mental health literacy project – indian women · the aim of the mental health literacy project...

TRIM Ref:

Mental Health Literacy Project – Indian Women

Report by: NSW Multicultural Health Communication Service (MHCS)

April - June 2018

nswmentalhealthcommission.com.au | Twitter: @MHCNSW | Facebook: mhcnsw | YouTube: NSWMHCommission

Table of contents

1. Background .................................................................................................................. 3

2. Objectives .................................................................................................................... 3

3. Audience ...................................................................................................................... 4

4. Community Partners .................................................................................................... 4

5. Activity Report .............................................................................................................. 5 5.1 Literature Review ........................................................................................... 5

5.1.1 Brief Summary of Review ..................................................................... 5 5.2 Survey for Indian Women on Mental Health ................................................... 6

5.2.1 Brief Summary Survey Results ............................................................. 7 5.3 Empowerment and skill building workshops ................................................... 9

5.3.1 Participatory video/photo skills workshop ............................................ 10 5.3.2 SBS Media Skills and Photovoice workshop ....................................... 11 5.3.3 Campaigning for change workshop ..................................................... 12

6. Learnings of the consultation process ........................................................................ 15 6.1 Current levels of literacy of the community ................................................... 17

7. Discussion of Issues and Reccomendations .............................................................. 18 7.1 Learnings of the process .............................................................................. 19 7.2 Reccomendations ........................................................................................ 19

8. References ................................................................................................................ 21

Mental Health Commission of NSW

Mental Health Literacy Project – Indian Women Report by NSW Multicultural Health Communication Service (MHCS) 3 TRIM Ref

1. Background Through a series of consultations, the Mental Health Commission of NSW (MHC) has identified women from Indian backgrounds as priority group where there is opportunity to help increase knowledge on mental health issues.

In March 2018, MHC engaged the NSW Multicultural Health Communication Service (MHCS) to develop an initative to help increase mental health literacy of Indian women in NSW through community engagement from April to June 2018.

There is presently limited research available on women from Indian backgrounds and mental health awareness, attitudes and initiatives which has prompted the Commission to work with MHCS which has a successful track record working with multicultural communities including the Indian community in NSW.

MHCS has demonstrated the effective use of culture-centred approaches with the success of the Pink Sari Project that saw a 17% increase of breast screening in women from Indian and Sri Lankan backgrounds. It sees empowerment and community engagement as key elements of any initiative that seeks to involve minority communities.

The aim of the mental health literacy project was to develop co-design workshops with key stakeholders on elements of a future communication campaign, run communication activities such as, but not limited to short videos that can be used and shared in social media, media interviews in various Indian languages and English as well as the evaluation of the communication and community engagement.

The learnings from this initiative with MHCS will help guide MHC to work on a communication campaign targeting the Indian women in NSW that would:

• Give permission and words to use to bring up the issue of mental illness, depression, anxiety, etc with women from Indian backgrounds and their loved ones

• Reduces stigma in discussing mental illness; that mental illness occurs in all cultures • Encourage engagement (conversations) in women from Indian communities in NSW

and those that support them

MHC envisions to document the process of the development of the initiative by MHCS as part of a set of guidelines they are developing to inform work with culturally and linguistically diverse communities.

This summary profiles the work undertaken by MHCS in engaging with the Indian women in NSW in identifying strategies to help increase mental health literacy in their community.

2. OBJECTIVES • Increase mental health literacy among Indian women in NSW • Identify enablers and barriers for mental health literacy with women from Indian

backgrounds • Identify opportunities for strategic collaboration through understanding broader

issues within the Indian community • Empower Indian women with skills and tools to contextualise and define issues in

ways that are culturally relevant



3. AUDIENCE Initially the brief for the project was to target women from Indian backgrounds.

Throughout the duration of the initiative, as a result of consultations with key stakeholders, the target group has extended to language groups such as Tamil which consists of both Indian and Sri Lankan communities.

As part of the evaluation strategy, a survey was also developed to be disseminated to women from the Indian community across NSW. Based on the feedback from key women leaders from Indian communities, MHCS had extended the reach of the survey to not just target women from an Indian background, but also those who may may identify as someone from an Indian background including the Indian diaspora, Sri Lanka, Malaysia, Singapore, etc.

