Within the general community, people with intellectual disability from CALD backgrounds may experience language issues, racism and stigmatisation in health care and community activities. They may also experience discrimination within their community. In some communities, there is stigma attached to having mental health problems and/or disability.

Discrimination within and outside CALD communities can lead to people with intellectual disability from CALD backgrounds to:

• seek services far away from their community areas, which can isolate people with intellectual disability and their families from their communities

• hide or deny their intellectual disability, mental health problems and true opinions or wishes regarding their intellectual disability or mental health. This can contribute to the inappropriate identification of the person’s needs (e.g. the person may receive intensive English language support rather than interventions like speech therapy)

• be reluctant to engage in formalised supports.

These can negatively impact on the mental health and experiences of people with intellectual disability in CALD communities.

Culturally responsive care is the ability to appropriately respond to different groups of people with a common and distinctive racial, national, religious, cultural or linguistic heritage. [2] Some mental health services may not adequately cater to the needs of people with intellectual disability from CALD communities when providing mental health services. This may be due to a lack of knowledge and awareness of:

• different cultures and languages
• how different cultures view mental health or intellectual disability
• expectations for family involvement in different cultures.

The lack of knowledge and awareness can act as a barrier to care and may contribute to:

• poorer overall quality of mental health care
• a higher risk of errors or incidents that can lead to potentially serious clinical consequences
• the person and their family not accessing disability and mental health support services until a crisis point is reached.

In some cases, a lack of cultural and linguistic diversity within the service itself can affect whether culturally responsive care is provided. A lack of workplace diversity can mean that people from CALD communities may not seek out services because the service provider does not share the same first language. Mental health treatment outcomes could also be poor because information is not provided in a language that the person understands.

Some people with intellectual disability may have poor English and/or health literacy, leading to difficulties participating in the mental health system. These issues can be exacerbated for people with intellectual disability from CALD communities.

Language constraints can mean that people from CALD communities may not be able to access services, and some mental health professionals may not have experience working with interpreters. Similarly, interpreters may not have experience working with a person with intellectual disability. These issues can be compounded if sufficient time is not allocated by either the mental health professional or the interpreter for the appointment. Face-to-face interpreters are also becoming increasingly rare, meaning that people with intellectual disability with communication difficulties are not able to access interpreting services.

Poor health literacy can mean that people with intellectual disability may not know that they can access help for their mental health, or know how to describe their symptoms to mental health professionals. People with intellectual disability from CALD communities may also have a lack of familiarity with the mental health system in Australia, particularly if they were born overseas.

Family members may be unable to support the person if they have poor English or health literacy themselves.

Existing service protocols or, in some cases, the law may be in direct contrast to the person’s beliefs and preferences. For example, under Australian mental health and disability support systems, an individual needs to have a diagnosis to access professional supports and treatments. However, a person with intellectual disability and their family may not want a diagnosis due to differences in their socio-cultural conceptualisation of mental health and/or disability, or the implications of a formal diagnosis.

People from CALD communities or their family members may not trust government or public services, which can act as a barrier to accessing mental health care. Government distrust may stem from a history of distrust towards governments, or trauma suffered, in their country of origin.

There may also be privacy concerns, especially when third parties such as interpreters are involved. People from CALD communities may be concerned that confidential information may be shared with other members of their community, which can lead to stigma and discrimination.

Meeting the mental health needs of people with intellectual disability from CALD communities requires the provision of holistic and empowering care by adapting your practice to be culturally responsive. By adopting culturally responsive practices, you can [3, 4]:

• increase the person’s access to mental health care and support services
• improve the effectiveness of the care received
• facilitate self-determination (e.g. decision-making)
• improve disparities in mental health outcomes
• contribute to shaping the mental health-related values, beliefs and behaviours of marginalised communities.

You can provide culturally responsive care by:

• listening attentively to and speaking clearly about concerns raised by the person and their support networks (e.g. concerns about negative staff attitudes, unfamiliar environments and cultural and linguistic differences)

• considering the person’s traditions and attitudes. Some examples of things to consider are presented below.

