MHIMA - FRAMEWORK FOR MENTAL HEALTH IN MULTICULTURAL AUSTRALIA: TOWARDS CULTURALLY INCLUSIVE SERVICE DELIVERY

ORGANISATIONS - IMPLEMENTATION GUIDE - Safety and quality

Safety and quality practices underpin all activities undertaken by mental health services. They exist to provide clear, evidence-based pathways for staff to follow to ensure the best quality of care for all consumers. Governance for safety and quality provide mechanisms to safeguard high standards of health care through continual improvement.

Governance frameworks include processes to ensure:

• High standards of clinical performance and clinical audits
• High standards of risk management
• Ongoing professional development
• Well-developed procedures to manage adverse events.

Standard 4 of the NSMHS (2010) focuses specifically on 'Diversity Responsiveness', however, the Framework considers all safety and quality governance mechanisms apply to all of Australia's multicultural population. Mental health services, for example, should be equally accessible to all members of the Australian community, including those from CALD backgrounds. The safety and quality of these services should be of the same high standard for everyone. To ensure this, services must be culturally and linguistically responsive to the population at all levels of service provision.

Culturally inclusive safety and quality practices require a multifaceted approach that recognises the need for:

• Transcultural specialist services for primary and secondary consultation, utilising bi-cultural specialists and cultural consultants
• A culturally responsive workforce that is equipped with the knowledge and skills to work across languages with the assistance of skilled mental health interpreters.

Sound safety and quality controls, such as the NSQHSS (2012) and the NSMHS (2010):

• Enable consumers to participate meaningfully in the provision of their own care, and also at the service delivery level
• Provide a clear understanding of a consumer's rights and ways to express their concerns, complaints or grievances
• Allow for the availability of translated information, as well as verbal explanations, in a way that is understood by the consumer and family carers.

The Framework advocates that in multicultural Australia, safety and quality practices should be culturally inclusive of all population groups, and that cultural responsiveness should be integrated rather than be seen as an add-on. The challenges of sound safety and quality practices are whether they can be applied equally to all Australians irrespective of language or cultural backgrounds.

KEY OUTCOME AREA 2: SAFETY AND QUALITY

Improved outcomes in access, coordination across the continuum of care, quality and safety for CALD mental health consumers, carers and their families.

• Outcome Indicator 2.1 Improved access to culturally appropriate mental health services

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation analyses demographic data to determine which CALD communities are represented in the catchment area to assess their needs.		NSMHS: 10.2
  Developing	The organisation implements strategies to address CALD consumer needs and access barriers in their catchment area.
  Advanced	The organisation implements mechanisms for ongoing evaluation and improvement of access for CALD consumers resulting in decreased access barriers for mental health services.

• Outcome Indicator 2.2 Improved access to professional interpreters

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation identifies the needs of diverse CALD client groups in regards to access to professional interpreter services.		NSMHS: 10.2.1
  Developing	The organisation develops and/or implements a Language Services Policy.
  Advanced	The organisation routinely collects interpreter usage data, evaluates and improves their language services provision on a regular basis.

• Outcome Indicator 2.3 Improved access to multilingual mental health rights and responsibilities

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation accepts and respects the need to provide CALD mental health consumers and carers with a written statement of their rights and responsibilities in an understandable language and format.		NSMHS: 1.4 NSQHSS: 1.17
  Developing	The organisation is able to facilitate access to multilingual information to CALD consumers and carers regarding their rights and responsibilities.
  Advanced	The organisation routinely provides access to multilingual resources in relation to rights and responsibilities and improves and updates access to these resources. The mental health service develops its own translated material when required.

• Outcome Indicator 2.4 Improved CALD data collection

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation ensures compliance with data collection of CALD data variables where available.		NSMHS: 4.1, 4.2, 4.3 NSQHSS: 2.1
  Developing	The organisation includes data of CALD consumers in mental health as part of service reports.
  Advanced	The organisation routinely collects and analyses CALD  mental health relevant data variables to improve service delivery to CALD communities.

• Outcome Indicator 2.5 Improved CALD relevant research development

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation acknowledges the need to incorporate CALD specific research topics in its research program.
  Developing	The organisation conducts CALD specific research topics.
  Advanced	The organisation allocates high priority to CALD specific research topics.

• Outcome Indicator 2.6 Improved CALD consumer safety

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation identifies specific needs of CALD consumers to ensure safety of services, including minimising the risk of self-harm, restraint, seclusion and adverse medication events.		NSMHS: 2
  Developing	The organisation has a plan in place to address the diverse needs of CALD consumers and carers to ensure safety of services and conducts regular safety reviews during all stages of care, including acknowledgement of prescribing medication appropriate to the ethnicity of the user.
  Advanced	The organisation regularly evaluates and improves services provided to CALD consumers and carers to ensure their safety.

• Outcome Indicator 2.7 Improved culturally appropriate mental health assessments

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation accepts and respects the need for culturally appropriate mental health assessments, including the need to consult with specialist services or cultural informants.		NSMHS: 10.4
  Developing	The organisation has processes in place to ensure assessments are conducted in a culturally appropriate manner, including working with specialist services or cultural informants.
  Advanced	The organisation routinely evaluates and improves their processes for culturally appropriate mental health assessments.

