Strengthening your Practice through Humility and Curiosity

Disclaimer: The following transcript has been autogenerated and may contain occasional errors or inaccuracies resulting from the automated transcription process.

Host (00:01):

Hi there. Welcome to Mental Health Professionals Network podcast series. MHPN’s aim is to promote and celebrate interdisciplinary collaborative mental healthcare.

Raj Ramanathapillai  (00:19):

Welcome to Mental Health In Practice, a podcast from Mental Health Professionals Network. In this episode, we are focusing on culturally safe and responsive Practice when working alongside migrant communities, asylum seekers and refugees, including how practitioners build trust, navigate barriers and create more accessible and person-centered approaches to care. My name is Raj Ramanathapillai . I have a very long name. That’s a cultural part and I’m a counsellor. I am joined today by Quan Nguyen. He’s a accredited social worker. Welcome. Just a brief introduction of myself. Beside my counselling part, I’m also used to be an academic teaching philosophy and peace studies in the US and Canada. I’m also an author of Turtle Without a Sandy Beach and mainly working on refugees history. Also, I’m a researcher and such a wonderful experience to be with you all today. Quan, would you like to introduce yourself?

Quan Nguyen (01:36):

Yes. Thank you for your introduction. So my name is Quan Nguyen, so I’m glad to be here to provide this talk about the topic about cultural safety and working with migrant or refugees. So I’ve been working with mental health services for about 30 years and also in my past experience I used to go to AIMS to provide mental health assessment for asylum seekers and refugee as well. Myself. come from Vietnam and with my cultural background so I understand how things can be challenges for migrants for refugees when they first come to Australia.

Raj Ramanathapillai  (02:17):

Thank you. I also should have said that I’ve been working with refugees and asylum seekers for over eight years and also family violence context. And it’s such a gratifying work that we do.

Quan Nguyen (02:32):

Yeah. So I guess from your perspective, what is important conversation to be having right now?

Raj Ramanathapillai  (02:39):

I think this is an exciting conversation we are having Quan, because I think cultural safety is something very central to migrant community, but there’s a history in Australia how that evolved before and where we are at. I think after… this is Australia, is a country of Aboriginal people and Torres Islanders. And after colonisation, I think in 1901 they brought the Immigration Restriction Act, that basically a legislation limited non-British migration to Australia. However, it took 70 years to shift that universal worldview to be part of inclusive multiculturalism. In 1973, a multicultural society for the future, a reference paper issued by the minister of immigration Al Grassby. And that triggered the whole open the door for multiculturalism and the work we do now. In 1975, there is a legislation called the Racial Discrimination Act that happened that also added to make sure the multicultural processes were guarded and safe people.

(04:07):

And 1979, the Act of Parliament established the Australian Institute of Multicultural Affairs. This all contributed to welcoming migrants to Australia from 1970s. As you suggested, the early wave of migration, the skilled migration come with business, family, sponsors, spousal sponsors, and then student coming here and later on become Australians and particularly the humanitarian clients. So that particular group of people were a migrant and also refugees. Refugees are the most important group of people who lived through the political prosecution in their country and they moved here. So it is here in this context, we are going to talk about the issue of cultural safety and migration population and immigration population, how we are going to work because it’s shaping our mental health system because when people coming from this area, they’re unfamiliar with our system, diagnosis, therapy, Australian healthcare system and so forth. So in this conversation, we are going to talk about this expanding diversity in Australia and what’s the best way we could serve the clients we do.

Quan Nguyen (05:41):

Yes. I pick up something you mentioned about cultural safety, working with asylum seekers and we have large population of migrants in our working area as well. And again, like when we’re talking about working with asylum seekers and migrants, there are two kind of different population as well. But I think in general, in our work, when we provide healthcare for community, we talking about culture safety, cultural competence and also another term I just picked up recently, this about cultural humility as well.