4. COMMUNITY PARTNERS The following groups committed their full support to the initiative to help raise awareness and advocate for improving mental health of Indian women in NSW:

Haathi in the Room

An initial search on community led initiatives identified Haathi in the Room (Haathi is Hindi for Elephant in the room) an initiative developed by a group of women from an Indian background and friends who have lived experience with mental health issues. Haathi in the room is a registered charity and organises information sessions on mental health issues primarily for the Indian communities. Participation at information sessions to date has been through donations.

Pink Sari Incorporated (PSI)

PSI is run by female volunteer community leaders from Indian and Sri Lankan backgrounds who have taken over the running of Pink Sari Project. PSI’s primary objective is focussed on the empowerment of South Asian women with respect to achieving positive health outcomes. They have an extensive network of contacts across many Indian communities. Together with MHCS, they have implemented a number of unique health promotion initiatives and in 2017 were recipients of the Australian Multicultural Marketing Award in the arts and culture category.

SAHELI (South Asian Hub for Enterprise Leadership and Initiatives, also a word meaning “female friend” in Hindi)

SAHELI is a South Asian women’s network which has been operating under SEVA International Inc. since 2012. SEVA is a not-for-profit organisation focussing on empowering South Asian women, seniors and youth focussing on employment, education and health. One of their key objectives is to provide an effective gateway between service providers and the South Asian community for collaborative initiatives based on evidence-based research of their needs. SAHELI’s key objective is to empower South Asian women in the areas of health, social and economic wellbeing. SAHELI has played a key role in pro-active initiatives relating to domestic violence and parenting for the South Asian community. They have extensive contacts in a number of Indian communities.



5. ACTIVITY REPORT 5.1 Literature Review MHCS conducted a rapid review of literature and online resources (including social media campaigns) that identified enablers and barriers for mental health literacy with women from Indian backgrounds.

The study included a search for in-language campaigns / materials in the top Indian languages in NSW (Hindi, Punjabi, Gujerati, Tamil etc). This review is aimed at reducing the risk of duplication and building on the success of past national and international initiatives.

The final literature report will contribute to building the evidence, good practice and identifying gaps in this area of work.

5.1.1 Brief Summary of Review: Studies on Indian Australians (2010-2017) Barriers

• Social stigma – Maheshawari & Steele (2012) • Mental illness or perceived mental illness was reported to reduce the chance of

marriage within community • The context of migration : Women on spouse-sponsored temporary visa in

Australia were reported to have higher levels of mental health issues- Nilaweera, I., Doran, F., & Fisher, J. (2014).

• Despite high psychological distress Indian patients in general will not seek psychological help

Enablers

• Evidence on the use of prayer as coping strategy – Hussain and Cochrane (2004) • Yoga and Ayuverda – Brijnath and Antoniades (2016) • Art Therapy and Dance as capacity building –Brijnath and Antoniades (2016) • Using GPs as first point of contact as they are not as stigmatised as compared to

Psychiatrists/Psychologists Harding, Schattner, Brijnaht (2015) • Intervention and prevention programmes for school curricula are needed for first

generation Indians born in Australia – Dey and Sitharthan (2017)

Past initiatives on Mental Health in the Indian Community

• SBS Hindi radio – regular updates with ethno-specific psychologists • Newspaper coverage • Indian groceries as distribution points • Indian media coverage exists but mostly adhoc, and not strategic e.g. to coincide

with national discussion during mental heatlh awareness week

Specific contexts/triggers

• Post natal depression and suicide due to migration, lack of employment, poverty due to financial issues

• Women on spouse sponsored visas are at higher risk of mental illness • Nilaweera, Doran and Fisher (2014)



Opportunities

• Akhil Bansal of University of Sydney - ReachOut.com – youth ambassador and online content creator

• “Whether it’s to produce good marks or to assimilate into a culture that is distinct from that in their own home, young Indians need to feel supported” – Bansal (2015)

• Umesh Chandra – Fijian Indian engaged in best practice collaboration with Beyond Blue in QLD

5.2 Survey for Indian Women on Mental Health MHCS and the Commission in collaboration with community organisations, Haathi in the Room, Pink Sari and Saheli, distributed an online survey to understand mental health literacy of women from Indian backgrounds in NSW.

An anonymous survey was made available to anyone who identify from an Indian background (including the Indian diaspora, Sri Lanka, Malaysia, Singapore, etc) to take a few minutes to answer questions and share their views on their understanding of mental health.

The result of the survey is envisioned to help advance conversations on mental health issues within the Indian community in NSW.

