CMY Submission to the Royal Commission into Victoria’s ... · Victoria’s Mental Health Service System July 2019 SUB.0002.0032.0067. CMY’s submission to the Royal Commission

CMY Submission to the Royal Commission intoVictoria’sMentalHealthServiceSystemJuly2019

SUB.0002.0032.0067

CMY’ssubmissiontotheRoyalCommissionintoVictoria’sMentalHealthSystem

CentreforMulticulturalYouth,304DrummondSt,CarltonVIC3053

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AbouttheCentreforMulticulturalYouth

TheCentreforMulticulturalYouth(CMY) isanot-for-profitorganisationbasedinVictoria,providingspecialistknowledgeandsupporttoyoungpeoplefrommigrantandrefugeebackgrounds.Ourvisionis that young people from migrant and refugee backgrounds are connected, empowered andinfluentialAustralians.

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Aboutthissubmission

CMYwelcomestheopportunitytoprovidefeedbacktotheCommissionaroundtheexperiencesofyoungpeople from migrant and refugee backgrounds engaging with Victoria’s mental health system. CMY ispleasedtoseetheCommission’sfocusongapsinservicesfacingparticulargroups,includingyoungpeopleand those from culturally and linguistically diverse backgrounds, and an emphasis on the broadercontextualfactorsthatimpactonmentalhealth.

CMYrecentlyundertookareviewofCMY’spreviouspolicyworkaroundissuesofmentalhealthandyoungpeople frommigrant and refugeebackgrounds, andbroader literature, tomakea joint submissionwithMYAN (Australia) to the Productivity Commission’s Inquiry into the Social and Economic Benefits ofImprovingMentalHealthfocusedontheneedsand interestsofyoungpeoplefromrefugeeandmigrantbackgrounds.1Thissubmissionisinformedbythiswork.Thissubmissionisalsoinformedbyconsultationswith:

• Young people from migrant and refugee backgrounds around mental health, including youngpeople involvedinCMY’sYouthAdvisoryGroupandinCMY’sShoutOutMentalHealth initiative(thisisayouthleadershippublicspeakingbureau);

• CMYstaff(manyofwhomarebiculturalworkers)whoworkdirectlywithyoungpeopleandtheirfamiliesandcommunities;

• ServicerepresentativesinvolvedintheVictorianSettlementYouthNetwork.

Thissubmissionfocusesonthefollowingareas:

1.Backgroundonmentalhealthandyoungpeoplefrommigrantandrefugeebackgrounds 82. Afocusonprevention 2.1. Promotingmentalhealthwithyoungpeoplefrommigrantandrefugeebackgrounds 112.2. Reducingstigmaanddiscriminationandpromotingmentalhealthliteracy 132.3. Socialinclusion,connectionandsupport 162.4. Co-designed,culturallycompetentyouth-focussedcommunitydevelopmentwork 172.5. Education 202.6. Employment 222.7. Addressingtheneedsoffamilymembersandcarers 233. Earlyinterventionandpromotingaccess 3.1. A‘wholeofcommunity’approach:Workingwithyoungpeople,familiesandcommunity 263.2. Culturallyrelevant,youthmentalhealthservices 283.3. Workingwith‘gatekeepers’ 333.4. Mentalhealthworkforcedevelopment 354. Focusissues 4.1. Addressingyouthsuicide 384.2. Data 434.3. Youthjustice 454.4. Online 504.5. Accesstoappropriatementalhealthservicesandsupportsinregional/ruralareas 52

1CMY&MYAN.(2019).JointSubmissiontotheProductivityCommission’sInquiryintotheSocialandEconomicBenefitsofImprovingMentalHealth.Retrievedfromhttps://myan.org.au/wp-content/uploads/2019/04/cmy-submission-productivity-commission-mh-inquiry.pdf

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Recommendations

Recommendationsforprevention

2.1.1 Continuetosupportinitiativesthatareaccessibleandpromotementalhealthandwellbeingamongyoungpeoplefrommigrantandrefugeebackgrounds,suchassport,recreation,arts,youth supportand leadershipdevelopment– that strengthenyoungpeople’s social capital,abilitytoaccesssupport,andincreaseasenseofbelonging.

2.2.1 Thattoaddressstigmaandpromoteaccesstomentalhealthsupportrequiresmentalhealthliteracy incommunities frommigrantandrefugeebackgrounds,aspartofabroaderhealthliteracystrategy.Suchanapproachshould:

a. Useaco-design,partnershipandtailoredapproachtoworkwithmigrantandrefugeecommunities to improve mental health literacy (including partnering withcommunity/faith leaders, bicultural youth/community workers, parents and youngpeople). This could include exploring opportunities to develop culturally relevant,mentalhealthearlyinterventionprogramswithparentsandcaregiversfrommigrantandrefugeebackgrounds,tosupportthewellbeingoftheyoungpeopleintheircare;

b. Incorporate a strengths-based, transcultural mental health lens that explores andintegratesthestrengthsofvariousculturesandreligious/spiritualviews;

c. Be funded recurrently to allow for long-termmental health literacy education anddialogue;

d. Invest inculturallyrelevantpeereducationandsupportprograms, includingtheuseofculturallyrelevantmentorsandrolemodels.

2.2.2 Resource (and/or require mental health services to resource) youth-led and peer-to-peerinitiativesbyyoungpeople frommigrantand refugeebackground thatcreateopportunitiesforpromotingsocialinclusionandaddressingracismanddiscrimination.

2.2.3 Look for opportunities to develop or align social cohesion and anti-racism strategies thatincludementalhealthandwellbeingapproaches.

2.3.1 Resourcetargetedandculturallyrelevantyouthwork interventionswithyoungpeoplefrommigrant and refugee backgrounds identified as ‘falling through the gaps’ (for example, LeManaandCSG).

2.4.1 Invest in culturally driven, youth-focussed community development approaches (such asCommunity SupportGroups or the CMY LeMana Project) that can engage holisticallywithyoungpeople, familiesandcommunity leaders frommigrantandrefugeebackgrounds,andcanactasapointofcoordinationforservicesandgovernment.Suchapproachesshouldbefunded for aminimumof 2-3 years, to allow for effective trust, engagement, coordinationandresponsestocommunity-identifiedneeds.

2.6.1 Look for opportunities to replicate successful models of cross-sector partnerships thatsupport the social and economic wellbeing of young people from refugee and migrantbackgrounds,suchastheJVENAfricanandPasifikayouthprogram.

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2.7.1 Resource programs thatworkwith parents frommigrant and refugee backgrounds aroundparenting adolescents in the Australian context, understanding education and employmentpathways;andthatsupporttheirownmentalhealthandwellbeing.

2.7.2 Invest in co-designed and community-led programs that strengthen intergenerationaldialogueamongstmigrantandrefugeecommunities.

Recommendationsforearlyinterventionandpromotingaccess

3.1.1 Resource working and learning partnerships between youth mental health providers,multiculturalyouthworkers,refugeementalhealthspecialistsandeducationwelfarestafftobettermeettheneedsofyoungpeoplefrommigrantandrefugeebackgrounds.

3.1.2 Resource(and/orrequirementalhealthservicestoresource)culturallyrelevant,co-designedpeereducationandsupportmodelsaroundmentalhealth.

3.2.1 Resourceinitiativesthatdrawontheexpertiseofthemulticulturalyouthsectortobuildtheyouthmentalhealthsectors’ability toengageandworkeffectivelywithyoungpeople frommigrant and refugee backgrounds. This goes beyond notions of ‘cultural competency’ andrequires a whole of organisational approach, including policies, systems, personnel andpractice.This includesbuilding inaccountabilitymechanismstofundingthatrequirementalhealthservicesensureservicesareaccessible(e.g.useofinterpreters).

3.3.1 Buildtheabilityofbothprofessionalandnon-professionalgatekeeperstoengage,assessandrespondtothementalhealthneedsofyoungpeoplefrommigrantandrefugeebackgrounds.

3.4.1 Build on thework of organisations like CMY to develop a best practice framework aroundmentalhealthearlyinterventionforyoungpeoplefrommigrantandrefugeebackgrounds.

3.4.2 Resourcebicultural/multicultural liaisonroles inyouthmentalhealthandcommunityhealthservices,whichcanplayacommunityengagementandbrokeringrole.

3.4.3 Provide scholarships and incentive programs to recruit mental health professionals fromdiverseculturalandlinguisticbackgrounds(ashasbeendoneamongstATSIcommunities).

Recommendationsforaddressingyouthsuicide

4.1.1 Adopt an ‘early warning system’ that identifies communities of young people who arestrugglingandatgreaterrisk(e.g.suchasystemcouldtrackriskfactorsassociatedwithyouthsuicidewithinrefugeeandmigrantcommunities,suchasengagementwithyouthjusticeandschool disengagement, and has mechanisms for mobilising timely prevention responses).Indicators could ‘trigger’ investment in community partnerships and projects to ensurevulnerablegroupsaredirectlyinformingserviceresponsesandearlyinterventionstrategies.

4.1.2 Investinearlyinterventionyouthsuicideprogramsthatspecificallytargetcommunitiesfrommigrantandrefugeebackgrounds.Suchanapproachshould:

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a) link in to existingprogramsaddressing issuesof cultural, educational, employment,social and economic disadvantage, so that initiatives are recognised as an integralpartofaholisticapproachtoyouthsuicideprevention2;

b) beinformedbyandworkinpartnershipwithyoungpeople,familiesandcommunity;

c) betargetedandlocally-based–thismeanstailoringprogramstotheparticularneedsofvariousmigrantcommunities(recognisingthatnoonesizefitsall);and

d) developmultilingualdisseminationstrategies (suchasuseofcommunitymediaandyouthchampions)tosupportcommunityengagement.

4.1.3 Improvedatacollection,qualityandreporting.BuildingontheSuicidePreventionAustralia’srecommendation, this would include a focus on “improving the integrity (accuracy andtimeliness),collation(localandnational information includingthe integrationofstate-baseddata)anddistributionofsuicidedatatoassistservicedeliveryandresearch”.3

4.1.4 Investinfurtherresearchto:

a) investigate the ‘early warning signs’ for youth suicide in refugee and migrantcommunitiesandhelpsinformthedevelopmentofan‘earlywarningsystem’todrivetargeted,earlyinterventionresponses.

b) evaluate selective interventions for targeted early intervention youth suicidestrategies with young people from migrant and refugee backgrounds. This shouldincludebuildingevaluationintoservicefundingagreementstoensureitiscarriedoutandrequiringservicestoevaluatetheiruseofyouthparticipationandpartnerships.

Recommendationsforimprovingdatacollectionandquality

4.2.1 Improve quality and consistency of data and feedback collected across Victoria’s mentalhealthnetworktounderstanddiversepopulationsandidentifytheirspecificneeds.

4.2.2 Introduceacompliancecomponentwithinmentalhealthservicereportingonserviceuserstoensuregenuineaccountability forprovisionof services topeople fromrefugeeandmigrantbackgrounds.

Recommendationsforyouthjustice

4.3.1 Workinpartnershipwiththeyouthjusticesystem,youngpeopleandcommunitytodevelopculturally appropriate mental health responses for groups of migrant and refugee youngpeople who are over-represented in the youth justice system. (Previous measures have

2ThisrecommendationisbasedonRecommendation6oftheParliamentoftheCommonwealthofAustralia’s2011reportintoyouthsuicide-Beforeit’stoolate:Reportonearlyinterventionprogramspreventingyouthsuicide.ThisrecommendationcameoutoftheCommittee’sidentificationofservicecomplexityandfragmentationofservicesasakeybarriertoyoungpeopleatrisknotbeingabletoaccessthesupporttheyneed.Strategiesarerequiredthatensureserviceslinkupanddelivercollaborativeresponsessoyoungpeopledonotfallthroughthegapsandcaneasilyfindtheassistancetheyneed.SeeTheParliamentoftheCommonwealthofAustralia(2011),p.413SuicidePreventionAustralia(2019).

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includedprograms thatbuildpositive relationshipsbetweenpoliceandparticulargroupsofmigrant and refugee young people; employing culturally specific workers in juvenile andyoung adult justice services; training and cultural support provided to court services andworkersintheyouthjusticesystem;andculturallyappropriateandspecificprogramsleadbyrespectedcommunityleadersandyoungpeople.)

4.3.2 The Royal Commission should recommend that section 344 of the Children, Youth andFamiliesAct2005beamendedtoraisetheageofcriminalresponsibilityto14years.

4.3.3 Fund further research into theunderlyingcausesofoffendingbehaviourspecific toculturalgroupsover-represented in crime statistics and theyouth justice system thatdrawson theexpertiseofyoungpeopleandcommunitiesconcerned.Thiswillinformservicesonhowbesttodevelopeffective,culturallyrelevantresponses.

4.3.4 Evaluate thesuccessofalreadyexistingprogramsdesigned tosupportmigrantandrefugeeyoungpeoplewithregardtooffendingandmentalhealth(bothearlyinterventionandmoretertiaryresponses).Thiswillassistwiththeidentificationofgoodpracticesandareaswherementalhealthserviceshaveaparticularrole,providingaframeworkforfuturepartnershipsandinitiativestodecreaseratesofoffending.

Recommendationforonlineaccess

4.4.1 Invest in research that explores how young people frommigrant and refugee backgroundsareusingonlinemeanstosupporttheirmentalhealthandwellbeing,anddevelopstrategiesandinterventionstostrengthensupportinthisspace.

Recommendations for access to appropriate mental health services and supports in regional/ruralareas

4.5.1 Resource thementalhealthsystem in ruralandregionalareas tobettermeet theneedsofyoungpeoplefrommigrantandrefugeebackgroundsthrough:

a) Providingculturallycompetent,youth focussedmentalhealthpractitioners thatcanoutreachtolocalschools,communityorganisationsandspacesthatyoungpeopleinruralandregionalareasaccess;

b) Skillingupteachersandyouthworkerswhoengagewithyoungpeoplefrommigrantandrefugeebackgroundsinruralandregionalareas,tobetteridentifymentalhealthissuesandmakeeffectivereferrals.

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1. Backgroundonmentalhealthandyoungpeoplefrommigrantandrefugeebackgrounds

The cultural diversity of Victoria’s population is on the rise.4 With almost half of Victoria’s youngpeople aged between 12 and 24 years either born overseas, or with one or more parent bornoverseas,youngpeoplefromrefugeeandmigrantbackgroundsarenolongertheexceptiontheyare‘themainstream’.5

Although often grouped together, there can be distinct differences amongst young people fromrefugee and migrant backgrounds. This includes the complexities and multiplicities of self-identification. Young people from migrant and refugee backgrounds can identify with multipleethnicities andancestries, includingadoptingordiscarding certain identities, regardlessofwhethertheywereborn inAustraliaorhave justrecentlyarrived.CMYusean inclusivedefinitionofrefugeeandmigrantyoungpeoplethatincludespeoplebetweentheagesof12and24yearswho:

• arrivedinAustraliaonhumanitarianvisasandthosewhohavefledtheirhomecountryundersimilarcircumstances;

• arrivedinAustraliaasamigrant;and• thosewhowereborninAustraliawithoneorbothparentsbornoverseas.

However, it is important tonote thatyoungpeopleborn inAustralia,andwhoseparentswerealsoborninAustralia,mayalsoidentifyasbeingfromamigrantorrefugeebackground.Oftenreferredtoasthird-plusgenerationAustralians, thiscohortofyoungpeopleare included inCMYprogramsandserviceswhenandiftheychoosetoself-identifyashavingarefugeeormigrantbackground.

Mostyoungpeoplefromrefugeeandmigrantbackgroundsareincrediblyresilientandgenerallycopewell despite the challengesof the refugeeand settlementexperience.6 It is therefore important tounderstandwhat it is thatcontributes to their resilience, inorder to informeffectivementalhealthpromotionandpreventionstrategies.7Resilienceismuchmorethantheinherenttraitsorqualitiesofayoungperson,butisaboutthe“qualityofthe‘soil’inwhichchildrengrow(theirhomes,schoolsandcommunities)”.8Wemust then focus on the systems and community connections that help youngpeopletoflourish.9

Adolescents are identified as a group that are vulnerable tomental ill-health, due to themultiplephysical, emotional and social changes that occur in this unique developmental stage.10 Promotingmental health amongst this age group is critical not only for their current wellbeing, but for their

4DepartmentofPremierandCabinet(2017)Victoria’sdiversepopulation:2016Census.Retrievedfromhttps://www.multicultural.vic.gov.au/population-and-migration/victorias-diversity/victorias-population-diversity5ABS.(2016).CensusofPopulationandHousing,CensusTableBuilder.Retrievedfromhttps://www.abs.gov.au/websitedbs/censushome.nsf/home/tablebuilder?opendocument&navpos=2406Colucci,E.Szwarc,J.Minas,H.Paxton,G.&Guerra,C.(2014).Theutilisationofmentalhealthservicesbychildrenandyoungpeoplefromarefugeebackground:asystematicliteraturereview,InternationalJournalofCultureandMentalHealth,7(1),86-108.7Coluccietal.,(2014),p.103.8CommissionerforChildrenandYoungPeopleWA.(2014).Reportofthe2014ThinkerinResidenceDrMichaelUngar:Resilience.Retrievedfromhttps://www.ccyp.wa.gov.au/media/1119/report-2014-thinker-in-residence-michael-ungar-resilience-may-2014.pdf9CommissionerforChildrenandYoungPeopleWA.(2014).10WHO.(2018).AdolescentMentalHealth.Retrievedfromhttps://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health;Blakemore,S.(2019).Theartofmedicine:Adolescenceandmentalhealth,TheLancet,vol.393,18May2019.