Raj Ramanathapillai  (06:22):

Absolutely. I think all this terminology came from the early stage of multicultural work. The framework was initiated by the Aboriginal and Torres Island community in terms of cultural safety, in terms of respect, value, they’ve been valued, feel able to participate in the process, can express their cultural and spiritual beliefs and feel comfortable with raising concern in the counselling or mental health settings. But when it comes to migrants and asylum seekers, which is the earlier discussion initiated by Aboriginal and Torres Islander people, this is adding another layer to that space, particularly when people from other countries move to Australia, they are navigating through new cultural space from one culture to another, new system space from one system, mental health system to here, and then the most importantly, the spatial space, one landscape to another landscape, this all bring in them a newness in that journey for them.

(07:44):

So most of them are really not quite sure how things are going to work out. They have worries, they have thoughts, how we are going to manage and this bring a lot of anxiety, additional anxiety and stress in terms of safety in their mind. The idea of counselling and mental health work are inherently cultural and it’s relational based from their cultural perspective. So for example, language as you know in our work, when clients, they express their feelings, thoughts, their worries in their own language, they feel much more control. The moment they have an interpreter and do that counselling work, they suddenly lose that sense of ownership in that process. Sometime often they lost in translation, that also bring a lot of issues. So there is language safe space we often create in our office and also for them learning new vocabulary in that process, new vocabulary we say “counselling” for the very idea counselling itself may be foreign to them, for some of them.

(09:01):

They may have a different word in their cultural language. So in that cultural safe space we constantly reconstruct language, vocabulary, building bridges between cultures. So understanding culturally safe Practice is an ongoing responsive process accordingly rather than standardise check the list approach. It’s not a formal method that be already existing. It’s something very fluid.

Quan Nguyen (09:35):

In fact, somehow you raised another question for me. When you say that someone is unable to express themselves, actually they feel not confident enough. Not part of the process. Yeah. And then they have to use interpreter to help them with the translation and also on the other hand, when they can’t speak the same language, so language can be a barrier and that’s why we need to interpret or translator. So this can be a dilemma, you know what I mean?

Raj Ramanathapillai  (10:06):

That’s a great space.

Quan Nguyen (10:07):

We always work and with, lost in translation. And that’s what I think mental health workers have to acutely aware what’s going on in language and body language and et cetera, et cetera, thing in this process. Quan, you work with a lot of skilled migrant people and tell me about your experience working with them in the context of safe space.

(10:31):

Yeah. You have touched on a couple of things there. First of all, it’s about language barrier for migrants, yep. So language barriers can be a challenge for some as well. So because of language barriers can lead to misunderstanding or misdiagnosis or poor medications.

Raj Ramanathapillai  (10:53):

That’s very critical. Yes. Yes.

Quan Nguyen (10:55):

And even a lack of informed consent as well. And also whether you come from a migrant background or asylum seekers or refugees, we often carry something in our life, drama, migration trauma and it can be variable. Some can be very deep, very hard to move on and this kind of scar in themselves, physical or psychological trauma, stay with them for a long time. And also from my past experience with the authority, when people come here they carry a lot of thing with them and talking about mental health, this is a hard thing because it often carry a lot of stigma.

Raj Ramanathapillai  (11:37):

Yeah, I think you’re absolutely right. One part we work with these deeper issues like trauma. We are also in the creative space and pushing the walls and creating new system to accommodate a safe space for the clients to advocate them. For example, my title is counsellor advocate.

(11:59):

The advocacy part, constantly I would talk to my manager or system to say we need to change little things. In my work with refugees, that is much more complex. I lived in that war context too. So I was able to check the notes with them, what they’re saying. It’s easy to understand. One of the Practice I do, not only I pay attention to the language, even though with some client I’m bilingual counsellor, I could understand directly that help them to ease and speak their language, express their emotions and so forth. That really helps me a lot. But with other clients I use translator beside that I also pay attention to body language. For example, if a torture survivor’s coming into my room or walking through the corridor, I pay attention how their body is. So that’s so important for a counsellor to ease them, create a safe space for them because it may trigger and remember the interrogation room, or shooting formal questions may trigger them to remember that is an interrogation set of questions rather than a relational question.

Host (13:19):

So I spend first two, three sessions to make sure that I don’t come across as from their own memory. Someone they can trust, be ease and feel home with it. That’s part of the big work we do, creating safe space for refugees in that sense.