Click link (and image) to access survey online: bit.ly/MHCSIndianCommunitySurveyMentalHealth

Process evaluation:

• The survey was distributed through a number of avenues which include the following: o Multicultural NSW Email link reaching up to 7,000 people across Australia o Indian community organisations in NSW o Multicultural Health Services in Local Health Districts in NSW o Indian and local media

https://docs.google.com/forms/d/e/1FAIpQLSc1WGLSZrLy7QSQ7GJauK3JsbeFzAaRsFPx4-uPlpDAfu1Ucg/viewform

https://docs.google.com/forms/d/e/1FAIpQLSc1WGLSZrLy7QSQ7GJauK3JsbeFzAaRsFPx4-uPlpDAfu1Ucg/viewform



• A total of 221 surveys were completed by participants across the state and around in Australia

• 10 people contacted MHCS indicating their interested to be involved in future strategies to raise awareness about mental health within the Indian community

5.2.1 Brief Summary of Survey Results • Do you live in NSW?

• What is your gender? More than 70% responsents = F

• What do you think of when you hear/ see the words “mental health” • The responses were coded and resulted in the following themes and distribution :

o Clinical 27 % o Advocacy 18 % o Need for support 17% o About the mind “ neutral” – 17% o Emotions, Stress, “temporary” condition – 15% o Personal stories – 4% o Negative/ pejorative – 2%



• Language o A major theme observed in responses was a confusion in language to

discuss mental health : the need to distinguish between mental illness versus mental health Some key quotes that were typical of comments on the language used to describe mental health issues:

“we all get stressed, lonely, sad, …but if we experience these for long periods of time..”(mental illness)

“helpless, lashing out, isolation, erratic behaviour “ ( behaviour) Negative decriptions : not thinking right” “ attention seeking behaviour

• Do you need a clinical diagnosis in order for you to say you have mental

health illness?

• What is your experience with mental health?



• Reported ways of addressing issues that is your experience with mental health

o Sought professional help - 40% o Meditation, yoga, social connections -30% o Combination of medical and social support-20% o Self coping – research -5% o Unsure – 3% o Diversion – drugs, sex, laughter, helping others – 2%

• If you answered ‘No experience’, are you aware of how to seek help in relation

to mental health issues?

• How to support people

Quote received from survey respondent:

“People think the term mental health or mental illness means people are crazy. This is not true at all. He thought I was telling him he's crazy. My challenge was knowing how to say he needed help in a way that would help him understand and accept it.”

5.3 Empowerment and skill building workshops Empowering communities to share their insights as well as gather evidence based research, MHCS conducted skill building workshops for Indian female community leaders from organisations including Pink Sari Inc., SAHELI, Haathi in the room, Tamil Women Development Group and other groups, in collaboration with the Australian Television, Film and Radio School (AFTRS), Special Broadcasting Service (SBS) and Third Space.

The women were trained with media interviewing and video/photo skills using smartphones. This skills training approach adopted a participatory technique called Photovoice which provides participants with tools to contextualise and define issues in ways that are culturally relevant.

The women were given time to take photos and/ or short videos to present back as a starting point for discussing mental health issues through their eyes and to further refine elements of the video/ photos for this initiative. Majority of the women participants felt that they had limitations to voice and communicate mental health issues to family and friends.



The result of the women's photovoice projects were showcased as posters at the Campaigning for Change workshop held on the 17th June at the Novotel in Parramatta. The workshop allowed for the participants to share photos and stories from the 4-weeks documenting their individual experiences relating to mental health issues.

The workshop program facilitated by Ms. Amrit Versha of Third Space included presentations on social issues campaigns in the Indian community as well as a round table discussion tackling how to engage communities to address mental health issues. Ms Pritika Desai from Shout Out also delivered a case study presentation on youth mental health.

The three workshops included:

• Participatory video/photo skills using smartphones • SBS Media Skills and Photovoice workshop • Campaigning for Change workshop

A final ‘Show and Tell’ forum to showcase the final Photovoice work of the women participants will be held by MHCS in July 2018.

5.3.1 Participatory video/photo skills using smartphones MHCS organised a one-day Mobile Content Creation workshop on Saturday 28th April, 2018 at the Australian Television, Film and Radio School (AFTRS) in Sydney facilitated by Gareth Tillson, Director and attended by up to 12 Indian women from the project partner community organisations (e.g. Pink Sari, SAHELI, Haathi in the room, etc).