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mental health as adults in the future. Many mental illnesses first appear before the age of 24.11Multipleriskfactorsidentifiedforthisagegroupinclude:

• desireforgreaterautonomy;• pressuretoconformwithpeers;• explorationofsexualidentity;• increasedaccesstoanduseoftechnology;• qualityofhomelife;• qualityofpeerrelationships;• exposuretoviolence(e.g.inthehome,orbullying,sexualviolence);• socio-economicproblems.12

However,youngpeoplefromrefugeeandmigrantbackgroundsfaceadditionalriskstotheirmentalhealth.13 Research outlines a number of social, cultural and psychological factors that negativelyimpactthementalhealthandwellbeingofyoungpeoplefromrefugeeandmigrantbackgrounds.1415Thesecaninclude:

• separationfromfamily;• lowsocioeconomicstatus;• insecurehousing;• lackofsocialnetworks;• trauma;• racismanddiscrimination;• intergenerationalconflict;• lackofEnglish;and• thechallengesofacculturationincludingexperiencesofidentityandbelonging.

These factors can place them at risk of depression, anxiety and other mental health issues.16Australian-based research has also highlighted a strong connection between mental ill-health andhavingfamilymembersstillbasedinconflictareasoverseas,whichisanexperiencecommontomanyhumanitarianyoungpeople.17Conversely,recentresearchwithHazarayoungpeopleinAustraliaalso

11Blakemore,(2019).12WHO,(2018).13WHO,(2018);Blakemore,(2019).14VicHealth,Data61,CSRIO&MYAN,(2017),BrightFutures:Spotlightonthewellbeingofyoungpeoplefromrefugeeandmigrantbackgrounds.VictorianHealthPromotionFoundation,Melbourne;LauW.,SiloveD.,EdwardsB.,ForbesD.,BryantR.,McFarlaneA.,Hadzi-PavlovicD.,SteelZ.,NickersonA.,VanHooffM.,FelminghamK.,CowlishawS.,AlkemadeN.,KartalD,O'DonnellM.(2018).AdjustmentofrefugeechildrenandadolescentsinAustralia:outcomesfromwavethreeoftheBuildingaNewLifeinAustraliastudy,BMCMedicine,16:157.14VicHealth,etal.(2017).15WHORegionalOfficeforEurope.(2018).HealthofRefugeesandMigrants:Regionalsituationanalysis,practices,experiences,lessonslearnedandwaysforward.Retrievedfromhttps://www.who.int/migrants/publications/EURO-report.pdf?ua=116Ibid.17Nickerson,A.,Bryant,R.,Steel,Z.,Silove,D.&Brooks,R.(2010).TheimpactoffearforfamilyonmentalhealthinaresettledIraqicommunity,JournalofPsychiatricResearch,44:229-235.

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highlightsthatpresenceof immediatefamilyinAustraliawasastatisticallysignificantcontributortopersonalwellbeing.18

Althoughthereisminimalresearchonthementalhealthofyoungpeoplefromrefugeebackgrounds,aliteratureanalysissuggestshigherratesofpsychiatricdisordersamongstthisgroupcomparedwiththeadultpopulation,andhighlightsthattheyalsofaceahighriskofsuicide.19TheBuildingaNewLifein Australia study revealed that young people from humanitarian backgrounds have much higherlevelsofpsychologicalstress–31%ofyoungmenand37%ofyoungwomen–thanthegeneralyouthpopulation inAustralia.20Research inWAalsohighlights thatchildrenandyoungpeople fromCALDcommunities are at greater risk of mental health problems and face additional service barriers.21These findings indicate that it isessential that servicesandprograms respond to thementalhealthneedsof theseyoungpeople–addressing settlement related stress,mentalhealth issuesandpre-migrationtrauma.22

Despite this, there are lower than expected numbers of young people from refugee and migrantbackgroundspresenting tomentalhealth services.23 In thecontextofAustralia, childrenandyoungpeople generally have relatively low levels of service usage (despite high levels of mental healthissues),whilerefugeechildrenandyoungpeoplehaveevenlowerratesofutilisationofmentalhealthservicescomparedwithyoungpeoplemorebroadly.24

A 2015 evaluation of headspace found that although the service is being accessed by significantnumbersofyoungpeople fromadiversityofbackgrounds,youngpeople frommigrantandrefugeebackgrounds remain “starkly under-represented as clients.”25 According to the report, almost allyoung people accessing headspace were Australian born (92.8%), and of the “7.2% of clients thatwerebornoverseas,only6.6%speakalanguageotherthanEnglishathome(comparedto19.3%ofAustralianyoungpeople).”26Stakeholdersidentifiedanumberofbarrierstoaccess,includingstigma,waitinglists,andalackofculturallyappropriateservices.27

Similarly,theVictorianAuditor-General’sOffice’sreportonChildandYouthMentalHealthidentifiedthat although young people fromCALDbackgrounds are identified as a vulnerable group, they are

18Copolov,C.Knowles.A.&Meyer,D.(2017).ExploringthepredictorsandmediatorsofpersonalwellbeingforyoungHazaraswithrefugeebackgroundsinAustralia,AustralianJournalofPsychology,70:122-130.19Colucci,etal.,2014.20Rioseco,P.&Liddy,N.(2018).Settlementoutcomesforhumanitarianyouthandactivecitizenship:Economicparticipation,socialparticipationandpersonalwellbeing.AustralianInstituteofFamilyStudies.Retrievedfromhttps://aifs.gov.au/publications/settlement-outcomes-humanitarian-youth-and-active-citizenship21CommissionerforChildrenandYoungPeopleWA.(2013).Thementalhealthandwellbeingofchildrenandyoungpeople:ChildrenandYoungpeoplefromculturallyandlinguisticallydiversecommunities,Policybrief.Retrievedfromhttps://www.ccyp.wa.gov.au/media/1292/policy-brief-mental-health-children-and-young-people-from-culturally-and-linguistically-diverse-communities-september-2013.pdf22Rioseco&Liddy(2018).23Colucci,etal.,(2014).24Colucci,E.Minas,H.Szwarc,J.Guerra,C.&Paxton,G.(2015).Inorout?Barriersandfacilitatorstorefugee-backgroundyoungpeopleaccessingmentalhealthservices,TransculturalPsychiatry,52(6):766-90.25Hilferty,F.Cassells,R.Muir,K.Duncan,A.Christensen,D.Mitrou,F.Gao,G.Mavisakalyan,A.Hafekost,K.Tarverdi,Y.Nguyen,H.Wingrove,C.&Katz,I.(2015).Isheadspacemakingadifferencetoyoungpeople’slives?FinalReportoftheindependentevaluationoftheheadspaceprogram.(SPRCReport08/2015).Retrievedfromhttps://headspace.org.au/assets/Uploads/Evaluation-of-headspace-program.pdf26Hilfertyetal.(2015).27Hilfertyetal.(2015).

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presenting in Child and YouthMentalHealth Services in lownumbers.28 A recentAustralian reportalsohighlights that families fromnon-English speakingbackgroundsare less likely toaccessmentalhealthsupportfortheirchildren.29Itisevidentthatthereismuchworktobedoneinordertoensurethat young people from refugee andmigrant backgrounds are getting access to themental healthsupporttheyneed,particularlyintheearlyinterventionspace.

CMY’s consultations revealed that particular groups of young people from refugee or migrantbackgroundswho ‘fall through thegaps’ of existingmental health andwellbeing supportprogramsinclude:youngpeoplewhohavebeeninAustraliaforoverfiveyears;thoseonorphanrelativevisas30;young asylum seekers who are 18 years or over; young carers; young people with disabilities;internationalstudents;and,thosefromPasifikabackgrounds.31Thisisbecausemanyservicesarenotfunded toworkwith thesegroups.At the same time, there is oftena shortageof generalist youthsupport roles (such as those available in local council), andwhere those thatdoexist they arenotalways well equipped to work with these specific groups or with those frommigrant and refugeebackgrounds.

2. Afocusonprevention

2.1. Promotingmentalhealthwithyoungpeoplefrommigrantandrefugeebackgrounds

Mental health is holistic and context driven; economic participation and social inclusion are thebuildingblocksof social andemotionalwellbeing.Research suggests that key social, environmentaland economic determinants ofmentalwellbeing andmental illness are shared across nations, andthattherearekeyrelationshipsbetweenthesedeterminantsandthedevelopmentofmentalhealthproblems.32TheWHO identifies that inaddition tomentalhealthbeingaffectedby socioeconomic,psychological and biological factors, it is also impacted upon by environmental factors such asviolence,discrimination,exclusionandhumanrightsviolations.33

As a result, it is important to focus not only on clinicalmental health reforms, but also on holisticcommunity-basedstrategiesthatworkontheindividual,communityandsocietallevelthatpromote

28VAGO.(2019).ChildandYouthMentalHealth,IndependentassurancereporttoParliament2018–19: 26.Retrievedfromhttps://www.audit.vic.gov.au/sites/default/files/2019-06/050619-Youth-Mental-Health_0.pdf29Hiscock,H.Mulraney,M.Efron,D.Freed,G.Coghill,D.Sciberras,E.Warren,H.&Sawyer,M.(2019).UseandpredictorsofhealthservicesamongAustralianchildrenwithmentalhealthproblems:Anationalprospectivestudy,AustralianJournalofPsychology.https://doi.org/10.1111/ajpy.1225630FormoreinformationonthisgroupseeCMY.(2014).YoungpeopleonRemainingRelativevisas(115)andOrphanRelativevisas(117):entitlementsandreferralpathwayoptions.Retrievedfromhttps://www.cmy.net.au/sites/default/files/publication-documents/Young%20People%20on%20Remaining%20Relative%20visas%20(115)%20and%20Orphan%20Relative%20visas%20(117).pdf31FormoreseeCMY.(2018).Youngpeopleonspecialcategory(444)visas:entitlementsandreferralpathwayoptions.Retrievedfromhttps://www.cmy.net.au/sites/default/files/publication-documents/Fact%20Sheet%20-%20Young%20People%20on%20Special%20Category%20%28444%29%20Visas.pdf32VictorianGovernment,citedinCMY.(2014a).MindMatters:TheMentalhealthandWellbeingofYoungPeoplefromDiverseCulturalBackgrounds,Carlton,CentreforMulticulturalYouth.33WHO

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wellbeing. There is a substantial body of literature around the protective factors that can be builtupontostrengthenresilience.34

For people frommigrant and refugee backgrounds, discrimination (and its resulting disadvantages)remainsoneofthesignificantdriversofmentalillnessinAustraliaandreportedexperiencesofracismarecurrentlyclosetothehighestlevelsrecordedinthelastdecade.35Extensiveresearchhighlightsastrong relationshipbetween racismandnegativehealthandwellbeingoutcomes for youngpeople,including depression, anxiety or psychological distress.36 It highlights the need to addressdisadvantage and marginalisation as a priority and to reinvigorate the national narrative thatrecognisesthestrengthofourculturaldiversity.

Inthelastdecade,therehasbeenasignificantincreaseinthereportedexperienceofdiscriminationbasedonskincolour,ethnicoriginandreligionto19%in2018from9%in2007.37Aroundaquarterofyoungpeoplebetween18and24yearsofagereportedexperiencingdiscriminationwithpeoplefromnon-Englishspeakingbackgroundsreportingthehighestexperienceofdiscrimination(25%).38

Longitudinal data from Building a New Life in Australia (BNLA) reveals young people experiencegreater levels of racism and discrimination the longer they are in Australia.39 The BNLA findingsindicatetheneedtoworkwithcommunitiesofallagestoreducediscriminationagainstyoungpeoplefrommigrant and refugee backgrounds.40 Furthermore in theMulticultural Youth Australia Census201741,66%of theparticipantsmentioned theyexperienceddiscriminationbasedonraceand25%statedtheywerediscriminatedbecauseoftheirreligion.Thisindicatesthatmoreshouldbedonetoachieve better settlement outcomes for young people upon arrival to Australia to ensure socialcohesion;somethingthatbenefitseveryone.42

A senseof inclusionandbelonging is critical to youngpeopleofmigrantand refugeebackground’smentalhealth.Apositivecultural identity increasesresilience,whereasalienationormarginalisationincreasestheriskofmentalillness.43

Therefore, a broader, contextual approach to supporting young people frommigrant and refugeebackground’smentalhealthshouldinclude:

• strengthening young people’s sense of belonging and social connectedness – to both theirownculturalcommunityandwiththebroadercommunity(supportingbondingandbridgingnetworks);

• creatingmeaningfulandsupportiveopportunitiesineducationandemployment;and• reducingracismanddiscrimination.44

34Chauvin,A.citedinCMY,(2014a).35Markus,A.(2014).citedinVicHealth&CSIRO(2015).36VicHealth.(2014).Racismanditslinkstothehealthofchildrenandyoungpeople,Carlton:VicHealth.37Markus,A.(2018),MappingSocialCohesion:TheScanlonFoundationsurveys2018.CaulfieldEast:MonashUniversity,pp.68-69.38Ibid.39Rioseco&Liddy(2018).40Ibid.41Thecensusisthefirstnation-widestudyofAustralia’smulticulturalyouthwith69%ofparticipantsaged15to19and37%aged20to25.Formoresee,Wyn,J.,Khan,R.,&Dadvand,B.(2018).MulticulturalYouthAustraliaCensus2017InfographicReport.Retrievedfromhttps://education.unimelb.edu.au/__data/assets/pdf_file/0011/2972036/MY-Aust-Report-17-18.pdf42Markus,A.(2017).MappingSocialCohesion:TheScanlonFoundationsurveys2017.CaulfieldEast:MonashUniversity,pp.59-60.43CommonwealthofAustralia,2010citedinCMY,2014a.

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CMYbelieves there is aneed forpolitical and social leadership toensure thatpublic conversationstakeplace in respectfulandconstructiveways,areevidence-basedand include thevoicesofyoungpeople.45 There is also a need for initiatives that actively promote the documented benefits ofdiversity to all of Australia and reiterate that successful settlement is a two-way process - equallydependent on the host community’s ‘reception’ or welcome as it is on new arrivals’ skills andattributes.Thefocusandcontinualreferraltobroadcharacteristicsandparticularculturalgroupsas‘problematic’ reinforces inaccurate stereotypes, harming young people, their families andcommunities, includinghavingasignificantnegative impactontheirmentalhealthandwellbeing. ItalsounderminesVictoria’soverallsocialcohesion.

2.2. Reducingstigmaanddiscriminationandpromotingmentalhealthliteracy

“Thesubjectofmentalhealthisverytabooinaculturalsense”–biculturalyouthworker

Althoughwehavecomealongwayinreducingsomeofthestigmaassociatedwithmentalill-healthyoung people frommigrant and refugee backgrounds, and those who work with them, identifiedstigma as a fundamental priority. Consultations with young people from migrant and refugeebackgrounds on the issue ofmental health revealed that stigma, shame, intergenerational conflictand fearofburdeningparents/familycreatesbarriers toserviceaccessandhelpseeking. Improvingmentalhealth literacyand reducingstigmashouldbeacorepriorityofanywork to strengthen thementalwellbeingofyoungpeoplefrommigrantandrefugeebackgrounds.

Communities of refugee and migrant backgrounds bring with them different cultural norms andunderstanding around mental health, shaped by cultural values and religious/spiritual beliefs. Attimes, these are accompanied by stigma. For example, speaking about issues outside of the familymay be considered culturally inappropriate, or talking about problems can be seen to exacerbatethem.Inthewordsofoneyoungpersonwhospokewithamentalhealthprofessional:“didIdotheright thing about telling?… did I do something against my cultural norms, standards andobligations?”46Mental illness can carry culturalmeaning, such as being a sign that the person hasbrokensomekindofhigherlawortrespassedinsomeway,whichcarriesblameandshame.Researchhas also highlighted a lack of understanding around ‘talk therapies’ in certain cultural contexts,particularlywithastranger.47

“Wetrytorefersomeonetoheadspace,andtheywon’tgo.Thereisstigmaassociated.Ortheperceptionthat‘headspaceisaplacethatwhitepeoplego’.”–multiculturalyouthworker

Theissueofinterpretationandtranslationaroundmentalhealthconceptswasalsoanissueregularlyraised throughout consultations. In many languages and cultures, the words to translateWesternmentalhealthconceptssimplydonotexist,andthosethatdoareattheacuteendofthespectrum

44CMY,2014a.45MYAN.(2017).SubmissiontotheJointStandingCommitteeonMigrationInquiryintoSettlementOutcomes,Carlton,MYAN.46Valibhoy,M.,Kaplan,I.&Szwarc,J.(2017),“Itcomesdowntojusthowhumansomeonecanbe”:AqualitativestudywithyoungpeoplefromrefugeebackgroundsabouttheirexperiencesofAustralianmentalhealthservices,TransculturalPsychiatry,54(1):23-45;Colucci,etal.,(2014).47Colucci,etal.,(2014).

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(i.e.‘crazy’)–andoftencarrystigma.Forexample,anAustralianstudyamongst13-17yearoldsfromAfricanbackgrounds revealed thatmost surveyedwerenot awareof the terms “mental health”or“mentalillness”.48

Evenifyoungpeoplehavewelldevelopedmentalhealthliteracy,theyreportedthattheissueisverysensitiveamongsttheirparentsandcommunity,whichcanmakethemreluctanttoreachoutorraiseissuesof concern. In a consultationwithnewly arrived youngpeople inMelbourne, they identifiedthattalkingtoparentsaroundmentalhealth issueswouldactuallyexacerbateproblemsratherthanhelp.Biculturalyouthworkerssimilarly reported ‘hittingwalls’when trying to talk toparentsabouttheirchild’smentalhealthandtheneedforsupport.Youngpeoplethatdoseekhelpcanruntheriskof experiencing stigma and judgement from others in their community, including parents orcommunityandreligiousleaders.