Quan Nguyen (13:41):

Yeah. That’s another thing is about the advantage of having skilled migrants, workers in a healthcare setting. When you come from the same background, you understand the culture, you can pick up the nonverbal cues or you can understand why the person’s citing like that. Even from studies has shown that for consumers or clients, they feel more comfortable when someone in the same culture background present there. So they feel more satisfied in the treatment as well, because they know that you understand them and you can provide what they hope for.

Raj Ramanathapillai  (14:16):

Sometimes it’s so funny, our clients can give some insights to us. Sometimes they say, “Yeah, I was told to go and get some counselling from my GP and you guys talk, talk, talk, talk.” What does that mean? I said, “That’s part of the process of counselling.” So we not only give counselling but also give some education for them to how counselling work, what narrative therapy means. You talk, talk, talk, that’s part of the therapy we do. So in a way, that’s an opportunity for them to help them to understand what’s going on within the system and also sometimes when it comes to cultural safety, when you have a complex client, refugee comes from a deep traumatised situation. I remember one of my client, he rarely open his mouth and whispers most of the time, even though he spoke my language. The only time I got a breakthrough with him is that he likes to cook and I like to cook and we started talking about recipes, exchanging.

(15:25):

That was the opener for us to culturally work through that process and then slowly become into counsel. Now he’s a very successful businessman. He owns a restaurant. So this is the kind of stories we work through through the cultural safety journey. Otherwise the mainstream, they become more formal. The more we create that therapeutic space into a formal thing, they connect sometime with the authority back home so they don’t respond much. So we need to undercut the authority space as a counsellor, but to make sure that we create a relational counselling process. Am I right?

Quan Nguyen (16:10):

Yes. I think that if you’re able to pick up the meaning behind it, understand from the person perspective, you can talk the same language with them, then people will engage with you in the whole process. Yes. Yes. And perhaps this might lead to another question. It’s about in our work, how do we work collaboratively across different roles and perspective? This can be a challenge issue in the big team with the multidisciplinary team and then you have to try to balance.

Raj Ramanathapillai  (16:42):

God, I have seen you working in this space in our office. You are the master in managing people from multidisciplinary, multicultural, and to pull everyone together with a sense of genuine passion for work and that’s inspire many younger mental health workers. I’m sorry, go ahead.

Quan Nguyen (17:04):

Well, I think that when you working with other people, you need to know who are they, why they work, and then you need to think about what the big goal we want to achieve, right? So collaboration doesn’t happen automatically. So it has to be- Work. Yeah, work designed. Yes.

Raj Ramanathapillai  (17:27):

Genuine interest in people and issues.

Quan Nguyen (17:31):

Yes. Yes. So doesn’t a matter where you work, but we always think about, okay, when you come to work, when you particularly in healthcare system, you think about the clients, the consumer, you think about the best thing we can help them to achieve their goals.

Raj Ramanathapillai  (17:49):

Yeah, absolutely.

Quan Nguyen (17:50):

Absolutely. So their goals, I think this is the number one priority. When people come to the service, they want to get better. They want to be happy.

Raj Ramanathapillai  (18:00):

And they feel safe and with a lot of care, that’s so important to them. And sometime I remember some clients after completing in the end of the closing session, they would say, “Raj, I feel home here.” That’s a deep sort of expression for them because for them home mean a safe space, they don’t need to worry. Then I feel like we are succeeded in our office with all the setup, all the contribution, all the service we provide.

Quan Nguyen (18:34):

Because if we focus on their goals, their priorities, then in our workplace we should help people to try to help them to achieve their goals.

Raj Ramanathapillai  (18:47):

Exactly.

Quan Nguyen (18:48):

Within the organisation, we need to provide psychological safety for staff to work together, to speak up when they feel that there’s something we need to fix, we need to improve.

Raj Ramanathapillai  (19:01):

Yeah. We have a multidisciplinary team in our office. We have case workers, cultural workers, peer workers, physiotherapists, physio exercise therapists. We have counsellors, psychologists, and even psychiatrists. We all work together to break the barriers to see what’s the best way we would work. For example, recently we know the barriers. Sometimes clients would come and we would offer a cup of tea and they would say no. And then we think, okay, that’s it, he or she doesn’t want it. But in their culture, you had to ask a couple of times and because if they jump and say, “Yes, I need a cup of tea,” that is kind of impolite. So recently we were thinking about having a one day workshop to talk about cultural idiosyncrasy, how do we understand each other culture, how they operate, how do we be respectful. That is self-creating a safe space for them.