The objective of the workshop was to equip to participants with the relevant tools to enhance their video storytelling ability, develop short videos and to improve their mobile content creation skills. The training focused on:

• how to create a compelling story with impact; • how to shoot and edit quality video with iPhone, iPad or Android devices; and • building the confidence of staff to develop, edit and post quality video

The classroom-style, activity-based one-day workshop was highly interactive, technically focused and covered the following key learning areas:

• how to shoot and edit quality video with your iPhone, iPad or Android; • framing, exposure and focus; • recording quality sound (the biggest challenge with a mobile device); • effective coverage - shooting sequences that tell a story; and • editing and uploading from your device - with either iMovie (Apple IOS) or

Power Director (Android).

The outcome of the workshop was the participants were equipped to make their own video content with confidence.



The members of group Haathi in the Room who attended the AFTRS training produced a 2 minute video at the end workshop with on-cam interviews showing how important it was for them to learn interactive ways to spread the important messages about mental health and well being to the Indian community.

Click link (and image) to watch video: https://www.youtube.com/watch?v=K71TkX4oaOc&feature=youtu.be

5.3.2 SBS Media Skills and Photovoice workshop In partnership with the Special Broadcasting Service (SBS), MHCS organised a combined workshop to provide media skills training to help the Indian women participating in the mental health literacy project in preparing and giving media interviews in English and key Indian languages and introduce them to the powerful concept of the Photovoice approach for the project.

The objective of the workshop was to further build upon and supplement the skills attained in the completed Mobile Content Creation workshop by AFTRS to help increase the confidence and effectiveness of community representatives in managing the media, most notably in radio and television as well as apply their newfound interviewing skills adnd developing videos as well as taking photographs for their Photovoice project.

The training was held at SBS studios in Artarmon on Sunday 6th May 2018. The meda skills session was facilitated by former SBS broadcast journalist and Heard Communication Director Christine Heard while MHCS Acting Director Michael Camit presented on the PhotoVoice methodology for the initiative.

The three major aims of PhotoVoice are to:

1. Allow participants to document their lives on their own terms 2. Raise critical consciousness among participants 3. Initiate positive change through reaching policy makers through the photographs and

project as a whole.

https://www.youtube.com/watch?v=K71TkX4oaOc&feature=youtu.be

https://www.youtube.com/watch?v=K71TkX4oaOc&feature=youtu.be



For the mental health literacy project for Indian women, the participants were given time to take photos and/or short videos to present back as a starting point for discussing mental health issues through their eyes and to further refine elements of the video/ photos for this initiative.

Evaluation and results of discussions from the PhotoVoice project was envisioned to be presented on 17th June 2018 at a show and tell workshop.

The SBS Media Skills Training showcased a number of interview techniques in a range of different scenarios for participants to have the opportunity to practice, reflect and prepare confidently for their media commitments, allowing them to champion your media campaign, to raise awareness of mental health issues within the Indian community.

The 19 participants who attended the workshop were able to learn and experience the following media skills training:

• How to be ‘good talent’ – credible, memorable, succinct, presentable, clear, reliable • The Statement-Evidence-Explanation (S-E-E) structure – how to answer ‘nice’

questions • Bridging technique – how to answer ‘tricky’ questions • On-camera interview techniques and On-camera interview practice • Radio studio interview technique & radio interview practice



Being able to conduct or give interviews with confidence is an essential skill that will enable key messages to be communicated with purpose and clarity.

The interactive training was very effective in improving the confidence of the Indian women participants, enabling them to prepare, practice and navigate interviews in producing their videos and photovoice narratives to communicate their messages and experiences about mental health issues to their community.

The feedback from the SBS Media Skills and Photovoice workshop was very overwhelmingly positive. All of the women expressed their appreciation for being able to attend such an empowering session were they proud to be part of a community of Indian women who have come together and trained with skills to be able to produce effective audio and visual expressions about mental health issues.

5.3.3 Campaigning for Change workshop MHC had commissioned Third Space Director and Indian community leader Amrit Versha to facilitate the Campaigning for Change interactive workshop with Pritika Desai, Founder of ShoutOut and experienced mental health campaigner to provide participants the opportunity to explore and further develop concepts and ideas about what a campaign on mental health for the Indian community would look like.