CMY’songoingconsultationwithyoungpeoplefrommigrantandrefugeebackgroundshighlightstheimportance of working from a proactive, collaborative, holistic and community developmentapproach in terms of promoting mental wellbeing in their communities, and de-stigmatising helpseeking around mental health.49 Increasing mental health literacy in order to reduce stigma andpromote help seeking should be culturally tailored, given this creates better outcomes and serviceaccessthangenericapproaches.50Youngpeoplehavelongadvocatedforcollectivemeansofworkingwithyoungpeople,families,communitiesandcommunity/religiousleaderstoeducateanddecreasestigmaassociatedwithseekinghelpformentalwellbeing.51

“Wehave togo throughour leaders – theyhavea lot of influenceon families.Weneed toraise awareness, create opportunities where families understand it is an issue, there is aneed.”–biculturalyouthworker

“It isverycommon inourcommunities thatwhenyouareworkingwithayoungpersonyouarenotjustengagingwithparentsandsiblings,butwithgrandparentsandauntsanduncles.”–biculturalyouthworker

YoungpeoplefromrefugeebackgroundsinValibhoyetal.'sresearchalsosuggestedotheroptionsforreducingstigmaandimprovingmentalhealthliteracy,including:

• school-based education programs (particularly English Language Schools and sites wherenewlyarrivedyoungpeoplewouldbeattending);

• advertisingontelevisionandothermedia(includingmultilingualmedia);• peermentorsandgroupactivities;• usingpositiverolemodelsto“normalise”mentalhealthproblems;and

48deAntiss&Ziaian,2010inColucci,etal.,(2015).49CMY,VFST,RoyalChildren’sHospital&CentreforInternationalMentalHealth(MelbourneUniversity).(2010).YoungPeopleofRefugeeBackgroundssharetheirthoughtsonmentalhealthissuesandservices.Retrievedfromhttp://refugeehealthnetwork.org.au/young-people-of-refugee-backgrounds-share-their-throughts-on-mental-health-issues-and-services-a-roundtable-discussion-between-young-people-service-providers-victorian-government-representatives-an/50MentalHealthinMulticulturalAustralia.(2014).FrameworkforMentalHealthinMulticulturalAustralia:IntroductoryGuide.MtGravatt,MHiMA.51CMY,etal.,(2010).

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• educating community/religious leaders who may be able to use their influence to changeattitudes.52

52Valibhoy,etal.(2017).

CaseStudy1–CMY’sShoutOutMentalHealthWorkingGroup

Young people frommigrant and refugee backgrounds have a wealth of unique perspectives andfresh ideas to contribute toAustralia’s rich diversity.However their voicesare often stereotyped,marginalised or invisible in mainstream culture and this can negatively impact their sense ofbelonging. ShoutOut is an innovative leadership program that trainsandnurturesyoungpeoplefrommigrantandrefugeebackgroundstosharetheirexperiencesandperspectivesonissuestheyaremostpassionateaboutwithawidevarietyofaudiences.ShoutOutisanopportunityforyoungpeopletopresenttheirstoriesandexperiencestoaudienceswhomaynotusuallyhavethechancetohearthem.

By training young people in public speaking and connecting them to speaking opportunities at arangeof public forums, ShoutOut empowers and enablesyoungpeople to beactive citizens andactivelypromotepositiveperceptionsofyoungpeopleasrespectedandinfluentialmembersofourcommunities.

In2018,CMY’sYouthAdvisoryGroup identifiedmentalhealth as akey issueofconcern toyoungpeoplefromrefugeeandmigrantbackgroundsinVictoria.Wantingtounderstandmoreaboutthisissue and how it affects not only young people but their families and communities the groupundertookaprojecttoresearchandconsultwithyoungpeopletolearnmoreaboutthisissue.

Theculminationofthisprojectwastheestablishment in2019ofa specialisedShoutOut speakersgroupwithafocusonmentalhealth.Theseareyoungpeoplewithlivedexperiencesoftheimpactsandchallengesofmentalill-health,theirownorthatoffamilyandfriends.

Thegroupidentifiedtheneedfordirectengagementonissuesrelatingtomentalhealthwith:

• Youngpeoplefromrefugeeandmigrantbackgrounds;• Mentalhealthservicesandworkers;and• Communityleadersandfamily/parents.

In2019,thisgrouphavepresentedontheirperspectivesandexperiencesonmentaltoanumberofmental health services and groups of young people. They have also worked on developingworkshops to undertake targeted, culturally relevant, peer-to-peer programs with other youngpeoplefromrefugeeandmigrantbackgrounds.Oneofthemainfocusesofthespeakersgroupwillbe delivering theseworkshops at schoolsas an early interventionwitha focus onpromotingself-careandhelp-seekingbehaviour.Thegrouparealsocurrentlyexploringopportunitiesandmethodsfor working with family and community leaders to raise awareness of mental health concernsamongyoungpeoplefromrefugeeandmigrantbackgroundsandaddressthestigmaexperiencedinmanycommunities.

Formorepleasevisitwww.cmy.net.au/shoutout/

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2.3. Socialinclusion,connectionandsupport

Asenseofinclusionandbelonginginsociety,includingapositivesenseof(multi)culturalidentityandstrongsocialconnections iscritical toyoungpeoplefrommigrantandrefugeebackground’smentalhealth.53 Additionally, having opportunities for positive influence and being involved in the localcommunityisimportantforyoungpeopleofrefugeeandmigrantbackground’soverallwellbeing-interms of friendships, developing new skills, and being able tomake a positive contribution to thecommunityinwhichtheylive.54

CMY’s 30 years of experienceworkingwith young people frommigrant and refugee backgrounds’highlightsthatculturallyrelevantyouthsupportforyoungpeopleofrefugeeandmigrantbackground-includingyouthsupport,socialprograms,arts,sports,recreationalandleadershipdevelopmentandopportunities – are critically important in terms of promotingwellbeing, a sense of belonging and

53CommonwealthofAustralia,2010citedinCMY,2014a.54CMY.(2014b).ActiveCitizenship,ParticipationandBelonging:YoungpeoplefrommigrantandrefugeebackgroundsinVictoria,Carlton,CMY.

CaseStudy2:Supportingmentalhealthamongstnewlyarrivedyoungpeople–DiversitatGeelong

TheSelf-caregroupisthecontinuationoftheRenewprojectdesignedin2018betweenDiversitatand Headspace to address concerns that young people from refugee backgrounds and theirfamiliestendnottoseekearly interventionandpreventionsupportfrommentalhealthservices.ThegroupissupportedbyDiversitat’smulticulturalmentalhealthworkerandHeadspace’syouthengagement,andmeetsfortnightly,integratingbothmentalhealtheducationwithsports,culturalandrecreationalactivities.

The Self-care group has been formed by a group of young people (16-25) from refugeebackgroundswhoshareacommoninterestinenhancingtheirawarenessofmentalhealthissues.Someoftheparticipantshaveadirectpersonalorfamilyexperienceofmentalhealth issuesandothers are aware of some mental health issues through friendship groups and communityconnections.Thegroupsoughtpeoplewhowantedtoconnectwithotheryoungpeopleandworkcollectively to raise community awareness aboutmental health issues and the support servicesthatareavailable.

Participants have collaborated in recruiting other young people through school and communityconnections.Themain aimof thisnewgroup is toextend awareness ofmental health issues toother young people and open up more and new conversations about mental health issues atindividual, family andcommunity level.Participants of theRenewprojectwill share experiencesandinsightswithnewparticipantsandsupporttheirengagementwiththegroup.

The group meets once fortnightly, alternating one mental health education session with arecreational activity in the next fortnight. Activities include sports, cultural activities and picnicdays,hikingtripsjusttonameafew.

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connectedness. Similarly, working to address key barriers such as racism and discrimination areimportant in protecting young people from migrant and refugee background’s mental health. Toaddressthis,theVictorianGovernmentshouldbelookingforopportunitiestolinkmentalhealthandwellbeingintobroadersocialcohesionandanti-racismstrategies.

Social inclusion could also be promoted through cultural mentor, peer leadership programs thatprovideyoungpeoplewithexamplesofyoungpeoplelikethemselveswhohavebeen‘successful’orprovidea‘livingsignpost’astowhattheycanalsoachieve.Thereisalsoaneedforculturallytailoredresponsestoengagecertaingroupsofyoungpeoplewhomaynotrelatetothe‘mainstream’servicesystem,includinglocalcouncilyouthservices,schoolwelfareworkersorteachers.

2.4. Co-designed,culturallycompetentyouth-focussedcommunitydevelopmentwork

For some groups of young people frommigrant and refugee background, a culturally competent,community-driven and community development approach is needed in order to bettermeet theirneedsandassistwithengagement inthebroadercommunityandservicesystem.CMY’sexperienceworkingalongsidebothPasifikaandSouthSudaneseyouth-focussedcommunitydevelopmentmodelsisthattheyareextremelyeffectiveandimportantatengagingwithnotonlyyoungpeoplefromthesecommunities,butalsowithfamilies,community leadersandthebroaderservicesystem.Theycouldbe considered ‘deep’ forms of community development, where program staff possess culturalexpertiseandholdestablishedtrustandrelationshipswiththecommunityconcerned.

Bicultural community and youth workers play a critical role in facilitating engagement with youngpeople,familiesandcommunity/faithleadersthatothermainstreamservicesfinddifficulttoaccess.Theirs isan importantrole thatengagescommunity,providesapointofcoordination,andthatcanbrokerrelationshipsbetweencommunity,servicesandgovernment.Theyprovideculturaladviceandexpertise to the mainstream service system. At the same time, bicultural workers work alongsidecommunities to build trust and understanding around existing supports. Additionally, they provideyoung peoplewith rolemodels from cultural backgrounds similar to their own – something youngpeople frommigrantand refugeebackgrounds frequently report is central todevelopingahealthy,bi/multicultural community (that is, seeing people like yourself who are successful and able tointegratetheirownculturalandfaithbackgroundwiththatofthebroadercommunity).

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55

55ManyPasifikacommunitymemberslivinginVictoriahavearrivedinAustraliaon444visas.TheSpecialCategory(subclass444)visaisatemporaryvisathatallowsaNewZealandcitizentoremainindefinitelyandlive,workorstudyinAustralia.Asthe444visaisnotapermanentvisa,visaholdersdonothavethesamerightsandbenefitsasAustraliancitizensorAustralianpermanentresidents.Thesevisaholdersarealsonotentitledtoonarrivalsettlementsupportsandservices,asaresomeothernewlyarrivedcommunities.SeeCMY(2018)https://www.cmy.net.au/publications/young-people-special-category-444-visasformoreinformation.

CaseStudy3:TheLeMana(Empower)PasifikaProject

Pasifika young people and the particular issues they face remained invisible in Victoria formanyyears.55 Overtime this group of young people came to the attention of CMY, and a number ofservices, as a group who were ‘falling through the gaps’ as they started presenting to frontlineservices in greater numbers withmultiple, complex needs. The extent of Pasifika young peoples’unmet needs slowly becomemore evident as their numbers grew in school disengagement andyouthjusticestatistics.

Over the last seven years, CMY worked with Pasifika community elders and leaders to build atrusting partnership in order to support the establishment of a Pasifika community peak body torepresenttheirownissuesasonevoice-UnitedPasifikaCouncilofVictoria(UPCOV).Intheprocess,CMY created deep engagement with this community to identify youth issues in a way that isculturally appropriate, sensitive and respectful of their culture and needs. In partnership withUPCOV,CMYbroughttheissuesandconcernsforPasifikayoungpeopletotheattentionoftheStateGovernment,whichculminatedinVictorianOffice forYouth (OfY)funding foraPasifikayouthandfamilies project. The project, Le Mana, is a genuine partnership between CMY and the Pasifikacommunitypeakbody, toaddresschallengesyoungpeople face in education, employmentand inyouth justice. More importantly, the project is also an opportunity to strengthen communitystructuresandtosupporttheiraccessintomainstreamservices.

Theprojectemploys skilledstaff fromPasifika backgrounds.Theprojecthasbeendevelopedwiththe dual aim of improving educational outcomes and aspirations for young people from Pasifikabackgrounds, and improving the local service sector to better support young people and theirfamilies.TheLeManaprojecthasstrongengagementwithyoungpeople,families,community/faithleaders and the local service system – and is effectively working with young people andcommunities to meet their needs – a group that the service system has not often effectivelyrespondedto.Thisprojectdemonstratesamodelofdeepcommunityengagementtosupportthiscommunitytoengagewiththemainstreamservicesystem.

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These co-designed, culturally competent community development approaches are critical for deepengagement with particular communities of young people, parents, community/faith leaders,governmentandservices.Culturalexpertise,relationships,trustandpartnershipsarethefoundationforthesuccessofthesetypesofapproaches,whichmeanstheyrequireadequatetimeandfundingtoestablish, gain trust and develop effective partnerships. Short-term funding has been raised as aseriousconcerninmanyprogramsthataimtocounterthesocialdisadvantagethatcommunitiesfrommigrantandrefugeebackgroundscanface.56Manyofthesetypesofprogramsmaybeonlygainingmomentumoncefundingceases.“Formalrecognitionandsupportofthetimeandresourcesrequired

56Bartels,L.(2011).CrimepreventionprogramsforculturallyandlinguisticallydiversecommunitiesinAustralia.Researchinpractice,18.Canberra:AustralianInstituteofCriminology.Retrievedfromhttp://www.aic.gov.au/publications/current%20series/rip/1-10/18.html

CaseStudy4:CommunitySupportGroup(CSG)–SouthSudaneseCommunityinVictoria

TheVictorianGovernmenthasfundedaCommunitySupportGroup(CSG)withtheSouthSudanesecommunityinVictoria-acoordinated,community-ledapproachtoenhanceyouthandcommunityengagement and to respond to local community issues and needs. CMY manages theMelton/BrimbankandDandenong/CaseyCSGs,whileWyndhamCommunityandEducationCentremanagestheWyndhamCSG.ThefocusofaCSGistolinkpeopletoanintegratedrangeofprogramsandactivitiessuchaseducation,training,employmentpathways,healthandhumanservices,sportand recreation and other community activities. A CSG can also implement new programs andactivitieswherecommunityneedsareidentified.

The Community Support Group (CSG) purpose is to actively engage the South Sudanesecommunities in and across Dandenong/Casey and Brimbank/Melton in the scoping anddevelopment of local responses and facilitating local community participation in the decision-makingprocess,inparticularyoungpeople’sinputintheproject.TheCSG:

• employsskilledstafffromSouthSudanesebackgrounds;• workswiththeSouthSudanesecommunitytosupportoutcomesforyoungpeopleandtheir

families;• establishes and maintains relationships with key community partners and service

stakeholders fromavariety of sectors including but not limited to theyouth, community,sportsandgovernmentsectors;

• engageswiththeSouthSudanesecommunitiesandyoungpeopletoco-constructprogramsto respond to issues affecting young people and support team members onimplementation;

• buildsthecapacityandknowledgeofgovernmentandnon-governmentservicesinworkingwithSouthSudaneseyoungpeopleandtheirfamilies;

• coordinates and/or collaborates with services to deliver relevant programs ensuringappropriatesystemsareinplaceforhighquality,costeffectiveandtimelyprogramdelivery,monitoringandreportingaccordingtobestpracticestandards.

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byprogramstotransitionfromanestablishmentphasemayincreasethechancesthataprogramwilldevelopaneffectiveandsustainableoperatingmodel.”57

2.5. Education

School is an important site for development of social relationships with success in educationsupportedbythequalityoftherelationshipsthatyoungpeopleandtheirparentsforgeintheschoolsetting. This has recently been recognised in theVictorianGovernment’sFramework for ImprovingStudent Outcomes, which identifies the promotion of inclusion as a priority under one of the fourstate-wideschoolimprovementpriorityareas.58Schoolsalsoplayacriticalroleinfacilitatingculturaland social capital for young people and for their families. Social support and feelings of safety atschoolareintegraltoimprovingstudentoutcomes.

Youngpeoplefrommigrantandrefugeebackgroundscanfaceconsiderablepressureandexpectationfrom family to succeed in education, compared with the broader youth population, negativelyimpacting on their mental wellbeing.59 This was a theme that emerged in CMY’s consultationsregarding this submission, and regularly inCMY’swork.A YoungThinker inResidenceat theYouthAffairsCouncilVictoria (YACVic)ofAustralian-Vietnamesebackgroundalsooutlinedthispressureheuncoveredinhisconsultationswithyoungpeoplefrommigrantandrefugeebackgrounds:

“IspokewithaLebanesegirlwhowastryingtoexplainherVCEresultstoherparents.Shegota40inbusinessmanagement,andhergrandparentswerelike,"Where'stheotherten?"Theydidnotrealisethat40meantshewasinthetop8percentinthestate(really impressive!)…It'sveryhardforthesekidstotranslatethesystemtotheirparentsduringastressfultime.”–HarryKoelyn,YoungThinkerinResidence-YACVic60

Similarly, bicultural youth workers spoke about the significant weight on the shoulders of youngpeople from migrant and refugee backgrounds – in terms of meeting the high and sometimesunrealistic expectations of their parents. Parents are often unaware that their children may bestruggling academically (manywith English as a second language, and interrupted education), andfrequently lack understanding around education and employment pathways in Australia. Relatedly,parents frommigrant and refugeebackgrounds can frequently lack a strong relationshipwith theirchild’sschoolorteachers.Theymaybebusywithotherpressuresoflife;mightnotfeelwelcomeorconfidenttobecomeinvolvedintheirchild’seducation;ormayhavedifferentculturalunderstandingsregarding the level of involvementparents shouldhave in the school setting. Similarly, schools canoften struggle to effectively engage and communicate with parents from migrant and refugeebackgrounds.

