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Multicultural Health - 26/06/2020 :: 31/12/2020

A question of diversity 

Australia is a successful multicultural, multi-faith, multilingual nation. So, it might be tempting to think a convenient, one-size-fits-all approach can meet the mental health needs of people from an immigrant background.

While individuals or communities might fall into this category, they by no means form a homogeneous group.

NSW is very culturally and linguistically diverse (CALD) with more than 27% of our population born overseas. More than 23% of us speak a language other than English at home, and nearly 4% don’t speak English well or at all. More than 260 languages are spoken in NSW.

In NSW, Chinese languages – mostly Mandarin and Cantonese – are the most commonly spoken other than English. Arabic is the next most common, followed by Vietnamese, Greek and Italian. For people aged over 55, Italian is the most common language other than English, followed by Cantonese and Greek.

The relative youth of recent arrivals – they are younger than the general population – is an important consideration for the issue of mental health because adolescence and young adulthood is the peak period of onset of most mental illness.

In contrast, older immigrants as a group are older than the general population. We need to consider health issues such as post-traumatic stress disorder, depression, anxiety, stress-related psychosomatic illnesses, and age-related memory loss which may trigger suppressed memories of trauma.

It’s also important to recognise the mental health and wellbeing needs of the children of immigrants – those born here who make up the second generation – and indeed of subsequent generations. While their experience varies by their parents’ country of origin, they too can experience stress in finding their identity between their family’s traditional culture and the culture of the society in which they are now living.


  • Arabic speakers are the largest group of carers
  • 20,735 people provide some form of unpaid assistance
  • This represents 11% of the Arabic-speaking population in NSW, compared with 9% in NSW overall
  • Number of carers in the Arabic-speaking community is almost double the number in other CALD communities
  • Other communities with relatively high carer numbers are: 15% of Italian speakers, 14% of Greek speakers

A history of trauma

The act of migration itself is a significant risk to mental health, especially when the circumstances have been very traumatic.

A person’s capacity to cope is impaired.

They may have arrived as an asylum seeker, as an unaccompanied minor, from a refugee camp or a country experiencing conflict. They may also have spent a long time in mandatory detention.

Refugees and asylum seekers are particularly vulnerable. Traumatic experiences such as being exposed to violence, war or torture can affect people long after the events have passed.

It takes time for immigrants, refugees and their families to adjust. Reshaping your personal identity can be stressful and it’s different for each person. Our culture not only influences the experience, expression, course and outcomes of mental illness and wellbeing, but also how, when and if we seek help and how we respond to health promotion, prevention or treatment interventions.

Access to services is fragmented because of issues such as language, low levels of mental health literacy, limited knowledge of types of services available, shame and stigma, lack of interpreter use by service providers, confidentiality concerns and so on. Visa types can also affect Medicare eligibility. Detained asylum seekders are not eligible for Centrelink services.

Towards change

A society that lets us express our multicultural identities, beliefs and practices can help us to adjust – and that bolsters our mental health. But it is crucial that care and support services take any history of trauma into account and be aware of the health and wellbeing needs of all age groups.

GPs and ethnic community organisations must connect directly with their communities in relation to mental health support and education. We need to ensure there are structures in place to make this happen.

Stigma and taboo

Stakeholders tell us there is considerable stigma and taboo associated with mental health issues, not only in recently arrived communities, but even in more established communities such as Greek, Italian and Russian. The stigma about issues, such as suicide, can be so significant they are not even acknowledged in the country of origin and so are not seen to exist. 

Towards change

Education about mental health issues as well as mental health services needs to be tailored and delivered by appropriately trained care and other professionals who are sensitive to and knowledgeable about our diverse communities.

Risk factors

Isolation is a particular risk for smaller, more recently arrived communities, women and people in rural areas.

Perceived resilience of more established communities means their needs are often overlooked because it is assumed they already have supports in place.

Poor general physical health of immigrants tends to be prioritised over mental health.

Under-resourced and culturally inappropriate mental health services are seen as limited in dealing with multicultural communities.

Towards change

We need:

  • more research on mental health issues in our multicultural communities
  • a stronger multicultural mental health workforce
  • flexible funding arrangements for services
  • support services for carers
  • early intervention services. 

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