MHC had requested MHCS to coordinate the Campaigning for Change workshop which was held on Sunday 17th June, 2018 at the Novotel Parramatta and invite the Indian women working on their Photovoice narratives as part of the mental health literacy project to take part of the discussions for the day.

The learning objectives of the workshop were:

1. To understand the elements of a social issues campaign 2. Explore culturally relevant concepts for a mental health campaign 3. Design content amd medium for the campaign



The women's Photovoice projects were showcased as posters at the workshop.

3 representatives from the 17 participants of the Indian Women Mental Health Project Photovoice also presented on the emerging themes from the photos and stories shared by the women as a result of their 4 week journey documenting their individual experiences relating to mental health issues.

The three themes that emerged from the women’s photovoice journey were the following:

• Identifying symptoms and strategies to overcome • Community experiences • Carer experiences

MHCS has organised a ‘Show and Tell’ forum on the 8th July 2018 at the Novotel Parramatta to provide an opportunit for all the women to individually present their Photovoice journey.

The workshop program also included presentations on social issues campaigns in the Indian community a case study presentation on youth mental health as well as a round table discussion tackling how to engage communities to address mental health issues.



6. Learnings of the consultation process (or MentalHealth in the Indian Sydney Community) literature review,surveys, workshops,The rapid review of the literature (published evidence) uncovered a small but growing number of studies in Australia. Majority of the studies confirmed that stigma of mental health in the Indian community. The following are key barriers, enablers and opportunities for future programs.

Barriers

• Social stigma – Maheshawari & Steele (2012)• Mental illness or perceived mental illness was reported to reduce the chance of

marriage within community• The context of migration : Women on spouse-sponsored temporary visa in

Australia were reported to have higher levels of mental health issues- Nilaweera,I., Doran, F., & Fisher, J. (2014).

• Despite high psychological distress Indian patients in general will not seekpsychological help

Enablers

• Evidence on the use of prayer as coping strategy – Hussain and Cochrane (2004)• Yoga and Ayuverda – Brijnath and Antoniades (2016)• Art Therapy and Dance as capacity building –Brijnath and Antoniades (2016)• Using GPs as first point of contact as they are not as stigmatised as compared to

Psychiatrists/Psychologists Harding, Schattner, Brijnaht (2015)• Intervention and prevention programmes for school curricula are needed for first

generation Indians born in Australia – Dey and Sitharthan (2017)

Past initiatives on Mental Health in the Indian Community

• SBS Hindi radio – regular updates with ethno-specific psychologists• Newspaper coverage• Indian grocers as distribution points• Indian media coverage exists but mostly ad-hoc, and not strategic e.g. to

coincide with national discussion during mental health awareness week

Specific contexts/triggers

• Post natal depression and suicide due to migration, lack of employment, povertydue to financial issues

• Women on spouse sponsored visas are at higher risk of mental illness• Nilaweera, Doran and Fisher (2014)

Opportunities

• Akhil Bansal of University of Sydney - ReachOut.com – youth ambassador andonline content creator

• “Whether it’s to produce good marks or to assimilate into a culture that is distinctfrom that in their own home, young Indians need to feel supported” – Bansal (2015)



• Umesh Chandra – Fijian Indian engaged in best practice collaboration with BeyondBlue in QLD

Key learnings from the online survey included the potential of social media to engage women from Indian backgrounds who are interested or have lived experiences with mental health issues. In three weeks, the online surveys recruited 221 respondents. Another insight was that majority of respondents still see mental health through a clinical perspective.

There were several key learnings from the workshops:

First, the mobile-video making workshop and media skills workshops proved to be great start and motivator for women already passionate or involved with mental health awareness to be involved in the project. These offered skills they can use to further engage their communities. These skills should be further enhanced to ensure continued use. Working together also brought women from various partner organisations a great opportunity to make connections.

Second, the Photovoice workshops, working in pairs, groups, and sharing their stories further enhanced a sense of community with women who shared similar experiences with mental health.

It was the interaction and feeling that they were “not alone" in their experience that fostered a sense of solidarity and were the most frequently commented aspect of all the workshops – just a chance to meet others and connect.

The Photovoice project participants say they have definitely been empowered after going through the experience helping them see their journey through a different way. The exercise has helped expose their inner voices through memories hidden away which they are now ready to share with others.