57Bartels(2011).58VictorianGovernment(DepartmentofEducationandTraining).(2019).FrameworkforImprovingStudentOutcomes.Retrievedfromhttps://www.education.vic.gov.au/Documents/school/principals/management/FISOModelandCycleA3Poster.pdf59VicHealth,Data61,CSIRO&MYAN.(2017).BrightFutures:Spotlightonthewellbeingofyoungpeoplefromrefugeeandmigrantbackgrounds.Melbourne:VictorianHealthPromotionFoundation.60HarryKoelyn,YoungThinkerinResidence–YACVic.Retrieved(28June2019)fromhttps://www.yacvic.org.au/blog/intergenerational-relationships-migrant-refugees/

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“Alotofparentsdon’tknowwhat’sgoingon,evenwhenkidsgetexpelled”–biculturalyouthworker

Yet according to themost recent State of Victoria’s Children report, evidence shows that parents’actionsandbehavioursexertan“early,strongand lastingeffectonchildren’soutcomes intermsoflearning and development, wellbeing, social and emotional functioning and health.”61 The reportemphasizes that of all factors in the home learning environment, parent encouragement andexpectationsfortheirchild’seducationalachievementcontributemosttostudentachievement.”62

Parents’ lack of knowledge of the school system and curriculum, own English language ability,disjuncture between expectations for their children’s educational prospects and young people’slanguageandliteracyabilities,andlackofsupporttofacilitateyoungpeople’sengagementinschoolin Australia were factors identified by CMY workers as key contributors to school disengagementamong young people from refugee andmigrant backgrounds. Schools are also critical sites for thedevelopment of knowledge and skills to navigate post-education pathways, both for students andtheirfamilies.

Schoolsandtheeducationsystemplayasignificantconnectingrole,supportingyoungpeople’saccessto future education and employment pathways, and facilitating access to mental health support.CMY’s experience delivering the Navigator program (specifically supporting young people fromrefugeeandmigrantbackgroundswhohavedisengaged fromschool)has reinforced theunderlyingreasons for the implementation of the program – that is, that disengagement is often related tomentalhealthandyoungpeoplefromrefugeeandmigrantbackgroundsoftenneedtargetedsupportto address their needs in this area. The transition from school is a particular point of risk foradolescence,asyoungpeoplecanfallthroughthegapsofservices.63Thereforeitiscriticalthatstrongpartnerships are established between schools, other educational providers and community basedservices,tofacilitatesupportforyoungpeopleoncetheyhaveleftschool.

ExamplesoffamilyengagementsuchasCommunityHubs,thatuseprimaryschoolasacentralpointto engage migrant and refugee women and connect them to health, education and employmentsupport,providesastrongexampleofthewayschoolscanbeasiteforconnectionandengagementoffamiliesfromrefugeeandmigrantbackgroundsinlocalservices.Asimilarmodelcouldbeexploredin the secondary school context – where schools become sites for support and connection withfamiliesintermsofprovidingservicesthatmeetcommunity-identifiedneeds,suchaseducationandemployment, whilst facilitating engagement with the broader service system (including access toparentingandmentalhealthsupport).

61DET.(2016).StateofVictoria’sChildrenReport–2015.Melbourne:DET,p.8362DET.(2016).,p.28&8363TheParliamentoftheCommonwealthofAustralia(2011)Beforeit’stoolate:Reportonearlyinterventionprogramspreventingyouthsuicide.Retrievedfromhttps://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-a-before,p.42.

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2.6. Employment

Research suggests that prolonged unemployment or underemployment has a serious detrimentalimpactonbothmental andphysical health.64 Effects of long-termyouthunemploymentonmentalhealthrangefromgreaterlevelsofanxietyanddepressionandhighersuiciderates,toalienationandincreasedanti-socialbehaviour.65

Young people from migrant and refugee backgrounds experience additional barriers findingemployment,duetoracialdiscrimination,lackofbridgingsocialnetworksandalackofunderstandinghowtheAustralianlabourmarketworks.66Theirparentsorguardiansarealsooftenunabletoassistthem in this difficult process, given they often lack information and understanding of employmentpathwaysintheAustraliancontext.

CMY’sprevious research regarding transitions toemploymenthighlighted the relationshipbetweenunemploymentandmentalill-healthamongyoungpeoplefromrefugeeandmigrantbackgrounds.67Young people spoke about experiencing knock backs in their attempts to securework as having aprofoundlynegativeimpactontheirmentalwellbeing,attimesmakingthemreluctanttoseekhelporreachoutagain:

“I apply somewhere, when I get rejected I pretty much – my world blacks down. I havenowheretogo”-youngwoman,refugeebackground

“LastnightIwastellingmyfiancéandmymumanddad–IneedtogotoHeadspace,IfeellikeIhaveananxietyanddepression,becauseIcouldnotsleepatnight–Iwasthinking,‘Why?’Youknowweworkhard[study]–butyouseenoresult”–youngwoman,refugeebackground

TheWHOoutlinesanumberofinitiativesworkplacesshouldundertaketopromotementalhealthinthe workplace.68 These include acknowledging employees’ strengths, and an awareness of theworkplace environment andhow it can be changed to promote bettermental health for staff. Foryoungpeoplefromrefugeeandmigrantbackgrounds,acknowledgingtheircapabilitiesisparticularlyimportantgiventhedeficitlenswithwhichtheycanbeviewed.Theybringnumerousstrengthstothework context, includingmultiple languages, diverse cultural worldviews, flexibility, adaptability andresilience-qualitiesthatshouldbeassetsinthechangingfutureofwork.

Thebenefitsof a culturaldiverseworkforce shouldbepromoted tobusinesses– including the factthat it can increase innovation, creativity, productivity, savemoney, and canpromotes staff healthandwellbeing.69Employersneedtoensuretheirworkplacesareinclusiveandsupportiveofpeopleof

64VicHealth&CSIRO(2015).BrightFutures:MegatrendsimpactingthementalwellbeingofyoungVictoriansoverthecoming20years.Melbourne:VictorianHealthPromotionFoundation;Paul&MoserinVicHealth,Data61,CSIRO&MYAN.(2017).65Morsy2012,McKee-Ryanetal.2005,Kieselbach2000,Philipetal.2015citedinVicHealth&CSIRO(2015).BrightFutures:MegatrendsimpactingthementalwellbeingofyoungVictoriansoverthecoming20years.Melbourne:VictorianHealthPromotionFoundation.66Derousetal.inVicHealth,Data61,CSIRO&MYAN.(2017);Beadle,S.(2014),FacilitatingtheTransitiontoEmploymentforRefugeeYoungPeople.Carlton:CentreforMulticulturalYouth(CMY).67Kellock.(2016).TheMissingLink?Youngpeoplefrommigrantandrefugeebackgrounds,socialcapitalandthetransitiontoemployment.Carlton:CentreforMulticulturalYouth(CMY).68WHO.(2017).MentalHealthIntheWorkplace,https://www.who.int/mental_health/in_the_workplace/en/69VicHealth.(2013).Howculturaldiversitycanbegoodforbusiness,Carlton:VicHealth.

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allagesandculturalbackgrounds.70Governmenthaveanimportantroleinsupportingthistobecomeareality.

Stronger partnerships between government, services, employers and communities are needed tobettersupportyoungpeoplefrommigrantandrefugeebackgrounds’abilitytosuccessfullytransitiontomeaningfulwork.

CMYwelcomes approaches such as the VictorianGovernment’s JVEN focus on young people fromAfrican and Pasifika backgrounds. This partnershipmodel draws on the respective strengths of theagencies involvedwithmulticulturalorganisations(inthiscaseCMY)actingascommunityengagers,CMY’strustedrelationshipsinthecommunitymeansworkerscanidentifyandreferyoungpeopletotheprogram.JVENpartnersestablishrelationshipsandpathwayswithindustryandemployers,linkingyoung people with employment opportunities. Both partners then work together to support theyoungpersontoremainengagedintheprogram.Thismodelcouldbereplicatedinthementalhealthsystem,leveragingtheparticularexpertiseofrelevantcommunityorganisations(includingsettlement,multiculturalandyouthorganisations),mentalhealthservicesworkinginpartnershipscouldachieveimprovedoutcomesforyoungpeoplefromrefugeeandmigrantbackgrounds.

2.7. Addressingtheneedsoffamilymembersandcarers

Intergenerational conflict is a common issue young people frommigrant and refugee backgroundsface, intermsoftheconflictingexpectationsthatcanarisewhennavigatingthespacebetweentwocultures.YoungpeoplearequicktoadaptandtheprocessofacculturationinAustraliaisoftenmuchfaster than the experience of their parents. Parents and guardians can often lack the resourcesneededtosupporttheiryoungpeopleinthecontextofAustralia,includingalackofinformationandawareness about the range of supports available to help them address these common challenges.Strengtheningyoungpeople’s connection to family isa criticalprotective factor,promotinghealthysupportiverelationships,andastrongsenseofculturalidentity.

CMY’s consultations emphasised once again that intergenerational relationships are key to youngpeople’s mental health and wellbeing, and yet in many families from migrant and refugeebackgrounds,thesecanbeunderstrain.Familiesneedculturallyappropriatesupportandinformationon how to address parenting challenges (particularly those associated with adolescents) in a newcountry often without extended family members to support and guide them. Support for familiescould include information about expectations and misconceptions for young people and parents/guardians, the types of issues that may naturally be a source of conflict during settlement andacculturation,andthat it isokaytoseekhelp.Empoweringfamilieswithknowledge, inasupportiveenvironment, should alleviate rather than exacerbate some of the insecurities and anxietiesexperiencedinsettlement.71Thisisnotonlyfornewlyarrivedcommunities,butthosethatmayhavebeeninAustraliaforsometime.

70WHO(2017).71CMY(2011).GoodPracticeGuide:YouthWorkintheFamilyContext.Carlton:CentreforMulticulturalYouth(CMY).

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“Theproblemisthattheparentsdon’thearthem…Someparentsjustwanttogetthembacktochurch.”–biculturalyouthworker

Despite this,manyservicescontinuetowork fromaWesternparadigmthatrespondstotheyoungpersonasan individual, rather thanunderstandthecollectivistcultures fromwhichtheymaycomefrom. Family and elders often play a critical role in the lives of young people, andworking from afamily centred perspective is extremely important. Not only that, but proactively engaging parentsaround parenting adolescents in the Australian context, including supports that are available, iscritical intermsofpreventingfamilyconflictandbreakdown,whichcontributestomental ill-health.Schoolscanplayan importantrole in facilitatingcontactwith familymembers.Thecommunityhubmodel used to engage mothers from migrant and refugee backgrounds in health, education andtrainingisonethatcouldbebuiltupontoestablishstrongerrelationshipswithfamiliesandincreasetheiraccesstoavailablesupport.

Theimpactofparent/guardianmentalhealth

Coherent with this family focussed approach, it is also evident that young people’s wellbeing isdirectly impacted by themental health of their parent’s or carers. CMY’s experience is that youngpeoplefrommigrantandrefugeebackgroundscanbeparticularlyvulnerabletopoormentalhealthasaresultoftheirparent’s/guardian’smentalill-health,whichcanbeexacerbatedbypre-arrivaltraumaor stress related to settlement. There is a strongneed towork holisticallywith families and youngpeoplearoundmentalhealthandwellbeing–tocreatemodelsthatcanworkwithcaregivers,youngpeopleandcommunity/religiousleaderstopromotementalwellbeing.Supportingthementalhealthof caregivers from migrant and refugee backgrounds is a critical factor to protecting the mentalwellbeingoftheyoungpeopleintheircare.

“Weseeyoungpeoplewheretheirstressisduetotheirparents’stress.Weknewayoungmanwhowastryingtohurthimselfatschool.Hisparentshadbeenkickedoutoftheirhomeanditwasverystressfulforthem.Nowthehousingissorted,he’shappyas,he’sgoinggreat.Thosethings are stable now, housing, dad’s work – now he can just worry about school.” –multiculturalyouthworker

Recommendationsforprevention

2.1.1 Continuetosupportinitiativesthatareaccessibleandpromotementalhealthandwellbeingamongyoungpeoplefrommigrantandrefugeebackgrounds,suchassport,recreation,arts,youth supportand leadershipdevelopment– that strengthenyoungpeople’s social capital,abilitytoaccesssupport,andincreaseasenseofbelonging.

2.2.1 Thattoaddressstigmaandpromoteaccesstomentalhealthsupportrequiresmentalhealthliteracy incommunities frommigrantandrefugeebackgrounds,aspartofabroaderhealthliteracystrategy.Suchanapproachshould:

a) Useaco-design,partnershipandtailoredapproachtoworkwithmigrantandrefugeecommunities to improve mental health literacy (including partnering withcommunity/faith leaders, bicultural youth/community workers, parents and youngpeople). This could include exploring opportunities to develop culturally relevant,

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mentalhealthearlyinterventionprogramswithparentsandcaregiversfrommigrantandrefugeebackgrounds,tosupportthewellbeingoftheyoungpeopleintheircare;

b) Incorporate a strengths-based, transcultural mental health lens that explores andintegratesthestrengthsofvariousculturesandreligious/spiritualviews;

c) Be funded recurrently to allow for long-termmental health literacy education anddialogue;

d) Invest inculturallyrelevantpeereducationandsupportprograms, includingtheuseofculturallyrelevantmentorsandrolemodels.

2.2.2 Resource (and/or require mental health services to resource) youth-led and peer-to-peerinitiativesbyyoungpeople frommigrantand refugeebackground thatcreateopportunitiesforpromotingsocialinclusionandaddressingracismanddiscrimination.

2.2.3 Look for opportunities to develop or align social cohesion and anti-racism strategies thatincludementalhealthandwellbeingapproaches.

2.3.1 Resourcetargetedandculturallyrelevantyouthwork interventionswithyoungpeoplefrommigrant and refugee backgrounds identified as ‘falling through the gaps’ (for example, LeManaandCSG).

2.4.1 Invest in culturally driven, youth-focussed community development approaches (such asCommunity SupportGroups or the CMY LeMana Project) that can engage holisticallywithyoungpeople, familiesandcommunity leaders frommigrantandrefugeebackgrounds,andcanactasapointofcoordinationforservicesandgovernment.Suchapproachesshouldbefunded for aminimumof 2-3 years, to allow for effective trust, engagement, coordinationandresponsestocommunity-identifiedneeds.

2.6.1 Look for opportunities to replicate successful models of cross-sector partnerships thatsupport the social and economic wellbeing of young people from refugee and migrantbackgrounds,suchastheJVENAfricanandPasifikayouthprogram.

2.7.1 Resource programs thatworkwith parents frommigrant and refugee backgrounds aroundparenting adolescents in the Australian context, understanding education and employmentpathways;andthatsupporttheirownmentalhealthandwellbeing.

2.7.2 Invest in co-designed and community-led programs that strengthen intergenerationaldialogueamongstmigrantandrefugeecommunities.

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3. Earlyinterventionandpromotingaccess

3.1. A‘wholeofcommunity’approach:Workingwithyoungpeople,familiesandcommunity

Communityengagementiscriticaltoaneffectivementalhealthservicesystem.Developingresponsesthat are timely, effective and successful requires a system that is capable of engaging with andlearning from the community.A key issue repeatedly identifiedby youngpeople from refugeeandmigrant backgrounds is the challenges they face engaging with a service system that doesn’tunderstand and respond to their needs. Young people continually tell us that they want moremeaningful participation and engagement, not consultation that tends towards tokenism, but realopportunitiestoinfluencedecisionmakingandinformhowservicesforthemareplannedfor,funded,designed, delivered and evaluated. For young people from a refugee and migrant background amental health service system that works well would adopt a ‘whole of community’ approach thatactively engageswith young people from refugee andmigrant backgrounds, and their parents andcommunities, as partners to identify needs and co-design, implement and evaluate targeted,culturallyrelevantsolutions.

Guidelines and good practice approaches for supporting meaningful participation and partnershipalreadyexist.Thementalhealthservicesystemneedstoexplorehowthesewouldbestfitatdifferentlevelsofthesystemandworkwithyoungpeoplefromrefugeeandmigrantbackgroundstodevelopmodelsfortheirongoing,meaningfulparticipation.