Quan Nguyen (20:04):

Yeah. So this means that having a bicultural workers can help other workers to understand the client’s perspective.

Raj Ramanathapillai  (20:13):

Exactly. And world views. Values.

Quan Nguyen (20:16):

At the same time as organisation, we need to make sure that the bicultural worker feels safe to express that views to the whole team about it.

Raj Ramanathapillai  (20:26):

Exactly. Rather than being judged.

Quan Nguyen (20:30):

And also at the same time we acknowledge that we are all different, we have a different style, we have a different ways of communication, but everyone feels respected, feel safe, feel supported in the work life. So that’s why these are some of the key things to help people to work together.

Raj Ramanathapillai  (20:50):

Exactly. And in that process we try to overcome the formal system, traditional clinical language and traditional institutional system we want to overcome much more friendlier welcoming. Even the reception, we don’t have a reception desk. We have, what do you call that? Wellbeing team. As a team. And around the half round table they will be sitting there welcoming rather than a reception and admin person welcoming. So that concept itself making the client feel easy and safe in that space, the physical space.

Quan Nguyen (21:31):

And also you know that like because with organisation, because we are accountable to the department, we have to meet the KPIs, we have to make sure that everything goes smoothly. Yeah. So this is okay, but at the same time we try to be responsive to our client as well. So our flexibility sometimes can be a challenge.

Raj Ramanathapillai  (21:56):

Yeah. I would call it creative challenge. We have to advocate again, again. So to summarise your point, we do have that open door policies, but constantly we are tuning the system to make sure that clients feel welcome and feel safe in the process of going through the mental health service that they are receiving from us.

Quan Nguyen (22:22):

On another aspect, it’s easy to say no. When someone asks you, can we provide more therapy? Can you provide long-term counselling from a manager perspective and then according to the framework we can provide long-term counselling, for example, we can say no. But I think that if we say no too early, then we can make people feel disappointed.

Raj Ramanathapillai  (22:44):

But we always say to them, you can always come back to us when you have another episode, right?

Quan Nguyen (22:49):

Yeah.

Raj Ramanathapillai  (22:50):

They have that feeling of ease. Yeah.

Quan Nguyen (22:52):

Yeah. But also at the same time, within organisation, we need to look at the way how we can a bit more flexible about it, right? For example, we might maybe look at the structure of the counselling. We may look at the modality of counselling. Exactly. And see, which one is more suitable for our population.

Raj Ramanathapillai  (23:13):

Yeah, exactly.

Quan Nguyen (23:14):

So we don’t say no and that’s it. We don’t do anything further. We have to think a bit more creative as well.

Raj Ramanathapillai  (23:19):

Even it’s interesting we are making some initiative there about the intake questions. Some of the questions the clients don’t get it. They may fall through the cracks of that question, so we need to create more questions that the clients can understand and responsive. So we are making that process, but it will take some time, but we recognise we identify there is a gap there. So those are the things that engage counsellors, managers will always look at it and work through that.

Quan Nguyen (23:53):

Yeah. Yeah. So you say about intake – again, it’s not only about a question, right? And also about how much time we are flexible to sit in with the client and try to understand them and try to talk with them at the same language. Yeah.

Raj Ramanathapillai  (24:09):

Exactly.

Quan Nguyen (24:10):

That’s the thing.

Raj Ramanathapillai  (24:12):

Go into depth. For example, a client would come – “Are you okay?”, “Yes, everything is fine. “And then the client goes quiet.

(24:22):

Then for a counsellor, a trauma counsellor, that quietness, that silence itself is a place you have to start with and you have to slowly, mindfully go into deeper and to open up that. That’s what we constantly do with an awareness, what’s going on with our migrant clients including skilled.