See quotes below:

"Never really opened up to anybody, because my initial attempts to open up weren’t taken seriously, or maybe were not understood by my family. I kept blaming myself for the situations in the name of exam phobia, inferiority complex, depressed at not reciprocated friendship and love, fear of low performance." - Participant

"The inferiority complex that it caused to me during my teens was very significant in my life. My confidence was hit so badly that I never for once thought I was beautiful. I realise now, that lost in that complex I have just not enjoyed the joys childhood that had in store for me. And, this paved way to depression, my haunting dark shadow." - Participant

"Awareness and acceptance are very essential while dealing with such cases." - Participant

"Remember it is only an illness hence like any other. So please take the stigma out of it. Open up and get help. You are living in Australia. I am a living proof that a person with mental illness can find love and lead a normal life because of the love acceptance and medication." - Participant

"The first effective step to pull myself out of depression has been to step out of my house. The minute I go out, I am forced by self to enjoy the beauty of nature or mingle with it. Watching the birds chirping, or feeling the wind pass by, or the leaves rustle, or just gazing at the starry sky, or a casual conversation with someone across the road, or any small act to divert my mind, is all that I need to ignite the end of a gloomy mind" - Participant



6.1 Current levels of literacy of the community; mental health issues in the community, language used, how to get messages across, what the barriers will be

It is important in general when we think about migrants in Australia of Indian or South Asian (Pakistani, Bangladeshi, SriLankan) backgrounds, we need to acknowledge that there is no one Indian community; there are diversities that exist within this community.

For example, it is important to contextualise education levels in particular if these were attained locally or overseas, capacity to speak the English language and its subsequent consequences on the settlement process, class, caste and classification of native language.

Mental health outcomes for Indian women can depend on some of these factors. There are 22 states in India and each of the language groups speak distinct dialects, have their own traditions and understandings of both health and mental health.

Indian Migrants bring those distinct traditions with them to Australia. According to the ABS statistics in June 2016 there were a total of 468, 800 (1.9% of the total Australian population) migrants settled across the big cities in Australia, out of this 159, 652 (0.7% spoke Hindi at home) whilst 132, 496 (0.6%) identified speaking Punjabi at home.

There is anecdotal evidence especially from the rise and building of large temples such as the Swami Narayan Hindu Temple in Sydney that there is an escalation of Gujarati speakers in Australia which mirror the numbers in the United Kingdom.

This information however, has not been captured in the 2016 census presented by ABS statistics. Hence, if the outcome of this project of a future campaign is to engage closely on mental health issues with women from Indian background, it is recommended that Hindi, Punjabi and Gujarati are the three groups that need to be considered from India, particularly those settled in the NSW.

Reflecting mainly on the participants recruited for this project, there appears to be several sub groups of women from Indian backgrounds that may need specific approaches:

• Children of Indian parents – intergenerational issues: identify and belonging, racism,as well as growing up in Australia and having strict traditional rules e.g. for young Indianwomen – not to go out to friends’ places or go out at night , expectations of becomingdoctors, lawyers, accountants – or professions that are perceived to be aspirational byparents but not necessariy children, pressure with studies

• Women from India brought out on spouse visas – isolation, lack of social capital orsocial support, unemployement or underemployment, domestic violence, issues withdowry

• Older women – racism, unfamiliar environment, isolation• Carers and familes of people with mental illness – how to support their friends and

familes with mental illness, how to address behaviour that may need professional help

An overall theme in the language used to discuss mental health appears polarised between the clinical theme: that one needs to have a clinical diagnosis – that mental health means mental illness versus how to deal with everyday / short term feelings of sadness, stress, isolation, anxiety to avoid prolonged periods of these and achieve wellbeing.



7. Disscussion of Issues and Reccomendations

7.1 Learnings of the process (or how to engage with the Indian women in Sydney)What worked well?

• Tapping into existing South Asian women’s networks and MHCS networks. Amajor challenge with this project was the very short timeframe for this project – April toJune 2018. The three month timeframe included engaging MHCS, developing aproposal, communicating the vison of the project with commitees from the three partnerorganisations, recruitment of participants with lived experience of mental health issuesand three workshops and online survey and engagement. The existing trust that hasbeen built among the partner organisations and MHCS facilitated buy in and approvalswithout formalising any agreements with partner organisations.

• Offering practical skills for participating organisations.Offering Video making skills using mobile phones and media interview skills werewelcomed by the participating organistions as skills that can contribute to the growthand sustainability of their engagement efforts with their own communities

What the barriers were

• Short lead time/ time frame and changing staffing and focus of projectWith a three month time frame and varying staff from MHC, the vision, the intent,parameters of the project were slightly altered and miscommunication occurred. Thisresulted in frustration with key committee members of participating organisations.