Examplesofexistingguidelinesandgoodpracticeinclude:

• Not “Just Ticking A Box”: Youth participationwith young people from refugee andmigrantBackgrounds(MYAN2018):“Youthparticipationisaboutdevelopingpartnershipswithyoungpeoplesothattheymaytakeavaluedpositionandrolewithinourcommunityandareabletobeactively involved inthedecisionmakingprocessesthataffectthem.”72Meaningfulyouthparticipation requires investment in individuals, organisations and systems to ensure thenecessaryknowledgeandstructuresare inplacetobuildthatcapacityofyoungpeopleandprovidetheopportunitiesforthemtoparticipate.73

• Inclusiveorganisations:Aguidetogoodpracticestrategies forengagingyoungpeople frommigrantand refugeebackgrounds in servicesandprograms (CMY2016):Building theyouthmentalhealthsectors’abilitytoengageandworkeffectivelywithyoungpeoplefrommigrantand refugee backgrounds requires going beyond notions of ‘cultural competency’ as a skillheld by an individual worker to adopting a whole of organisational approach, includingpolicies,systems,personnelandpracticecompetence.Understandingtheneedsandinterestsofyourcommunityrequiresworkingwiththem–thismeanspartnershipwithyoungpeoplefromrefugeeandmigrantbackgrounds,andtheirfamiliesandcommunities,isessential.74

72AYACcitedinMYAN.(2018).Not“JustTickingABox”:YouthparticipationwithyoungpeoplefromrefugeeandmigrantBackgrounds.Retrievedfromhttps://myan.org.au/wp-content/uploads/2018/11/youthparticipationfinalinteractive.pdf,p.773MYAN,(2018).74CMY.(2016).InclusiveOrganisations:Aguidetogoodpracticestrategiesforengagingyoungpeoplefrommigrantandrefugeebackgroundsinservicesandprograms,Carlton,CMY.Retrievedfromhttps://www.cmy.net.au/publications/inclusive-organisations

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• PartnershipPracticeGuide(VCOSS2018):Partnershipsacrossserviceorganisationsandwithgovernmentandcommunityarea critical component toeffective service systemresponsesand are necessary when responding to complex social issues such as mental health.Partnershipsallowforbetterandmoretimely identificationof issuesandneeds,moreswiftdevelopmentoftargetedresponsesandforgoodpracticetobeshared.75

• Cultural Responsiveness framework: Guidelines for Victorian health services (VictorianGovernment (Department of Health) 2009): The empowerment of supported communitiesand their inclusion in theirowndevelopment isa central tenetof communitydevelopmentwork.76 This idea has been drawn upon to inform the concept of ‘consumer participation’within health services, with participation in health recognised as “an essential principle ofhealthdevelopment,clinicalgovernance,communitycapacitybuildingandthedevelopmentofsocialcapital”.77‘CALD’consumerparticipationisoutlinedunderDomain3(withStandard5 specifically outlining community participation as an ongoing element of program andservice planning, improvement and review) and refers to the various activities that involveactiveconsumerinvolvementacrossthelevelsoftheVictorianhealthsystem.78

• DHHS Cultural Diversity Plan 2016-19 (Victorian Government (Department of Health andHuman Services) 2009): Cultural responsiveness at the organisational level: Organisationpolicies,structuresandprocessesthatpromotepartnershipandpartnership:Equallyvaluabletoamentalhealthservicesystemthatworkswellarethepresenceofstructuresandsystemsthatpromoteand value cultural diversity.Anexample is theelevationof partnershipswithdiverse communities to a priority area (Objective 10). Additionally, this plan builds in, at asystem level, recognition of cultural competency as an ongoing process of learning andimprovementthattranscendstheskillsofanindividualworkerbyrequiring“frameworksandprocesses thatenableculturallyand linguisticallydiverseclients,carersandcommunities toengageandparticipateinserviceplanning,designanddelivery”.79

• Collective impact approach: The value of this approach as an effective tool for addressingcomplex social problems in the area of mental health has been recognised within theVictorian suicide prevention framework 2016-2025. This approach centres the experiencesand knowledge of those people who are the target of policy and services as experts anddrawsthemintotheprocessof identifying issuesanddesigningsolutions. Italsorecognises

75VCOSS.(2018).PartnershipsPracticeGuide.Retrievedfromhttps://vcoss.org.au/resources/vcoss-partnership-practice-guide/76Couch,J.&Francis,S.(2006).ParticipationforAll?SearchingforMarginalizedVoices:TheCaseforIncludingRefugeeYoungPeople,Children,YouthandEnvironments16(2):272-290.Retrievedfromhttp://www.colorado.edu/journals/cye.77VictorianGovernment(DepartmentofHealth).(2009).CulturalResponsivenessframework:GuidelinesforVictorianhealthservices.Retrievedfromhttps://www2.health.vic.gov.au/about/participation-and-communication/consumer-participation/participation-policy,p.27378KPMGfortheVictorianGovernment(DepartmentofHealth).(2014).Doingitwithusnotforus,DiscussionPaper.Retrievedfromhttps://www2.health.vic.gov.au/about/participation-and-communication/consumer-participation/summative-evaluation-of-participation-policy,p.7.79VictorianGovernment(DepartmentofHealthandHumanServices).(2009).DHHSCulturalDiversityPlan2016-19.Retrievedfromhttps://www2.health.vic.gov.au/about/publications/policiesandguidelines/dhhs-delivering-for-diversity-cultural-diversity-plan-2016-19,P.20

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theneedtobringallstakeholderstogethertomapouttheissuesanddesignnewsolutions.80

A ‘whole of community’ approach seeks to engage with the community, as well as with relevantservicesandorganisationsandalllevelsofgovernment.Thisapproachtakespartnershipsasessential.Throughoutthissubmission,wehaveidentifiedcasestudiesandopportunitiesforgreaterpartnershipandengagementwithyoungpeople fromrefugeeandmigrantbackgrounds,and their familiesandcommunities, to improve their access to and engagementwithmental health services, andmentalhealthandwellbeingoutcomes.

3.2. Culturallyrelevant,youthmentalhealthservices

There is significantwork tobedone to strengthenaccessandensure that theyouthmentalhealthsystem is a safe, trusted and culturally relevant place for young people frommigrant and refugeebackgrounds to seek support. Strategies needed include work within migrant and refugeecommunities to reduce stigma and increase mental health literacy, as well as a more culturallyresponsivementalhealthsystem.Thiswasemphasisedthroughoutrecentconsultationswithyoungpeople from migrant and refugee backgrounds on the issue of mental health, who identified keybarrierstoaccessingmentalhealthsupportbeingdueto:

• stigma,shame,intergenerationalconflictaswellasfearofburdeningparents/family;and• racism,lackofculturalresponsivenessandnegativeexperienceswhenvisitingmentalhealth

services.

Mentalhealthservicesneedtoadoptanactive,communityengagementmodelthatisbothyouthandculturally relevant, particularly for early intervention services such as headspace. Valibhoy, et al.’sresearch amongst young people of refugee backgrounds in Melbourne highlights the need forculturallyrelevantyouthmentalhealthservicesthatare:

• well-located• accessible• flexible• adequatelytrainedandresourced;and• ‘nowrongdoors’fornewclients.81

Youth mental health services need to be more flexible and adaptable, and adopt youth-centred,culturally relevant ways of engaging with young people from refugee and migrant backgrounds.Outreachmodelsthat‘gotowhereyoungpeopleare’(suchasschoolsorco-locationinmigrantyouthservices)arecritical,asareapproachesthatuserecreationalactivityasapointofengagementratherthanexpectingyoungpeopletoattendsettingsthatareoverlyclinicalorformal.82Giventhecentrality

80VictorianGovernment(DepartmentofHealth&HumanServices).(2016).Victoriansuicidepreventionframework2016-2025.Retrievedfromhttps://www2.health.vic.gov.au/about/publications/policiesandguidelines/victorian-suicide-prevention-framework-2016-2025.Formoreonthisapproachseehttps://collaborationforimpact.com.81Valibhoy,etal.,(2017),p.24.82Ibid.

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oftrustandrelationshipbuildingaskeytoimprovingaccess,youthmentalhealthservicesmustworkclosely with services or groups that have well-established relationships with young people frommigrantandrefugeecommunities.

“Weneed(cultural)mentorsoutthere,tosupporttheyoungpeople,becauseit’ssotaboointhecommunity.”–multiculturalyouthworker

Religiousleaders,faithhealersorcommunityleadersareoftenthepeoplefamiliesfrommigrantandrefugeebackgroundsturntoforsupport,ratherthantheservicesystem.83Theseleadersthenareacriticallinkbetweenfamilies,communitiesandtheservicestryingtoimprovementalhealthandwell-being.”84Thereisaneedtointegrateanapproachtomentalhealththatbuildsuponthestrengthsofvariousculturalandreligious/spiritualworldviews.

Partnerships between organisations that work with young people from migrant and refugeebackgrounds,andyouthmentalhealthservicesareintegral.Agapoftenexistsbetweenservicesthatwork more broadly with young people from migrant and refugee backgrounds around issues ofsettlement,supportandwellbeing,andtheyouthmentalhealthspace.Multiculturalyouthworkersmaynotfeelequippedtodealwithmorecomplexmentalhealthissues,yettheyareoftentheonesthatyoungpeopledisclose togiven theirestablished relationship.At thesametime, thoseworkingwith young people from refugee and migrant backgrounds can struggle to get referrals to youthmentalhealthprovidersto‘stick’.

“ServiceshaveKPIsand things theyhave todo,but froma cultural view thatdoesn’tmeanmuch. If you don’t have a relationship with the young person they’re not interested” –multiculturalyouthworker

Forthosethatdoreachoutforhelp,feedbackfrommulticulturalyouthworkerssuggestthatoverthephoneassessmentsareinadequateformanyyoungpeople.Intakeprocessesarefailingtodetecttherisk these young people face. Greater resources are required to allow for face-to-face trust and

83DeSilva,S.&Santhanam-Martin,R.(2013).CulturesintheKnow:EnablingMultifaithCommunitiestoimproveMentalWell-Being.ADEC&VTPU.84Ibid.

CaseStudy5–ATransculturalApproachtoMentalHealth

The TeWhareMarie SpecialistMāoriMentalHealth Service in Porirua,NewZealand, is a serviceproviding mainstreammental health services to the Maori community complemented by Māoriculturalconceptsandpathwaysofhealth.ThemodelblendsWesternmentalhealthparadigmsandmodels of care withMaori spiritual and cultural knowledge. In practice,mental health cliniciansworkalongsideculturaltherapists–ortohunga–inanapproachwhereeachbodyofknowledgeisvaluedequally,allowingforbothclinicalandculturalperspectivestodiagnosisandcare.This isanapproach that is “about giving the options to the person and allowing the person to decide andmaketheirowndecisiontogetwell.”WiremuNiaNia,Tohunga,TeWhareMarie.

For more see, Te Moananui (2018)Under the Korowai: a look at Maori mental health practice.Availablefromhttps://www.youtube.com/watch?v=odo_-Vh2-fI&feature=youtu.be&t=8

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rapportbuildingaspartoftheassessmentprocess.Similarly,thelengthofwaittimeisofconcern–andcommunitymembersofyouthworkersareleftcarryingtheburdenofsupportwhilstwaitingfortheyoungpersontoreceiveprofessionalhelp.

“I’vegotabout sixyoungpeople I supportwhoareon thewaiting list forheadspace.Whentheygetassessedonthephone,theyoungpersonsays‘yes,yesI’mokay’sotheyareputtoback of thewaiting list, because they don’t trust the person. But they are not okay… They[headspace]needtositwiththemandreadtheirbodylanguage.I’mtryingtoworkwiththeheadspace staff as to how to get the real response from the young people. Questions like“when is the last time you had an anxiety attack?” doesn’t always translate for our youngpeople… Three weeks wait for headspace is too long” – bicultural youth worker

“The initial engagement and assessment tool needs to change. It’smore aboutmaking theconnection around initiating that relationship, than an assessment tool like ticking a box…Mentalhealthcaseworkerssayourcaseloadsaresohigh–it’saboutresourcingofthesector”–biculturalyouthworker

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CaseStudy6–Servicecollaboration(headspaceHobartandMulticulturalYouthTasmania)

Multicultural Youth Tasmania (MYT) program of Migrant Resource Centre Tasmania providestargeted services and projects to support young people up to 25 years from multiculturalbackgrounds to reach their full potential to thrive as active citizens of theTasmaniancommunity.MYT works withmainstream services through its partnerships withMYAN to build their capacityworkwithyoungpeoplewhoaresettlinginHobart.

Uponseeinganeedandlimitedaccessofyoungpeopletomainstreammentalhealthservices,MYTreachedouttoheadspacetodiscuss improvingreferralpathways formulticulturalyouth intotheirservice. This was the beginning close collaboration betweenMYT as the onlymulticultural youthspecificserviceinTasmaniaandheadspaceHobart.MYTteamandheadspacestaffstartedworkingtogether to try and deliver culturally competent mental health services within headspace formulticulturalyoungpeople.

This included project collaboration of youth health and information workshops, and site tours toheadspace for MYT clients. headspace increasingly acknowledged that they did not have strongengagement with multicultural youth in their service. Clinicians from headspace also reportedsometimes feeling under skilled oroutofdepthdeliveringclinical interventions to thiscohortandheadspaceHobartmanagementidentifiedthatmoretrainingwasrequired.Duetoalreadyexistingrelationship,headspaceHobartapproachedMYT forthistraining. InApril2018,MYTdeliveredtheNationalYouthSettlementFramework(NYSF)trainingtoheadspaceHobart.Aspartofthisongoingcollaboration, MYT continued to engage headspace in implementation of NYSF good practicecapabilities and the two organisations maintained the relationship at different levels, frommanagementtofront-lineworkers.

Collaborationsuccesses:

• headspace reported increased engagement of young people from migrant/refugeebackgrounds–numbersofyoungpeoplefromthiscohortaccessingheadspacetripledintheyeartheycollaboratedwithMYT.

• Change in young people’s perception – young people reported viewing Headspace as amoresafeandinclusivespacebecauseoftheirrelationshipwithMYT.Whereasinthepast,the referralsmade fromMYT to headspace were bouncing back, young people reportedthat they’re more open to referrals to headspace, as they became familiarized withheadspaceservicesandsawheadspacestaffinMYT.

• SuccessoftheprogramwasduetothecommitmentofbothMYTandheadspacestaff,andwillingness from headspace to accept they needed up-skilling in relation to multiculturalyouthengagement.

• Anongoing approach to collaboration rather than a ‘onceoff’ approach to a professionaldevelopmentsessionwasalsokeytothissuccess.

• MYT and headspace are also exploring models of outreach to continue to increasefamiliarity,trustandengagementwiththeservice.

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Additionally,mentalhealthorganisationsneedtoensuretheyrepresenttheculturaldiversityofthecommunitytheyservice.Organisationsneedtoensuretheyvisuallyreflectadiversityofyoungpeopleintheirpromotionalmaterialandonlinepresence,tohelpcommunicatethattheirserviceisavailablefor all. Young people have consistently informed CMY of the importance of representation infacilitatingaccess–thatis,seeingpeoplewholooklikeyou,reflectedinallaspectsofaservice.Inourconsultations, some young people from migrant or refugee backgrounds conveyed that there issometimesaperception thatmental health services are for ‘whitepeople’, andnot forpeople likethemselves.

Research has identified a number of facilitators to promoting access andworkingmore effectivelywith young people from refugee and migrant backgrounds around mental health issues. Theseinclude:

• Understandingculturaldefinitionsofmentalhealth,illnessandtreatment• Thestyleandapproachofmentalhealthproviders• Serviceaccessibility• Trust• Workingwithinterpreters• Engagingfamilyandcommunity• Advocacy–holisticallyrespondingtoself-identifiedneedsoftheyoungperson;and• Continuityofcare.85

Our consultationswith youngpeople frommigrant and refugeebackgrounds and serviceprovidersadditionallyhighlightedkeyfeaturesofgoodyouthmentalhealthserviceresponses.Theseincludedthosethat:

• werewellconnectedwithmigrantandrefugeecommunitiesandservicesintheirlocalareas• wereoperatinginlocationsyoungpeopleregularlyfrequent(e.g.outreach,co-location)• employedworkersfrommigrant/refugeecommunities• providedwraparoundservicesincollaborationwithotherserviceproviders• includedearlyinterventionasatargetedserviceresponse• activelyworkedtoaddressruralandregionalinequalities.

Similarly,effectivefamilyengagementiscriticaltosupportingthementalhealthofyoungpeoplefrommigrantandrefugeebackgrounds.

Our consultations with young people frommigrant and refugee backgrounds also highlighted thattheyvalue:

• Choicearoundtheculturalbackgroundofmentalhealthprofessional(somewouldliketoseestafffromsimilarbackgrounds;othersdesiretheanonymitythatcomeswithsomeonefromadifferentbackgroundtotheirown);

• Mental health staff to be aware and informed around issues of culture, religion,migrationhistory(e.g.refugeebackground);

85Colucci,etal.(2015).

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• Tobeseenasanindividual(theyoungpersonasexpert intheir life-noassumptionsaboutwhattheirculture,religion,ageormigrationhistorymeanstotheyoungperson);

• Seeing people themselves reflected in the mental health workforce (a culturally diversementalhealthworkforce).

CMYwouldliketoreiteratethefrequentlyvoicedconcernsoftheyoungpeoplewespoketoforthisconsultationthatwhiletheywanttoberecognisedasadiversegroupwithdiverseneedstheydon’twant or need a totally separate or distinct mental health system that further amplifies their‘difference’.Thismeanstheywanttobetreatedasindividualsandnothavetheirculture,religionormigrationpathwaysdeterminehowthesystemrespondstotheirneeds.Instead,theywanttobeabletochoosethetypeofmentalhealthservices theyaccess–whether theseareservicesdeliveredbybicultural workers who work alongside trained mental health professionals, or are culturallycompetent serviceswithin the ‘mainstream’mental health system – because a diversity of qualityservicesareavailable.