• considering the expectations of family involvement in the person’s care, while asking the person’s individual preference about whether to include family members

• arranging interpreters in advance and working collaboratively with the interpreter

• providing written information in a language the person and their support networks can understand, if possible

• routinely including culturally responsive screening for trauma. You can read more about trauma and how to respond to trauma here

• using trauma-informed care. You can learn more about trauma-informed care here

• minimising power imbalances between professionals and the person with intellectual disability (e.g. removing the use of titles, engaging openly and transparently in a co-design fashion)

• facilitating the person’s access to housing, employment, health and other support services that are culturally responsive.

Consider the traditions and attitudes of individuals, their families and cultures, where relevant, towards:

• disability
• mental health
• community
• trauma
• gender and sexuality
• religion
• health and wellbeing services
• socioeconomic disadvantage
• people or organisations regarded as being in positions of power or authority.

Cultural competency describes the ability of individuals and services to work or respond effectively across cultures. Cultural competency can be built by engaging in cultural competency training programs. If there are certain ethnic minorities that are more prevalent in your area, it may be helpful to access cultural competency training specific to these groups.

Cultural competency may also be supported by getting involved in your local or relevant CALD community. There are many ways you can get involved, including:

• learning about how different cultures view intellectual disability and mental health
• getting involved in local community development events run by CALD community groups
• talking with community leaders
• raising awareness of how social conditions may be negatively affecting people with intellectual disability in these communities (e.g. stigma that associates disability with curses)
• partnering with local support services and advocacy groups
• connecting with the Multicultural Disability Advocacy Association of NSW
• using case studies and success stories to help motivate change
• being part of a larger social movement to create supportive environments for health.

There are many ways to achieve cultural competency but it is important to consult and involve the person, their family and available services whenever possible and appropriate.

Each person from a CALD community has a slightly different culture and culturally determined perspective affecting their understanding, expectations and styles of communicating. [5] This may create an added layer of communication complexity and you may need to carefully consider whether further communication supports are needed. You can read more about adapting your communication here.

Some people from CALD communities may prefer a worker who speaks their language and understands their culture, while others may prefer someone outside their community. Some people may also prefer to be supported by a worker of a specific gender. If appropriate, involve family members and interpreters. If the interpreter is not a family member, it can be beneficial to have the same interpreter attend each session to support the development of short-hand and rapport between the interpreter and the person. Short-hand is a method of interpreting quickly by substituting different expressions without losing the message.

It is a NSW Health policy that professional interpreters, rather than family members, are used for health consultations. However, for other services, some people may request that their family member acts as their interpreter. If this is the case, you may still want to recommend to the person the use of a professional interpreter, as family members may be reluctant to pass on negative messages or may have a lack of understanding of medical terminology that could lead to inaccuracies in the interpretation.

You can play an important role in advocating for accessible services for people with intellectual disability from CALD communities. For example, you could:

• encourage training and education in cultural competency within your service

• become familiar with interpreters who have experience working with people with intellectual disability in your local community

• use and promote the use of Easy Read and plain English resources for the people you support, as well as resources in their own language

• use case studies and success stories to help motivate change.

You can learn more about advocating for people with intellectual disability from CALD communities through the Multicultural Disability Advocacy Association and our information on how to advocate within the I am a person with intellectual disability section.

1. Australian Bureau of Statistics. Cultural and Linguistic Characteristics of People Using Mental Health Services and Prescription Medications. Canberra: ABS; 2016.  Contract No.: ABS Cat. No. 4329.0.00.001.
2. Tucker CM, Arthur TM, Roncoroni J, Wall W, Sanchez J. Patient-centered, culturally sensitive health care. American Journal of Lifestyle Medicine. 2015;9(1):63-77.
3. Grant J, Parry Y, Guerin P. An investigation of culturally competent terminology in healthcare policy finds ambiguity and lack of definition. Australian and New Zealand Journal of Public Health. 2013;37(3):250-6.
4. El-Amouri S, O’Neill S. Supporting cross-cultural communication and culturally competent care in the linguistically and culturally diverse hospital settings of UAE. Contemporary Nurse. 2011;39(2):240-55.
5. O'Toole G. Communication-eBook: Core Interpersonal Skills for Health Professionals: Elsevier Health Sciences; 2016.