For example, from the initial recruitment and throughout the skill building workshops(SBS interview skills workshops, Video making workshops) MHCS communicated thatthe participants will have the opportunity to “show and tell” their photovoice projects atone final workshop scheduled for 17th June 2018.

Instead the photovoice projects were displayed and not everyone were able to sharetheir stories. In addition, at the start of the project, it was envisioned that the main targetaudience was women from Indian backgrounds. At implementation, a slight changewas introduced to include women who spoke Tamil which is spoken in India and SriLanka. By the last workshop on the 17th June 2018, women from Nepal and Bhutanwere invited to attend.

This caused confusion among the original participants who commented that the groupneeded more representation from other South Asian countries. As one participantcommented, “While this observation of lack of representation is true for the workshop,it was not by intent or original plan.”

This change of focus in the target audience from Indian women to include other SouthAsian women also caused considerable discussion at the last workshop (17th June2018) as women who originally agreed that Haathi in the Room (the Facebook page)was an appropriate name for the group, questioned the use of “Haathi” (Hindi word forElephant ) as the Hindi word Haathi is not understood by other South Asian women(e.g. Tamil, Nepali, Bangla, etc).



How were these barriers addressed?

Anticipating possible conflicts for the last workshop, MHCS having existing relationships with the committee members of the various participating organisations, held meetings and teleconferences to address the concerns and requested the key committee members to have an open mind and respect what was planned for the 17th June 2018 workshop. MHCS also offered to fund a separate day (8th July 2018) upon completion of this project to honour the expectations of participants who agreed to work on the Photovoice project.

What would MHCS do differently?

• Funding for initiatives for CALD communities are often short term and not sustained.While MHCS found this project a great opportunity to fund a potentially participatoryand empowering approach to mental health and resulted in identifying women withlived experiences, there were several challenges in implementation. In the futureMHCS will need to rethink how it handles commissioned work with less than 6 monthstimeframes.

7.2 Recommendations Based on the observations and activites in this project, as well as its experience with working with CALD communities, MHCS recommends the following :

Establish the purpose of engagement

A short campaign to produce resources that can be used in the future? Compliance to show that MHC is achieving equity with minority populations?Building capacity of people with lived experience and those that support them to sustain ethno-specific intiativies? Is it to build long term relationship with a specific culturally and linguistically diverse (CALD) community? Build capacity of mainstream mental health services to work with CALD communities?

Depending on the specific objective/s of the engagement initaitives, the following are options for consideration:

• Hold an exhibition of the Photovoice projects that participants have produced. Invitepolicy makers, service providers and CALD community leaders and media who caninfluence change or further champion awareness of mental health issues

• Develop and fund a 3 year pilot to measure baseline awareness and attitudes ofindivdiuals from Indian backgrounds, use a multi-prong community and engagementstrategy and evaluate to see any changes in health literacy / mental health awarenessand positive support

• Use a community development or peer support network approach to build on the workof the women recruited for this project. With their permission and their contribution,enable them to tell their lived experience in varous forms – media interviews, videos,story telling performances, .. to encourage discussion about mental health issues. This,in turn, will also invite others with lived experiences of mental health to join the network

• Use a consumer participation and leadership mentoring model to invite members ofHaathi In the room to be on advisory commitees, planning commities for mental healthintiatives to be inclusive of CALD issues



• Develop a resource that includes ethno-specific Indian mental health professionals aswell as in-language videos, stories, resources

• Explore cultural competency models and mainstreaming where “mainstream” mentalhealth organisations adopt cultural competency at staff, management andorganisational level to be inclusive of cultural difference and collaborate with CALDcommunities to ensure their services reach out and collaborate with CALDcommunities e.g,. Haathi in the Room to meet with Beyond Blue to explore ways ofworking together. This will contribute to sustainability of services for CALDcommunities.



8. ReferencesBrijnath, B. (2015). Applying the CHIME recovery framework in two culturally diverse Australian communities: Qualitative results. International Journal of Social Psychiatry, 61(7), 660-667.

Brijnath, B., & Antoniades, J. (2016). “I'm running my depression:” Self-management of depression in neoliberal Australia. Social Science & Medicine, 152, 1-8

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