3.3. Workingwith‘gatekeepers’

Thesecommunityleadersareourgatekeepers–Pasifikayouthworker

Access tomental health services by children and young people from refugee backgrounds is ofteninfluencedby‘gatewayproviders’whoshapethekindofdecisionstheymakeandhelptheyseekout.For example, Ellis et al. found that “family, religious leaders, friends and schools, apart frombeingprovidersofhelp,arealsoidentifiedasgatewaystohelp”.86ThiswassupportedbyMelbourne-basedresearch,which found that youngpeople from refugeebackgroundswerehighly influencedby theattitudes of family and friends towardsmental health professionals, including at times, their directexperiencesofservices.87

The 2011 federal government’s report on youth suicide prevention highlights the importance ofGatekeepertraining,referringto

“a diverse range of individuals who have regular contact with young people. These peopleinclude family, friends, teachers, youth workers, sports coaches, health professionals, lawenforcement and emergency services personnel… Each of these groups of people play twocriticalroles:toactas‘detectors’andmonitorforearlywarningsignsofyoungpeopleatrisk;and to act as ‘facilitators’ – alerting andmaking appropriate referrals to specialist serviceprovidersasrequired.”88

Forparticulargroupsofyoungpeoplefrommigrantandrefugeebackgrounds,the‘non-professional’gatekeepersplayasignificantrole–suchasfriends,culturalmentors,trustedcommunitymembers,faithorcommunityleaders–giventheymaylacktrustwithmore‘typical’gatekeeperssuchasschoolwelfareworkers. CMY consultations highlighted that some youngpeople donot perceive teachers,schoolwelfareworkersor‘professional’helpservicesassafeplacestoturnincrisis,andarefarmore

86Ellisetal.,inColucci,etal.,(2014),p.98.87Valibhoy,etal.(2017).88TheParliamentoftheCommonwealthofAustralia(2011).

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likely to turn to a friend or trusted person in the community. Educating these ‘non-professional’gatekeepers such as friends, family and trusted community members can be more challenging interms of time, resources and engagement, and requires a proactive strategy that works alongsidecommunities.89

Improving the ability of ‘professional’ gatekeepers to engagewith, detect and assess the need formentalhealth support is alsoextremely important for thewellbeingof youngpeople frommigrantandrefugeebackgrounds.ThereisinternationalevidencethatgatekeepertrainingaimedatGPscanbe very effective in reducing the risk of youth suicide.90 Teachers, schoolwelfare coordinators andGPsforinstanceareimportantpointsofinterfaceforfacilitatingeffectivesupportforyoungpeople,yetCMYsconsultationsindicatethatthesegatekeepersarenotalwaysabletoeffectivelyengagewithorassesswithyoungpeoplefrommigrantandrefugeebackgroundswhomaybeatrisk.

“Theboysfromschools,theydon’tseeksupportfromwellbeingstaff.Thestaffcan’tengagewiththestudents–the languagetheyuse, they’renotsomeonetheywouldgoto.Theboyscan’ttalktotheirparents,don’thaveadultstoturnto.”–biculturalyouthworker

Youngpeopleandfamiliesmaynotknowthelanguagetouseand/orhaven’trecognisedthesignsofmental illness, and this is not always being detected by gatekeepers around them. Exampleswereprovidedofwhereaservicehadworkedalongsideafamilytoencouragethemtoseekhelpfortheirteenage child, but when they attended the GP, their concerns were dismissed. Similarly, youthworkersgaveexamplesofafamilytakingtheirchildtotheGPwhohadmentalhealthconcerns,butthefamilydescribedphysicalsymptomsratherthanusingthelanguageofmentalhealth.TheGPdidnotdetectthementalhealthissuespresentandnomentalhealthplanwasprovided.Concernshavebeen raised around the wording of screening questions used by GPs and whether this would beunderstoodbyyoungpeopleandparents.Theissueof10rebatedsessionsperyearbeinginsufficientisalsoaconcernsomeyouthworkersraised.

Given that someyoungpeopleare reluctant toseekhelp fromteachers, schoolwelfareworkersorGPs-keypointsofreferraltotheyouthmentalhealthservicesystem–itisimportanttoalsoinvestinother culturally relevant and community-based responses where we build on the existing trustingrelationships that young people have. Specialist multicultural youth workers, peers, trustedcommunity members, and multicultural/bicultural youth workers are key points of referral andsupport.

However, community responses need adequate support, training and resourcing. Bicultural youthworkers spoke of receiving calls at all hours of the day or night, sometimes from interstate, fromyoungpeople fromtheirculturalcommunitieswhowereneedinghelpwithmentalhealthconcerns(sometimeswhowereunknowntothem).Similarly,theyspokeofvolunteerswithinthecommunitywho runcasemanagementoutofhours for free formembersof their community.However, therewerequestions aroundwhat kindof support and training these volunteers receive, to ensure suchresponsesareeffective,sustainableanddon’tresultinburnout.

89TheParliamentoftheCommonwealthofAustralia(2011).90TheParliamentoftheCommonwealthofAustralia(2011).

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“We come and pick the young person up after hours, provide that supported referral,we’lltakeyou–otherwisetheyjustwon’tgo.IgotacallfromSydneyandIsaid‘Ican’tgettoyou,haveyougotsomeoneelsewhocancomeandgettoyouandhelp’”–biculturalyouthworker

Atthemoment,biculturalyouthcommunitydevelopmentinitiatives(suchasCMY’sLeManaandCSGprograms) are doingmuch of this important early interventionwork amongst young people in thecommunity,fillinggapsintheservicesystembetweenyoungpeople, ‘professionalgatekeepers’andthementalhealthservicesystem.

InCMY’sexperience,placingspecialistmulticulturalyouthworkersinschoolsthathavehighnumbersofyoungpeople fromrefugeebackgrounds isaneffectivewayofbuilding trustandmeetingyoungpeople’ssupportneeds.Additionally,youngpeoplecontinually informusthatpeersareakeyplacethey seek support – so investing in culturally relevant peer education and support is an area thatshouldreceivefurtherattention.

3.4. Mentalhealthworkforcedevelopment

Biculturalmentalhealthworkersareimportantresourcesinthementalhealthservicesystem.Theserolesarecriticalin‘brokering’–thatis,buildingtrustandhelpingyoungpeopleandfamiliesnavigatemental health services, and helping services more adequately respond to these communities.Biculturalliaisonroleshaveahistoryofeffectivenessinpromotingaccessandbuildingtrustbetweenmigrantandrefugeecommunitiesandservices.Similarly,designatedrolesthatfocusonengagementwithmigrantandrefugeecommunitiesareimportantinbuildingmentalhealthliteracyandreducingstigma.

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Additionally,thereistheneedtoencourageandpromotementalhealthcareerpathwaysforpeopleofmigrant and refugeebackground to ensure there is greater representationwithinmental healthservicesandencourageaccess.

“Itissohardtogetouryoungpeoplethroughthedoor.Ifwehearofbiculturalworkersaroundweletourcommunityknow,especially iftheyspeakthelanguageit isevenbetter.Wejustdon’thavetheworkerscomingthrough,intermsofpsychologists,counsellors.WehavethembackinNewZealand,butnothere. It’saboutworkingwiththewholefamily,culturallythat’showthingswork–buildingthattrustfromthegetgo–andthattakestime”–biculturalyouthworker

Providing scholarship or incentive programs that target individuals from particular communities orlanguagegroups,withtheaimofincreasingthepoolofbi-culturalmentalhealthprofessionals,couldbeonewayofexpandingtheculturaldiversityofthementalhealthworkforce.

CaseStudy7:MulticulturalMentalHealthandWellbeingWorker

DiversitatGeelonghasadedicatedMulticulturalMentalHealth&WellbeingWorkerfundedbytheDepartment of Health. The role has two main areas of focus, one is delivering mental healtheducation to newarrival communities to the Geelong area and the second is providing culturalcompetencyandsecondaryconsultationtomentalhealthservicesinGeelong.

Theroleisabletooutreachtogroupsofnewlyarrivedyoungpeople,includingparentsgroups,toeducate and reduce stigma aroundmental health – including working in partnership with localmentalhealthproviders.Oftensettlementandyouthworkersdon’thavethetimeandresourcesto develop explicit partnerships and relationshipswith all of the programs and services offeringmental health and wellbeing programs thatmay be of relevance. A role such as this is able tomake theseconnections for services, linkingnewarrival communities in to important,andoftentypicallyunderutilised,servicesinthisarea.

Keyfactorscontributingtothesuccessofthisroleinclude:

• Statusincommunityasatrustedorganisation:Thetrustedpositiontheorganisationholdswithcommunitiesmeanstheworkerisabletoleveragethistrusttoengagemorereadilywithcommunitiesonatopicthatmaybetypicallyquitechallenging.Thiscanalsoassistinthe facilitation of referrals, with the trust often transferring to other organisations andservices introduced by the working - facilitatingmore timely and smooth referrals intootherservices.

• Dedicated programs, teams and workers: The process of establishing partnerships tosupportnewcommunitiestoaccessandengagewithlocalservicesandsupportsisgreatlyenabledbytheexistenceofdedicatedprograms,teamsandworkerswhounderstandtheparticular needs and interested of community members with refugee and migrantbackgrounds.Again,thismeansthatpathwaysandlinkagesaremorereadilyopenedupasthere is shared understanding and awareness of the community needs and an existingcommitmenttoworkingtoaddressthese.

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Recommendationsforearlyinterventionandpromotingaccess

3.1.1 Resource working and learning partnerships between youth mental health providers,multiculturalyouthworkers,refugeementalhealthspecialistsandeducationwelfarestafftobettermeettheneedsofyoungpeoplefrommigrantandrefugeebackgrounds.

3.1.2 Resource(and/orrequirementalhealthservicestoresource)culturallyrelevant,co-designedpeereducationandsupportmodelsaroundmentalhealth.

3.2.1 Resourceinitiativesthatdrawontheexpertiseofthemulticulturalyouthsectortobuildtheyouthmentalhealthsectors’ability toengageandworkeffectivelywithyoungpeople frommigrant and refugee backgrounds. This goes beyond notions of ‘cultural competency’ andrequires a whole of organisational approach, including policies, systems, personnel andpractice.This includesbuilding inaccountabilitymechanismstofundingthatrequirementalhealthservicesensureservicesareaccessible(e.g.useofinterpreters).

3.3.1 Buildtheabilityofbothprofessionalandnon-professionalgatekeeperstoengage,assessandrespondtothementalhealthneedsofyoungpeoplefrommigrantandrefugeebackgrounds.

3.4.1 Build on thework of organisations like CMY to develop a best practice framework aroundmentalhealthearlyinterventionforyoungpeoplefrommigrantandrefugeebackgrounds.

3.4.2 Resourcebicultural/multicultural liaisonroles inyouthmentalhealthandcommunityhealthservices,whichcanplayacommunityengagementandbrokeringrole.

3.4.3 Provide scholarships and incentive programs to recruit mental health professionals fromdiverseculturalandlinguisticbackgrounds(ashasbeendoneamongstATSIcommunities).

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4. Focusissues

4.1. Addressingyouthsuicide

Suicide isagrowingpublichealthconcern inAustralia,withratesofsuicide increasingover the lasttwodecades.91Particulargroupsofyoungpeopleinsocietyareconsideredtobeatagreaterriskofsuicide.Youngpeoplefrommigrantandrefugeebackgroundsareonesuchgroup.92Despitebeingatgreater risk, there is a “paucity of data on suicide in culturally and linguistically diverse (CALD)populations”.93Evenwithsuchgapsinofficialdata,CMYisawareofanincreaseinsuicideandsuicideattempts by young people from migrant and refugee backgrounds in Victoria. There are certaincommunitiesCMYisawareofwhoarereportingthatthisisofgrowingconcern.

Theimpactofayoungpersontakingtheirlifehasfar-reachingeffectsinthecommunitiesofconcern,including negatively affectingmentalwellbeing, or triggering self-harmor suicide ideation amongstotheryoungpeoplefromwithinthosecommunities.Familiesandcommunitymembersareoftenataloss as to how to respond. At times warning signs may have been missed because of a lack ofunderstandingandawarenessofhowmentalhealthissuesmaypresent;otheraccountsindicatethatpeoplemayhavehadconcerns,yetwereunsureofwheretoseekhelporhowtorespond.

Despitebeingatgreaterriskofyouthsuicidetherearefewexamplesoftargeted,culturallyrelevantyouth suicide strategies for young Victorian’s from refugee and migrant backgrounds – with thenotablerecentexceptionofaresponsethatwasinitiatedonceyouthsuicidehadreachedcrisispoint(seeCase Studybelow).Victoria’smentalhealth service system requires an immediate investment,from early intervention to crisis response, to address the particular needs of young people fromrefugee and migrant backgrounds in regards to youth suicide. This work must adopt both apartnershipsapproach,thatengagesyoungpeople,familiesandcommunities,andmustbetargeted,locally-basedandculturallyrelevant.

91SuicidePreventionAustralia(2019),p.392TheParliamentoftheCommonwealthofAustralia(2011),p.21.Itshouldbenotedthatthisisbasedonresearchusingdatafromtheperiod1979–1994–seeDiversityHealthInstitute(2010),SubmissiontotheStandingCommitteeonHealthandAgeing(No12),p1,availablefromhttps://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=haa/./youthsuicide/subs.htm93TheParliamentoftheCommonwealthofAustralia,2011.,2.10,p.10

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Crisis responses are important for supporting community and youth workers, and other non-professionals (e.g. faith leaders, friends and family members), who are often the first responderswhenyoungpeoplefromrefugeeandmigrantbackgrounds,ortheirfamiliesandcommunities,areincrisis.

“Peoplearegettingcallsat3inthemorningre:kidsjumpingoffthebridge…ourcommunityleadersarepickingupthepieces.”–biculturalyouthworker

Whilethecapacitytorespondtoacommunityincrisisisanimportantelementofaneffectiveservicesystem,aswehaveoutlinedabove(see3.Earlyinterventionandpromotingaccess)muchmoreneedstobedoneearlier tobuild thecapacityofpeopleyoungpeople turn to in timesofneed toensuretheyhavetheskillsandresourcestorespondandprovideappropriatesupport,andtopreventyoungpeoplereachingcrisispoint.94

CMYstronglysupports theVictorianGovernment’scommitmenttosuicideprevention,expressed inthe Victorian suicide prevention framework 2016-2025, particularly objective 5 – helping localcommunitiespreventsuicide.95Locallybasedsolutionsarecriticallyimportanttoensuringresponsesaretargetedtomeetthediverseneedsofcommunities.CMYisalsoencouragedbytheGovernment’scommitmentto“developingculturallyappropriateandsafesuicidepreventionapproaches”,howeverwould like to see greater proactive efforts to work alongside migrant and refugee communities(including young people and families) to co-design culturally appropriate early intervention youthsuicideinitiatives.96

Whilemore research and data are needed to understand the particular risk and protective factorslinkedtosuicidalbehaviours for refugeeandmigrantyoungpeople,wedoknowthat lowersuicideriskisassociatedwithstrongconnectiontofamily,religionandtraditionalvalues.97Thishighlightsthe

94Thisincludestheadoptionofanapproachwithinyouthsuicidestrategiesthatissensitiveto“earlyresponsestoconcerns”from‘atrisk’communities.Objective2-VictorianGovernment(DepartmentofHealth&HumanServices)(2016),p.695VictorianGovernment(DepartmentofHealth&HumanServices)(2016).96VictorianGovernment(DepartmentofHealth&HumanServices)(2016).97Burvill,Armstrong&Carlson,1983;Kliewer,1991;McDonald&Steel,1997;Morrell,Taylor,Slaytor&Ford,1999citedinMentalHealthinMulticulturalAustralia,(2014),FrameworkforMentalHealthinMulticulturalAustralia:IntroductoryGuide.MtGravatt,MHiMA.

CaseStudy8:YouthmentalhealthfirstaidwiththeMelbourneSouthSudanesecommunity

In response to a high number of recent youth suicides in the South Sudanese community inMelbourne,theVictoriangovernmentisworkingalongsidecommunityrepresentativestobuildthemental health capacity of both bicultural youthworkers and community volunteers (both youth,religiousandcommunityleadersfromSouthSudanesebackgrounds).Thisincludesofferingtrainingsuch as Suicide Assist (suicide interventionmodel) and ‘SafeTALK’ (suicide alert helper training).There is a significant need for these kinds of tailored interventions in other communities frommigrant and refugeebackgrounds – in partnershipwith youth and community leaders. However,suchinitiativesshouldbepreventativeratherthanwaitinguntilcrisispoint.

Whilethisisanimportantinvestmenttomeettheneedsofacommunityincrises,CMYwouldliketoseegreaterinvestmentinearlyinterventionapproachesthataddresstheneedsofyoungpeople,theirfamiliesandcommunities,beforetheyreachcrisis.

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importance of strengthening young people’s relationshipswith family and culture,which formanyyoungpeoplemayincludespiritualityorreligion,asacentralelementtoyouthsuicidestrategieswithrefugeeandmigrantcommunities.

TheParliamentof theCommonwealthofAustralia’s reportonearly interventionandpreventionofyouth suicide outlines the need for indicated (individual), selective (group) and universalinterventions.98CMYsupportsthisapproach,andwouldadvocatethatindicativeapproaches(suchasworkingwith young people identified as ‘at risk’ and supporting friends, family and community tosupport them) are critically important. Also important is a universal approach that promotes socialandemotionalwellbeingofyoungpeople(includingsocialandeconomicinclusionandfreedomfromracismanddiscrimination).

