, or in a homeless situation, with the father absent.  Anne was referred to our service in September 2021.

Many services have been involved with the family over several years, including various high schools, Dept of Housing, hospitals, and Centrelink.  Current services include Anne’s senior high school, CPFS, CAMHS, EDAC and other medical services (e.g. GP, hospitals).

Issues

Anne’s family has a history of long-term chronic family and domestic violence, abuse, and dysfunctional relationships between various family members.  Her father apparently has been a long-time perpetrator towards (ex) wife, and abuser (including possible sexual abuse) towards some of the children, including Anne.  He has a history of controlling and manipulative behaviour towards the family.  Anne don’t want anything to do with him.

Her mother has longstanding serious mental health issues and has had a number of psychiatric hospital admissions, but is lacking in community support.  Anne’s Mother’s English literacy level is very low, and she mainly uses Anne as an interpreter.

Anne has more recently been diagnosed with serious MH issues, including PTSD and dissociative disorder.  She also has a history of seizures, possibly triggered by trauma.

Anne and her older sister have been the primary carers for their mother for several years.  The burden has rested more with Anne now, because her older sister moved out of the family home.

Challenges/Barriers

• Anne often not attending school due to unstable/chaotic family circumstances.
• Anne conflicted between caring for her mother, and her own care, development, and goals.
• Lack of engagement; family can be dismissive of services unreliability and often family actions/changes are unpredictable.
• Father is still ‘in the picture’ (has own agenda?), contributing to family instability and uncertainty, especially regarding relationship with his (ex) wife – having a ‘hold’ on her.
• Ongoing distrust/fear of services, lack of understanding by family.  Cultural differences/beliefs and fears about ‘mental health’ and treatment/medications
• Unrealistic (demanding?) expectations about services and meeting the family needs.
• Services not working together effectively, disjointed, not coordinated. A more coordinated ‘whole of family approach’ by services is needed.

Working with the client

• Building rapport and trust with Anne and family members.  Understanding family circumstances and cultural issues in more detail.  Including Anne’s mother and older sister in discussions about family needs.
• Flexibility and assertive outreach (‘respectful persistence’) to promote engagement and client choice.
• Providing information and clarity about services, processes and navigating the systems.
• Ongoing advocacy and liaison to try and strengthen supports and have a more collaborative approach by services e.g. case conferences.
• Assistance with finding suitable supported youth accommodation (still pending).
• Informal counselling and some practical support such as transport, ER.
• Exploring other supports and/or referrals to help build client and family capacity.
• Monitoring and reporting any safety concerns or risks for Anne and her mother in particular.

MHAS funded by the WA Mental Health Commission provides a metro wide advocacy and support services to migrants and refugees affected by mental health concerns. For more information and referral please contact us on 9336 8282.