• Outcome Indicator 2.8 Culturally appropriate discharge planning

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation accepts and respects the need for culturally appropriate discharge planning.		NSMHS: 10.6
  Developing	The organisation has processes in place to ensure patients are discharged with culturally appropriate support services.
  Advanced	The organisation routinely evaluates and improves their processes of culturally appropriate discharge planning.

• Outcome Indicator 2.9 Improved access to professional interpreters for CALD mental health consumers & carers

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation has a Language Services Policy which provides guidelines for bookings and effective use of accredited and competent interpreters trained in mental health interpreting.
  Developing	The organisation adheres to a Language Services Policy and provides training to staff on the effective use of interpreters.
  Advanced	The organisation routinely evaluates and improves their language services provision and training to staff in working effectively with interpreters and using the Language Services Policy.

• Outcome Indicator 2.10 Increased development and access to multilingual resources for CALD mental health consumers & carers

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation accepts and respects the need for improved CALD consumer access to multilingual resources in regards to their illness and recovery.
  Developing	The organisation provides CALD consumers with resources in their preferred language and develops new multilingual resources when required.
  Advanced	The organisation routinely evaluates, improves and updates their multilingual resources for CALD consumers and carers.

• Outcome Indicator 2.11 Enhanced culturally inclusive strategic planning

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation accepts and respects the importance of including CALD consumers and carers in the development of the strategic plan.
  Developing	The organisation has processes in place to include CALD consumers and carers in the development and reviews of the strategic plan.
  Advanced	The organisation regularly reviews the strategic plan in conjunction with CALD consumers and carers.

• Outcome Indicator 2.12 Enhanced culturally inclusive mental health education and training

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation accepts and respects the need for cultural competency/responsiveness training and education for staff.
  Developing	The organisation integrates cultural competency/responsiveness content in existing training.
  Advanced	The organisation routinely provides and reviews processes in place to ensure cultural competency/responsiveness training of staff and volunteers.

• Outcome Indicator 2.13 Increased use of culturally appropriate assessment

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation accepts and respects the importance of culturally appropriate assessments for CALD consumers and carers.		NSMHS: 10.4
  Developing	The organisation has processes in place to ensure the incorporation and use of culturally appropriate assessment for CALD consumers and carers.
  Advanced	The organisation routinely uses, reviews and improves processes to ensure the use of culturally appropriate assessment tools for CALD consumers and carers.

• Outcome Indicator 2.14 Ensuring non-discriminatory practices

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation accepts and respects the need to address issues associated with prejudice, bias and discrimination in regards to its own staff to ensure non-discriminatory practices and equitable access to services.
  Developing	The organisation addresses issues associated with prejudice, bias and discrimination in regards to its own staff to ensure non-discriminatory practices and equitable access to services.
  Advanced	The organisation regularly evaluates and improves its services in regards to ensuring non-discriminatory practices and equitable access and promotes the inclusion of CALD consumers and advocates.

• Outcome Indicator 2.15 Integration and coordination of services with multicultural sector support services

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation accepts and respects the importance of integration and coordination of all mental health and relevant multicultural support services to CALD consumers and carers.		NSMHS: 9
  Developing	The organisation has multicultural sector links to facilitate integration and coordination of all mental health and multicultural support services provided to CALD consumers and carers.
  Advanced	The organisation regularly reviews and improves integration and coordination with other services provided to CALD consumers and carers.

• Outcome Indicator 2.16 Enhanced resourcing of CALD quality and safety strategies

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation accepts and respects the importance of adequately resourcing of culturally inclusive and safe service provision to CALD consumers and carers.
  Developing	The organisation has processes in place to support the resourcing and sustainability of the provision of high quality mental health care to CALD consumers and carers.
  Advanced	The organisation regularly reviews and improves processes to ensure ongoing resourcing and sustainability of high quality mental health care to CALD consumers and carers.

• Outcome Indicator 2.17 Improved use of information and communication technology in CALD specific initiatives

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation accepts and respects the importance of the use of information and communication technology in facilitating access for CALD consumers and carers when appropriate.
  Developing	The organisation has processes in place to improve the use of information and communication technology appropriate to mental health service delivery to CALD consumers and carers.
  Advanced	The organisation regularly reviews and improves the effectiveness of the use of information and communication technology in working with CALD mental health consumers and carers.

• Outcome Indicator 2.18 Improved person-centred care

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation accepts and respects that culturally competent/responsive and person-centred approaches are complimentary approaches when working with CALD  mental health consumers.		NSMHS: 10.4
  Developing	The organisation uses a culturally responsive and person-centred approach when working with CALD  mental health consumers.
  Advanced	The organisation regularly reviews and improves methods and strategies to deliver culturally responsive person-centred mental health care to CALD consumers.

• Outcome Indicator 2.19 Enhanced cultural approaches to recovery-oriented mental health care

  Level	Strategy	Good Practice Examples	Referencing
  Entry	The organisation accepts and respects the importance of recovery-oriented care within the cultural context when working with CALD mental health consumers.		NSMHS: 10.1
  Developing	The organisation uses a recovery-oriented approach in their work with CALD mental health consumers and seeks cultural input into their care.
  Advanced	The organisation routinely evaluates and improves their recovery-oriented approach in working with CALD consumers incorporating cultural issues and approaches tailored to the diverse needs of CALD consumers.