However,aselective interventionapproach (targetedspecifically toyoungpeopleandcommunitiesfrommigrant and refugeebackgrounds, tailored to particular cultural groups) is especially needed.“Selective intervention programsmust be tailored to the particular group in question, in order toreflectagroup’sattitudesandbeliefsaboutsuicide,mentalhealthandwellbeing”.99Thisapproachissupport by Suicide Prevention Australia who has called for the development of a National SuicidePrevention Plan that “recognise(s) the importance of customised broad based (biopsychosocial)strategiesforPriorityPopulationgroups”inAustralia’ssuicidepreventionstrategy.100

Selectiveearlyinterventionwithrefugeeandmigrantyoungpeoplewouldworktoaddressthesocial,economic, health, occupational, cultural and environmental factors involved in suicide prevention.Examples for this cohort could include culturally relevant youth work, social and recreationalprograms,initiativeswithyoungpeoplefrommigrantandrefugeebackgroundstoreducestigmaandincreaseunderstandingofmentalhealthandwellbeing.

Evaluationandreporting–data

Inaddition to investing in targetedearly intervention strategies,CMY recognise theneed foryouthsuicideprograms tobeevaluated, sowe knowwhatworks, and for quality data tobe collected tosupport timely, targeted intervention andpreventionprograms.A lackof datahaspreviously beenidentifiedasimpactingupontheeffectivenessofAustralianyouthsuicidepreventionapproaches.Forexample, the 2011national inquiry into youth suicide reported that “where evaluations havebeenundertaken,evidencesuggeststhattosomeextentassessmentshavebeenhamperedbyapaucityofdisaggregatedstatisticaldataonhighriskgroups.”101

InVictoria,theCoroner’sCourtofVictoriakeepsasuicideregister(VictorianSuicideRegister,VSR),inparttoidentifyhigh-riskpopulationgroups.However,thisrecorddoesnotcapturedetaileddataontheculturalandlinguisticbackgroundofpersonsanddatafromtheregisterisnotcurrentlypubliclyaccessible.102 While CMY recognise that data collection on youth suicide is problematic, with the

98TheParliamentoftheCommonwealthofAustralia,2011.,pp.19-2399TheParliamentoftheCommonwealthofAustralia,2011.,p.21100SuicidePreventionAustralia(2019),p.6101TheParliamentoftheCommonwealthofAustralia,2011.,3.37p.30102PersonalCorrespondencewithCoroner’sCourtofVictoria–28June2019:Seealso,Elston,R.,‘MelbourneSouthSudaneseYouthSayTheyaresickoflosingtheirfriendstosuicide’,SBSNews,7June2019,availablefromhttps://www.sbs.com.au/news/melbourne-s-south-sudanese-youth-say-they-re-sick-of-losing-their-friends-to-suicide

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contributingissueswell-documented,103thecollationofcomprehensiveinformationaboutthosewhodie by suicide and their wider social circumstances is recognised as “a necessary prerequisite forguidinglocaldecisionsonsuicidepreventionplanningandaction.”104Alackofinformationandpoordatamakesitverychallengingtogatheracompletepictureofyouthsuicideandhasflowoneffectsforthedevelopmentofeffectiveandtimelyserviceresponsesandpreventativeinterventions.

Recommendationsforaddressingyouthsuicide

4.1.1 Adopt an ‘early warning system’ that identifies communities of young people who arestrugglingandatgreaterrisk(e.g.suchasystemcouldtrackriskfactorsassociatedwithyouthsuicidewithinrefugeeandmigrantcommunities,suchasengagementwithyouthjusticeandschool disengagement, and has mechanisms for mobilising timely prevention responses).Indicators could ‘trigger’ investment in community partnerships and projects to ensurevulnerablegroupsaredirectlyinformingserviceresponsesandearlyinterventionstrategies.

4.1.2 Investinearlyinterventionyouthsuicideprogramsthatspecificallytargetcommunitiesfrommigrantandrefugeebackgrounds.Suchanapproachshould:

a) link in to existing programs addressing issues of cultural, educational, employment,social and economic disadvantage, so that initiatives are recognised as an integralpartofaholisticapproachtoyouthsuicideprevention105

b) beinformedbyandworkinpartnershipwithyoungpeople,familiesandcommunity;

c) betargetedandlocally-based–thismeanstailoringprogramstotheparticularneedsofvariousmigrantcommunities(recognisingthatnoonesizefitsall)and

d) developmultilingualdisseminationstrategies (suchasuseof communitymediaandyouthchampions)tosupportcommunityengagement.

4.1.3 Improvedatacollection,qualityandreporting.BuildingontheSuicidePreventionAustralia’srecommendation, this would include a focus on “improving the integrity (accuracy andtimeliness),collation(localandnational information includingthe integrationofstate-baseddata)anddistributionofsuicidedatatoassistservicedeliveryandresearch”.106

4.1.4 Investinfurtherresearchto:

103TheParliamentoftheCommonwealthofAustralia,2011.,p.12104Sutherland,G.Milner,A.Dwyer,J.Bugeja,L.Woodward,A.Robinson,J.&Perkis,J.(2017).ImplementationandevaluationoftheVictorianSuicideRegister,AustralianandNewZealandJournalofPublicHealth,42(3):296-302.Retrievedfromhttps://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12725105ThisrecommendationisbasedonRecommendation6oftheParliamentoftheCommonwealthofAustralia’s2011reportintoyouthsuicide-Beforeit’stoolate:Reportonearlyinterventionprogramspreventingyouthsuicide.ThisrecommendationcameoutoftheCommittee’sidentificationofservicecomplexityandfragmentationofservicesasakeybarriertoyoungpeopleatrisknotbeingabletoaccessthesupporttheyneed.Strategiesarerequiredthatensureserviceslinkupanddelivercollaborativeresponsessoyoungpeopledonotfallthroughthegapsandcaneasilyfindtheassistancetheyneed.SeeTheParliamentoftheCommonwealthofAustralia(2011),p.41106SuicidePreventionAustralia(2019).

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a) investigate the ‘early warning signs’ for youth suicide in refugee and migrantcommunitiesandhelpsinformthedevelopmentofan‘earlywarningsystem’todrivetargeted,earlyinterventionresponses.

b) evaluate selective interventions for targeted early intervention youth suicidestrategies with young people from migrant and refugee backgrounds. This shouldincludebuildingevaluationintoservicefundingagreementstoensureitiscarriedoutandrequiringservicestoevaluatetheiruseofyouthparticipationandpartnerships.

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4.2. Data

In the 2017-18 Victorian Mental Health Services Annual Report it was reported that just 3.9% ofpeople accessing mental health community support services had a CALD status107, while thepercentageof‘consumersofculturallydiversebackgrounds’accessingclinicalmentalhealthserviceswas13.7%.108

Currentmental health services data collection systems do not adequately capture data about theculturaland languagediversityofserviceusersfromrefugeeandmigrantbackgrounds,theirneeds,outcomes or service utilisation experience.109 In Victoria, this lack of data on and feedback fromVictoria’s refugeeandmigrant communities is seen tobenegatively impactinguponmental healthservices from the level of system design and funding prioritisation to service planning,implementation,monitoringandevaluation,andoutcomes.

A recognised challenge for service planning and investment in programs with newly arrivedcommunitiesisthelackofuptodate,accurate,publiclyavailablesettlementdata.110However,whilerecognisingchallengesassociatedwithaccessingdatafromother jurisdictions,theVictorianAuditorGeneral has argued “service delivery departments and service providers could be doing more tocollectandanalyseclientfeedbackandotherrelevantdataforplanningandevaluationpurposes.”111Acknowledgingthatthecollectionofaccurateandconsistentdataonculturalandlinguisticdiversitycan be a challenge, standards and guidelines have been developed that can support services tounderstandwhatinformationmaybeusefultocollectinordertoinformtheirplanningandimprovetheirservices.112

Beyondthecollectionofdemographicdata,effectivedatasystemsmustalsocapturetheviewsandfeedback of service users from refugee andmigrant backgrounds and undertake data analysis andreporting. Capturing service user feedback and experiences for refugee andmigrant communitiesmayrequiretranslatinginformationintolanguageandnecessarilyincludesregularconsultationswithcommunities in order to track progress, to identify emerging trends (well before statistical datacollectionmethods can identify these) to more comprehensively understand needs and to informsolutions.

Additionally,atanationallevelithasalsobeenreportedthat“thereislimitedmonitoringorreportingonthestatusofmentalwellbeinginCALDcommunities,thelevelofserviceaccessormentalhealth

107Thisappearstobeabinary‘yes/no’variablewhereCALDstatusisnotdefined.SeeVictorianGovernment(DepartmentofHealthandHumanServices).(2018).Victoria’sMentalHealthServicesAnnualReport2017-18.Retrievedfromhttps://www2.health.vic.gov.au/-/media/health/files/collections/annual-reports/m/mental-health-services-annual-report-2017-18.pdf?la=en&hash=9A002E3E14738001A85BFB46FB49DBA016F065A4,p.71108VictorianGovernment(DepartmentofHealthandHumanServices)(2018),p.65109MentalHealthinMulticulturalAustralia(2014).110SeeMYAN.(2019).2019FederalElectionPolicyPlatform.Retrievedfromhttps://myan.org.au/wp-content/uploads/2019/04/myanfederalelectionpolicyplatform2019.pdf111VAGO.(2014).Accesstoservicesformigrants,refugeesandasylumseekers.Retrievedfromhttps://www.audit.vic.gov.au/sites/default/files/20140529-Migrants-Services.pdf,p.xi112Forexample,ABS(AustralianBureauofStatistics)1999.StandardsforStatisticsonCulturalandLanguageDiversity.ABScat.no.1289.0.Canberra:ABS.Note,challengeswithdatarelatedtothispopulationgrouphavealsobeenidentified.Forarecentexamplesee,FECCA.(2019).Measuresofculturalandlinguisticdiversity–dataandreporting,PolicyPaper.Retrievedfromhttp://fecca.org.au/wp-content/uploads/2019/05/Issue-Paper-Data-Standards-Policy-Final.pdf

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outcomes.”113MonitoringandreportinghasalsobeenidentifiedasanissueinVictoriaaccordingtoa2019 report from the Auditor General’s Officer which noted “DHHS does not set expectations forservicedeliveryformostfundedprogramsanddoesnotmonitorwhatprogramsandactivitieshealthservices deliver.”114 A lack of accountability for services to identify and respond to the particularservice needs of the community is concerning. A 2014 report from the Victorian Auditor Generalsuggests that thismaybeamore systemic issuewhen it comes to communities froma refugeeormigrant background, as “Departments do not undertake systematic analysis of needs, and theirservice provision to CALD communities and achievement of related policy outcomes are notmonitored,reportedorheldtoaccount.”115

Acomprehensivedatacollection,analysisandreportingsystemthataccuratelycapturesinformationabouthowyoungpeoplefromrefugeeandmigrantbackgroundsareengagingwithVictoria’smentalhealth service system, their mental health needs and their experiences of the system is urgentlyrequired.Thedevelopmentofclear,consistentguidelinestosupportVictoria’smentalhealthsystemto respondmost effectively to theneedsof the state’s increasinglydiversepopulation shouldbeapriority. Guidelines should considerwhat already exists and should be informed by the needs andinterests of communitymembers from refugee andmigrant backgrounds, including young people.Thereisalsoaneedtoensuregenuineaccountabilityforprovisionofservicestopeoplefromrefugeeandmigrant backgrounds. This is a crucial element of the ‘whole of community’ approach, whichrequiresfundedservicesandprogramstocollect,analyseandreportondatathatdemonstrateshowthey are undertaking youth participation and engagementwith refugee andmigrant young peopleandhow theyare translating this into services that aremeeting identifiedneedsandareachievingoutcomesforthecommunitiestheyareworkingin.

Recommendationsforimprovingdatacollectionandquality

4.2.1 Improve quality and consistency of data and feedback collected across Victoria’s mentalhealthnetworktounderstanddiversepopulationsandidentifytheirspecificneeds.

4.2.2 Introduceacompliancecomponentwithinmentalhealthservicereportingonserviceuserstoensuregenuineaccountability forprovisionof services topeople fromrefugeeandmigrantbackgrounds.

113MentalHealthinMulticulturalAustralia(2014).114VAGO(2019).115VAGO(2014),p.xii

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4.3. Youthjustice

“Interactionsbetweenthecomplexneedsofyoungpeople, thenatureoftheiroffendingandthemegatrendsshapingand influencingtheir livesposessignificantchallenges fortheyouthjustice system. It necessitates the need for holistic, integrated thinking to address health,mentalhealth,disability,educationandemploymentneedsinordertoreducereoffending.”–ArmytageandOgloff,2017116

The intersection between youth justice andmental health iswell documented,with young peoplewithmentalhealthneeds found tobesignificantlyover-represented inVictoria’s justice systems.117Despitethisthe“barriersexperiencedbyallVictorianstoobtainmentalhealthcarearecompoundedforyoungoffenderswhodonothavepriorityaccesstoservices.”118

ThereisarecognisedneedtobetterintegratementalhealthservicesforyoungoffendersinVictoriain order to respond to offending from a more holistic frame. A 2017 report into Victoria’s YouthJusticeSystem identifiedarangeof issuespreventingaccess toappropriatementalhealthcareandsupport for youngoffenders. Issues ranged from inconsistentpractice for identifyingmentalhealthconcerns and referring youngpeople for appropriate support and care at intake, to limitedmentalhealthskillsandtrainingofstaff(particularlytoaddressinadequatescreening),inadequateprovisionofmentalhealthserviceswithintheyouth justicesystemanda lackofprioritisationforassessmentand treatment for complex young offenders.119 The report also highlighted how detention andisolationexacerbateunderlyingmentalhealthissues.120

Mental health symptoms do not cause offending but are associated with offending behaviours.Successful youth justice responses are informed first by recognition that disengagement andmarginalisation are key underlying drivers for risk factors associatedwith offending behaviour andsecondlyby identificationof risk andprotective factors associatedwith criminal offendingorotheranti-socialbehaviouramongyoungpeople,includingmentalhealth.121Keyriskandprotectivefactorsidentifiedatvariouslevelsinclude:

• Community(e.g.risk–poverty/protective-connectedness);• School(e.g.risk-academicfailure/protective-senseofbelonging);• Family(e.g.risk-familyconflict/protective–maintenanceofrituals);and• Individualorpeer(e.g.risk–alienation/protective–worksuccessduringadolescence).122

Adolescence has also been identified as an associated factor in youth offending behaviour, withadolescents“moresusceptibletopeerinfluenceandrisk-takingbehaviourasaresultoftheirstageof

116Armytage&Ogloff.(2017).YouthJustice:Reviewandstrategy–Meetingneedsandreducingoffending,ExecutiveSummary.Retrievedfromhttps://www.justice.vic.gov.au/sites/default/files/embridge_cache/emshare/original/public/2018/08/bf/6198c2b50/report_meeting_needs_and_reducing_offending_executive_summary_2017.pdf,p.11117Ibid.118Armytage&Ogloff.(2017),p.13119Ibid.120Ibid.121Sutherland&Millsteed(2016a).122DrugsandCrimePreventionCommittee(2008).,p.34citedinMYAN(2017).SubmissiontotheJointStandingCommitteeonMigrationInquiryintoSettlementOutcomes.Carlton:MYAN,p.45

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physical, mental and emotional development”.123 As a result however, most young offending isepisodic,transitoryandunlikelytocontinueintoadulthood.Youngpeoplearelikely,withappropriateintervention, to be successfully diverted from this behavior, especially if underlying factors placingthematriskareaddressed.124Youthjusticeapproachesshouldrecogniseaddressingoffendingamongyoung people requires a focus on diversion and rehabilitation – addressing mental health andwellbeingisacriticalelementtothiswork,withdrugandalcohol interventionsanintegralpartofabroadersuiteofmentalhealthresponses.

Youngpeoplefromrefugeeandmigrantbackgroundsoftenfaceadditionalbarriersthatcanresultinthem missing out on opportunities to participate, limiting connectedness and belonging andnegatively impacting upon social and economic wellbeing.125 Research shows that risk factorsassociatedwithyoungpeople’soffendingbehaviourcanbe linkedtoparticularsocialandeconomicvulnerabilities,126 including poor mental health.127 While the offending behaviour of some youngpeople from refugee and migrant backgrounds has been linked to experiences of discrimination,feelingsofsocialisolationandeconomicexclusion,128insomereportingthishasbeentakenfurthertoproposeasupposedconnectionbetweenrefugeeandmigrantminoritiesandcriminality.129However,Australian research into youth offendingmakes clear that it is misleading to suggest that being amemberofaparticularethnic,religiousorracialgroupiscausallyrelatedtocriminalactivity.130

The Armytage and Ogloff report has identified the need for more culturally appropriate andresponsiveprogramsandapproachesbedevelopedwithintheVictorianyouthjusticesystem.131Thisincludes development of crime prevention approaches that draw on the strengths of the broaderculturalcommunityandtheadoptionofapproachesthatbuildonexistingmodelsand“community-inclusiveinitiatives”thatareworkingwithyoungpeoplefromrefugeeandmigrantbackgrounds.132

Greaterengagementwithfamilies isalsonecessaryforeffectiveyouthjusticeresponseswithyoungpeople fromrefugeeandmigrantbackgrounds, recognising that “strongprosocial connectionswithfamilyandparentsareprotective factors foryoungpeople” in regards toyouthoffending.133/134Toaddressthementalhealthneedsofyoungpeoplefromrefugeeandmigrantbackgroundsintheyouthjustice system, the youth justice system should also seek to employworkers from various culturalbackgrounds.Asothershavereported,andasthemodelsexploredinthecasestudiesthroughoutthis

123HephillandSmith(2010).citedinMYAN(2017),p.45124JSS(2015).Anescalatingproblem:RespondingtotheincreasedremandofchildreninVictoria.Melbourne:JSS.citedinMYAN(2017),p.45125CMY(2014b).126DrugsandCrimePreventionCommittee.(2008).Inquiryintostrategiestopreventhighvolumeoffendingbyyoungpeople.(DiscussionPaper).Melbourne:ParliamentofVictoria,p.34127VAGO(2019).128Armytage&Ogloff(2017).,p.10:seealsoCMY.(2014).Fairandaccurate?MigrantandRefugeeYoungPeople,CrimeandtheMedia.Carlton:CMY.129Collins,J.&Reid,C.(2009)citedinCMY(2014c),p.6130Baur(2006).citedinBartels.(2011).CrimepreventionprogramsforculturallyandlinguisticallydiversecommunitiesinAustralia.Researchinpractice,18.Canberra:AustralianInstituteofCriminology.131Armytage&Ogloff(2017),p.24132Armytage&Ogloff(2017),p.10133Armytage&Ogloff(2017),p.9134Armytage&Ogloff(2017),p.13&24.FamilyengagementwasanidentifiedgapincurrentVictorianpracticeaccordingtothisreport.

