Mental health impacts for diverse communities

The way an individual experiences mental health concerns, trauma or access to support can be influenced by their diverse attributes, such as:

• culture and ethnicity

• Aboriginal and Torres Strait Islander identity
• socioeconomic status
• sexual orientation
• disability
• religion
• language and migration background.

Intersectionality in the context of mental health and wellbeing, refers to the way these various aspects of a person’s identity interact to shape their experiences. 

Consider two mothers experiencing post-natal depression:

• an Aboriginal mother living in regional Queensland
• a white, middle-class mother living in a city centre.

Both may have similar symptoms, but their barriers to support, community responses, and impacts on wellbeing may be very different.

Culturally and linguistically diverse children and families

For culturally and linguistically diverse (CALD) children and families, their mental health challenges may stem from significant trauma, such as migration stress, displacement or refugee experiences, racism, marginalisation or intergenerational trauma from war and persecution. 

Language barriers and differing cultural norms around parenting, mental health, and help-seeking can further complicate their interactions with mental health and child protection systems (Slewa-Younan et al). 

For many CALD families, contact with child protection systems can be particularly distressing due to heightened fears stemming from past experiences or cultural contexts. Families who have fled persecution, war, or oppressive regimes may carry a deep mistrust of authority figures, fearing deportation, systemic harm, or family separation. These fears can be exacerbated by a lack of understanding of how child protection systems operate in Queensland, as well as cultural differences in parenting practices that may be misinterpreted. 

To support CALD families effectively:

• provide clear, simple explanations of child protection processes
• engage cultural liaison officers (Refer to Queensland Transcultural Mental Health Centre.)
• use interpreters when necessary and appropriate
• address fears with respect and empathy
• create safe spaces for families to share concerns
• acknowledge a family’s strengths and resilience.

The following 1-minute video introduces Emerging Mind’s course which offers practice strategies to support work with culturally diverse families, promote mental health of children aged 4-12 years and explain five key skills for working with families from diverse cultural backgrounds. 

Mental health stigma can be a significant barrier for CALD families, often influenced by cultural or religious beliefs that may view mental health challenges as a source of shame or weakness. In some cultures, mental illness may not be openly discussed or may be attributed to spiritual causes leading to reluctance in seeking help or disclosing concerns. This stigma can prevent families from accessing necessary mental health services, leaving issues unaddressed and potentially worsening over time. 

To reduce stigma and promote help-seeking:

• normalise mental health support
• frame discussions in ways that align with the family’s values
• engage community-specific supports
• build trust through respectful, non-judgemental dialogue.

Similar to practice with Aboriginal and Torres Strait Islander families, consideration needs to be given to the presence of cultural-bound syndromes, the inclusion of traditional ways of healing and viewing connection to culture as a protective factor. Consultation with cultural liaison officers or discussions with interpreters is necessary to develop a culturally appropriate understanding of a person’s mental health and wellbeing. (Refer to Queensland Transcultural Mental Health Centre.)

Understanding mental health across cultures

Based on Dr Arthur Kleinman’s Explanatory Model, the following 8 questions can be used to ask children, young people and their parents about their mental health. 

1. To understand the mental health presentation

To understand the child’s (and parents) cultural and linguistic framing of the child’s mental health and behaviour ask: 

• How would you describe your (your child’s) behaviours or difficulties in your own words? What do you and your family call this problem?

2. To understand perceived causes

To explore culturally informed beliefs about causation, including spiritual or historical factors (for example, trauma, migration, or racism) ask: 

• What do you think might be causing your (your child’s) behaviours or challenges? 
• Are there things—such as family, community, spiritual, or past experiences—that you think have contributed?

3. To understand timing and context

To link the onset of behaviours to family, cultural, or environmental stressors (for example, resettlement, family separation, involvement with services) ask: 

• When did you first notice these behaviours, and what was happening in your family or community at that time?

4. To understand how the mental health concern is viewed

To gain insight into the child’s and family’s understanding of the child’s and family’s emotional or behavioural responses, ask: 

• How do you understand your (your child’s) behaviours? 
• What do you think is happening for your child when they act this way?

5. To assess perceived severity

To gauge the child’s and family’s perception of the impact on their wellbeing, routines, and relationships ask: 

• How much do these behaviours worry or affect you (your child), your family, or your daily life?

6. To explore preferred supports or treatment

To identify culturally relevant supports and integrate them with professional interventions, ask:

• What kinds of help or healing do you think would be most helpful for you (your child and family)? 
• Are there traditional, community, or spiritual ways of healing that are important to you?

7. To identify broader impacts

To explore the broader family and systemic impact, including service interactions and stigma, ask: 

• How have your (your child’s) behaviours affected your family life, relationships, or your involvement with services like Child Safety or school?

8. To understand fears and concerns

To uncover fears related to the child’s wellbeing and involvement with authorities, which may be heightened for families from marginalised or refugee backgrounds, ask: 

• What worries you most about your (your child’s) behaviours or the situation with Child Safety? 
• Are there things you’re afraid might happen to you (your child) or family?

Acculturation and acculturation stress 

Acculturation is the cultural and psychological change that occurs when migrant and refugee families settle in Australia. This change involves adapting to elements of the new or dominant culture while potentially retaining aspects of one’s original culture.

Berry identified four acculturation strategies:

• assimilation—adopting the new culture and abandoning the original 
• separation—rejecting the new culture to retain the original 
• integration—maintaining both cultures
• marginalisation—losing connection to both cultures, often due to discrimination.

Acculturation stress arises when parents and children adapt at different rates or adopt different strategies, leading to intergenerational conflict and challenges that can negatively impact parents and children’s mental health and wellbeing. 

In addition to intergenerational conflict, acculturation stress may also appear in various ways and often reflects the tension between a family’s cultural values and the expectations of the Australian culture. The following table identifies how this stress may be observed:

This 2-minute video by Headspace shows how acculturation stress impacted Lehan’s mental health, growing up in multicultural Australia.

Diverse SOGIE-SC people

The acronym SOGIE-SC is a useful way to remember and distinguish these concepts and means: 

• SO – Sexual Orientation 
• GI – Gender Identity 
• E – (Gender) Expression 
• SC – Sex Characteristics

Refer to the practice guide, Supporting children and young people with diverse SOGIE-SC.

Young people with diverse SOGIE-SC may face higher mental health risks, particularly when they experience family rejection, discrimination, bullying, suppression of identity or involvement in unstable care systems. These experiences can increase distress. Identity-affirming support is essential to promote safety and wellbeing.

Contemporary research and literature demonstrate children and young people with diverse SOGIE-SC are more likely to experience higher rates of depression, anxiety, increased risk of suicide and self-injury, greater psychological distress and difficulty accessing inclusive health services, than the general population. 

Research shows these challenges are further amplified for Aboriginal and Torres Strait Islander children and young people with diverse SOGIE-SC, who face even higher rates of mental health issues, self-harm, and barriers to accessing culturally safe and inclusive support services.

Studies also indicate young people with diverse SOGIE-SC find it difficult to access health services, reporting feeling isolated from medical and mental health services, or in reaching out to a service provider, the provider did not understand or respect their gender identity. 

Poor mental health outcomes for children and young people with diverse SOGIE-SC are not caused by their identity. Instead, these outcomes are linked to:

• stigma, prejudice, and discrimination
• lack of gender-affirming care
• feeling unsafe or unsupported
• families or networks lacking awareness or knowledge.