Quan Nguyen (24:42):

So when we’re talking about the system, right? How do we more be more responsive and then how do we overcome the barriers? Yes. Do you have any ideas?

Raj Ramanathapillai  (24:54):

I think we have already touched on it.

(24:57):

The questions we ask, we pose and to see that question itself is a barrier for them to understand the language. So we need to mind that language. We will put it in a very informal language to get the information. The other barriers would, as I mentioned before, the torture survivors may get different response to questions or space. So we pay attention to the physical language and to address that. And also sometimes clients would say,” Yes, I have this mental health issue, but also I have some legal issue. “Then we do some advocacy. Luckily we have a clinic, the legal clinic in our office, they could come and seek some help. So in a way we have a holistic approach that they don’t need to go in again and again, knock against the wall. We identify, that’s how we walk with them. That’s the word I would say.

(25:55):

We walk with them to overcome the barriers. We are very sensitive to understand their barriers and work through that barriers and we discuss those barriers in our everyday morning meetings and how to overcome. That’s a good example in early morning hurdle meeting, people bring this as a barrier. So we discuss about it, what are the alternative way to approach that. So we do that.

Quan Nguyen (26:23):

So again, this is a morning meeting, and this is space for everyone to contribute.

Raj Ramanathapillai  (26:28):

All staff meeting, any observation, anything they identify, anything they need to get input from each other. So there’s a kind of a collaborative collective work we do to make sure the clients are safe.

Quan Nguyen (26:43):

Yeah. And I remember a couple of times you mentioned to me about when you provide a talk in the community, some people come to you and they homeless have physical health problems and you try to increase them to go to see your GP or to go to hospital. But again, you can’t force them to go and it’s up to them. So for me, when I heard this thing, I feel can be a bit hard for me because on the one hand we look at it of risk, we support an individual with their choices in their life, but at the same time from a critical perspective, I have to think about, okay, to make sure that we try to minimise the risk, to make sure the person feels safe. There’s a lot of things there as well.

Raj Ramanathapillai  (27:27):

Absolutely. We have many particularly the asylum seekers, some of them they don’t have Medicare card. They cannot see a GP. They have to do some advocacy to make sure some years ago they didn’t have a work rights. Some children didn’t have educational rights to go to uni. So all these things, beside counselling, we do advocacy. So there’s a holistic approach for them to feel is, reduce less stress and anxiety so they can heal well. I think we covered a lot today.

Quan Nguyen (28:05):

Do you have any extra, anything to add or you are happy?

(28:09):

Yeah, yes. I think that I’m happy because this is a big topic we can talk forever.

Raj Ramanathapillai  (28:17):

That’s true.

Quan Nguyen (28:20):

So thinking about everything we discuss, anything we can think about how to improve our Practice or anything we can take back to our work and make this better.

Raj Ramanathapillai  (28:31):

I think we are constantly learning from clients, service users and their needs and then we are adapting. I think we have a resilient system. The counsellors, mental health workers have to be resilient and to pay attention to change, willing to change, be creative and adapting their needs into our system is so critical and that’s I think we just began to do that because this particular population are struggling and now they know where to go where they could find a space that they feel attend their mental health needs.

Quan Nguyen (29:12):

And I think for me, I’m thinking about how to improve our collaboration for the whole teams, working together and we provide safe space for everyone to express their views and also we need to anchor with staff to have an open mind, to listen and keep learning because with the cultural humility, I think it’s about more self-reflection. We shouldn’t feel like, okay, I know enough and I’m happy with that, but it’s not enough, never enough, because everything is different. So we need to be more open mind and then a bit more reflected in our work as well.

Raj Ramanathapillai  (29:55):

Absolutely. That itself helps us how many new clients everyday coming to our office. So that’s a testament for our work.

(30:08):

Thank you for listening to Mental Health In Practice, a podcast from the Mental Health Professionals Network. If you would like to learn more about today’s guest or access related resources, visit this episode’s landing page. We would also love your feedback. You’ll find a short survey on the landing page to share what was useful and what would you like to hear more of. Thank you for your commitment to multidisciplinary care and lifelong learning. Thank you.

Quan Nguyen (30:46):

Thank you.

Host (30:49):

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