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submission attest to, a culturally diverseworkforcehas “thepotential to build community capacityandsupportforat-riskyoungpeople”.135

Addressingtheover-representationofcertaingroupsinyouthoffendingrequirestargetedinvestmentinmentalhealthearly interventionandpreventionstrategiesthatpromotethesocialandeconomicwellbeingoftheyoungperson,theirfamilyandcommunity.Suchinterventionsshouldberecognisedas important elements of an effective and proactive youth justice diversion strategy. Whole ofgovernment approaches that encourage cross-portfolio collaboration are required to ensure suchinterventions, targeting the upstream factors contributing to poormental health and youth justiceoutcomesforyoungpeoplefromrefugeeandmigrantbackgrounds,aresuccessful.Suchapproachesshould also work with young people, families and communities from refugee and migrantbackgroundstoidentifyissues,supportlinkagesacrossareasandtoexplorepartnershipsandmodelsthatcanpromotesocialandeconomicwellbeingandparticipation.

A related factor identifiedbyyoungpeopleas impactingupon theirmentalhealthandwellbeing isnegative stereotypes and portrayals of young people from refugee and migrant backgrounds inrelation to youth justice in the media and broader community.136 Such portrayals can lead youngpeople to feel stigmatised by themedia and the public, and targeted by authority figures such aspolice.137 According to Australian research, “there are strong and consistent relationships betweenracial discriminationanda rangeofdetrimentalhealthoutcomes suchas low self-esteem, reducedresilience,increasedbehaviourproblemsandlowerlevelsofwellbeing.”138Toaddressthis,programstargetingattitudesandperceptions in thewidercommunityareneeded.Suchprogramsshouldnotonly promote social inclusion but need to directly challenge racism and discrimination in ourcommunity.

Raisethelegalage

TheSmartJusticeforYoungPeople(SJ4YP)CoalitioninVictoria–acoalitionofleadingAboriginalandTorresStraitIslander,socialservices,health,legalandyouthadvocacyorganisationswhoadvocateforevidence-basedandeffectiveresponsestojusticeinvolvedchildrenandyoungpeople.CMYsupportSJ4YPincallingontheGovernmenttoraisetheageofcriminalresponsibilitytoatleast14yearsold.ThiscallissupportedbytheAustralianMedicalAssociation,theRoyalAustralianCollegeofPhysician,theAustralianIndigenousDoctors’Association,theNationalAboriginalandTorresStraitIslanderLegalServices, the Lowitja Institute aswell as PublicGuardians andChildren’s Commissioners across thecountry.139

IntheirworktoraiseawarenessofthisissueSJ4YPhavenoted:

135Armytage&Ogloff(2017),p.19136Armytage&Ogloff(2017),p.24137Seeforexample,Smith,B.&Reside,S.(2016)‘Boys,youwannagivemesomeaction?’:InterventionsintopolicingofracialisedcommunitiesinMelbourne.Retrievedfromhttp://smls.org.au/wp-content/uploads/2016/09/Boys-Wanna-Give-Me-Some-Action.pdf138Priestetal,2013citedin(2015).Haile-Michael,D.&Issa,M.‘Themorethingschangethemoretheystaythesame’:ReportoftheKFCLCPeerAdvocacyOutreachProjectonracialprofilinginMelbourne.Retrievedfromhttp://www.policeaccountability.org.au/wp-content/uploads/2015/07/More-Things-Change_report_softcopy.pdf,p.15139AustralianMedicalAssociation.(2019).AMACallsfortheAgeofCriminalResponsibilitytobeRaisedto14YearsofAge,25March2019,availablefromhttps://ama.com.au/media/ama-calls-age-criminal-responsibility-be-raised-14-years-age

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“Criminalising the behaviour of young and vulnerable children creates a vicious cycle ofdisadvantagethatcanentrenchchildren in thecriminal justicesystem.140Studiesshowthatthe younger a child has their first contact with the criminal justice system, the higher thechanceoffutureoffending.141

TheageofcriminalresponsibilityinVictoriais10years.142Thisistheageatwhichachildcanbeinvestigatedforanoffence,arrestedbypolice,chargedandlockedupinayouthprison.

The current legal minimum age of criminal responsibility is against medical evidence thatchildrenaged10to14yearslackemotional,mentalandintellectualmaturity.Researchshowsthatchildren’sbrainsarestilldevelopingthroughouttheseformativeyearswheretheyhavelimitedcapacityforreflectionbeforeaction.143Childreningradesfour,fiveandsixarenotatacognitivelevelofdevelopmentwheretheyareabletofullyappreciatethecriminalnatureoftheiractionsorthelife-longconsequencesofcriminalisation.144

Thecurrentminimumage is inbreachof internationalhumanrights lawand is inconsistentwithinternationalstandards.Themedianageofcriminalresponsibilityworldwideis14yearsold. The United Nations Committee on the Rights of the Child has consistently said thatcountries should be working towards a minimum age of 14 years or older.145 The RoyalCommission into the Protection and Detention of Children in the Northern TerritoryrecommendedthattheNorthernTerritoryraisetheageofcriminalresponsibility.146”

CMY join with SJ4YP in calling on the Royal Commission to recommend that section 344 of theChildren, YouthandFamiliesAct2005 be amended to raise theageof criminal responsibility to14years. It is crucial that these reforms be included in the recommendations made by the RoyalCommission to prevent the criminalisation of children and the significant mental health risksassociatedwiththis.

140AustralianInstituteofHealthandWelfare(2016).Youngpeoplereturningtosentencedyouthjusticesupervision2014–15.Juvenilejusticeseriesno.20.Cat.no.JUV84.Canberra:AIHW.Theyoungerapersonwasatthestartoftheirfirstsupervisedsentence,themorelikelytheyweretoreturntosentencedsupervision.Forthosewhosefirstsupervisedsentencedwascommunity-based,90%ofthoseaged10-12atthestartofthissentencereturnedtosentencedsupervision,comparedwith23%ofthoseaged16andjust3%ofthoseaged17.Morestaggeringwerethosesentencedtodetentionastheirfirstsupervisedsentence,all(100%)thoseaged10-12atthestartofhissentencereturnedtosometypeofsentencedsupervisionbeforetheyturned18.Thisrateofreturndecreasedwithage,toaround80%ofthose14and15,56%ofthose16and17%ofthose17.141Ibid.SeealsoAustralianInstituteofHealthandWelfare2013.YoungPeopleAged10–14intheyouthjusticesystem,2011-12.JuvenilejusticeseriesNo.12JUV19.Canberra:AIHW.142Children,YouthandFamiliesAct2005(Vic),s344.143AndrewBecroft,‘FromLittleThings,BigThingsGrow:EmergingYouthJusticeThemesintheSouthPacific’(PaperpresentedattheAustralasianYouthJusticeConferenceonChangingTrajectoriesofOffendingandReoffending,NewZealand,21-22May2013)5referringtoScienceAdvisoryCommitteeImprovingtheTransition:ReducingSocialandPsychologicalMorbidityDuringAdolescence(May2011)at24.SeealsoKellyRichards,‘Whatmakesjuvenileoffendersdifferentfromadultoffenders?’(2011)409Trends&issuesincrimeandcriminaljustice,4;LaurenceSteinberg‘RiskTakinginAdolescence:NewPerspectivesfromBrainandBehaviouralScience’(2007)16CurrentDirectionsinPsychologicalScience55,56.144Ibid.145CommitteeontheRightsoftheChild,GeneralCommentNo.10Children’srightsinjuvenilejustice,44thsess,UNDocCRC/C/GC/10,(25April2007),pp.32-33.146TheCommonwealthofAustralia.(2017).RoyalCommissionintotheProtectionandDetentionofChildrenintheNorthernTerritory,FinalReport(2017)vol2B,p.420.

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Recommendationsforyouthjustice

4.3.1 Workinpartnershipwiththeyouthjusticesystem,youngpeopleandcommunitytodevelopculturally appropriate mental health responses for groups of migrant and refugee youngpeople who are over-represented in the youth justice system. (Previous measures haveincludedprograms thatbuildpositive relationshipsbetweenpoliceandparticulargroupsofmigrant and refugee young people; employing culturally specific workers in juvenile andyoung adult justice services; training and cultural support provided to court services andworkersintheyouthjusticesystem;andculturallyappropriateandspecificprogramsleadbyrespectedcommunityleadersandyoungpeople.)

4.3.2 The Royal Commission should recommend that section 344 of the Children, Youth andFamiliesAct2005beamendedtoraisetheageofcriminalresponsibilityto14years.

4.3.3 Fund further research into theunderlyingcausesofoffendingbehaviourspecific toculturalgroupsover-represented in crime statistics and theyouth justice system thatdrawson theexpertiseofyoungpeopleandcommunitiesconcerned.Thiswillinformservicesonhowbesttodevelopeffective,culturallyrelevantresponses.

4.3.4 Evaluate thesuccessofalreadyexistingprogramsdesigned to supportmigrantand refugeeyoungpeoplewithregardtooffendingandmentalhealth(bothearlyinterventionandmoretertiaryresponses).Thiswillassistwiththe identificationofgoodpracticesandareaswherementalhealthserviceshaveaparticularrole,providinga frameworkfor futurepartnershipsandinitiativestodecreaseratesofoffending.

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4.4. Online

Onlineinterventions,particularlyforyoungpeople,couldbeanareathatfacilitatesaccesstomentalhealthsupport.InthegeneralyouthpopulationofAustralia,theinternetisoneofthemostpopularsourcesofinformation,adviceandsupportforyoungpeople,alongsidepeers,bothwithandwithoutaprobableseriousmentalillness.147Howeveritmaynotbethesameforyoungpeopleofmigrantandrefugeebackgrounds.Furtherresearchisrequiredaroundassessingthekindofonlinementalhealthsupportthatismosteffectiveforyoungpeoplefrommigrantandrefugeebackgrounds,andhowbesttoencourageaccesstothisinformation.

Abriefreviewofkeyinternetbasedyouthhealthwebsiteswhereyoungpeoplemaygotoseekhelpwith mental health concerns, such as beyondblue, headspace, Reach, Orygen, and Kids Help Lineindicatesthatthereislittleifanyacknowledgementofculturaldiversityoroftheadditionalbarriers,or alternative understandings ofmental illness offered.148 There is virtually no support directed atyoung people from migrant and refugee backgrounds who may be grappling with a range ofadditionalissues.149

CMYconsultedseveralofouryouthfacilitatorsonthis topicwhoreportedthatmanynewlyarrivedyoung people from refugee backgrounds are unaware that basicmental health supports exist (forexample,somewereunawareofservicessuchasLifeline),letaloneknowhowtonavigateandaccessonlinementalhealthsupport.Theyweredoubtful thatmanynewlyarrivedyoungpeoplewouldgoonlineforhelpwiththeirmentalhealthneeds.However,somedidsuggestthatbeingintroducedtoonlineresourcesbyateacheroryouthworkermighthelpyoungpeopletobeawarethatthissupportisavailable,andincreasetheirlikelihoodofusingit.

ThisissupportedbyYouthAffairsCouncilVictoria’s(YACVic)researchinthisarea,whichemphasisestheimportanceoftrustedworkersorstaffintroducingyoungpeopletopotentialonlinesupport:“Itisimportant to learn from models of e-counselling which have generated high demand, such aseheadspace.Wewouldsuggestthatoneimportantcomponentisactivein-personengagementwithyouthworkers and school staff,whocan introduceyoungpeople to suchonline servicesand ‘walkthemthrough’usingthematfirst.”150

Thissuggeststhatthereismoreworktobedoneinunderstandinghowonlineplatformscansupportthementalhealthandwellbeingofthiscohortofyoungpeople.Atrustingrelationshipthatcanhelpintroduceyoungpeopletonavigateonlinesupportappearstobeanimportantingredient.Similarly,anecdotalfeedbackindicatesthatsomeyoungpeoplefrommigrantandrefugeebackgroundsreachoutonlinetopeerstheyrespectinordertoseekhelpwiththeirmentalwellbeing.

147Ivancic,L.,Perrens,B.,Fildes,J.,Perry,Y.&Christensen,H.(2014),YouthMentalHealthReport,June2014.MissionAustraliaandBlackDogInstitute.148CMY(2014a).149CMY(2014a).150YACVic.(2015).Strengtheningyoungpeople’smentalhealth:AsubmissiontotheVictorianGovernment’s10yearMentalHealthStrategy.Retrievedfromhttps://www.yacvic.org.au/assets/Documents/SUB-YACVic-submission-to-Victorias-10-Year-Mental-Health-Strategy.pdf

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Buildingon recommendations from theConsumersHealthYouthHealthForum151CMYalso call forthedevelopmentofculturallyrelevantpeersupportsystemsaroundmentalhealth–whichcouldbedevelopedbothonlineandface-to-face.Furtherresourcingisrequiredtolearnmoreaboutthebestapproaches to promote onlinemental health support for young people frommigrant and refugeebackgrounds.

Recommendationforonlineaccess

4.4.1 Investinresearchthatexploreshowyoungpeoplefrommigrantandrefugeebackgroundsareusingonlinemeanstosupporttheirmentalhealthandwellbeing,anddevelopstrategiesandinterventionstostrengthensupportinthisspace.

151ConsumersHealthForumofAustralia.(2018).YouthHealthForumCalltoAction.Retrievedfromhttps://chf.org.au/sites/default/files/chf_yhfcall_to_action_final_002.pdf

CaseStudy9–migrantyoungpeopleseekinghelponline

CMY’s community development programs with Pasifika young people and their communities hasrevealed that many young Pasifika people in Victoria are following influential peers online fromsimilarculturalbackgrounds,forexample,bloggersormusicians.IthasemergedthatsomePasifikayoungpeoplearereachingouttothesebloggerstoseeksupportaroundmentalhealthissues.Thishighlights the importance of peer support, but also reveals challenges in that these bloggers orsocialmedia influencers are not necessarily skilled or equipped to respond to themental healthneedsoftheirpeers.Itsuggeststhatthereismoreworktobedoneintermsoftheintersectionofonlineplatforms,peersupportprogramsandculturallyrelevantapproaches.

The CMY LeMana team worked alongside Pasifika young people to develop a youth-led forum.Youngpeople invitedpeers, including influentialPasifikabloggers,toattendanddiscussanumberofcommunityissuesidentifiedbyyoungPasifikapeople,includingmentalhealth.

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4.5. Accesstoappropriatementalhealthservicesandsupportsinregional/ruralareas

CMY have particular concerns around the accessibility of culturally relevant, youth mental healthservicesinruralandregionalareas.Servicefeedbackisthatyoungpeoplefrommigrantandrefugeebackgrounds at times have to travel great distances to access mental health services – at timestravellingacrossstateborders-anditcanbedifficultandtimeconsumingtoreachtheseservicesbypublictransport.Oftenthereisnoavailableyouth-specificmentalhealthservice,letaloneonethatisculturallyrelevantandequippedtoworkwithyoungpeoplefrommigrantandrefugeebackgrounds.

Educational providers and settlement services in these areas report struggling under the strain ofthesemultiplebarriers.Asaresult, ill-equippedteachersandcommunityworkersareattemptingtofill gaps in mental health support for these young people. There is a need for flexible, outreachmodelsofmentalhealthsupportthatarebothageandculturallyrelevantinruralandregionalareas.Thisallpointstoacriticalneedforyouthmentalhealthoutreachtoensurethatyoungpeopleaccessthesupporttheyneedandtowhichtheyareentitled.

Recommendations for access to appropriate mental health services and supports in regional/ruralareas

4.5.1 Resource thementalhealthsystem in ruralandregionalareas tobettermeet theneedsofyoungpeoplefrommigrantandrefugeebackgroundsthrough:

a) Providingculturallycompetent,youth focussedmentalhealthpractitioners thatcanoutreachtolocalschools,communityorganisationsandspacesthatyoungpeopleinruralandregionalareasaccess;

b) Skillingupteachersandyouthworkerswhoengagewithyoungpeoplefrommigrantandrefugeebackgroundsinruralandregionalareas,tobetteridentifymentalhealthissuesandmakeeffectivereferrals.

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