Reflections on culture in practice amongst team leaders and directors in Australian public mental health services

This study explores team leaders’ and directors’ perceptions of the facilitators and barriers to effective mental health care to meet the needs of culturally and linguistically diverse (CALD) clients in the public mental health system across greater Brisbane, Australia. This is critical given Australia’s cultural diversity and treatment limitations and gaps for CALD clients. A purposive sample of decision-makers working in the public mental health system (<i>N</i> = 6) completed semi-structured interviews. A thematic analysis was undertaken to identify dominant themes. Participants discussed planning, delivery, and evaluation of culturally inclusive and effective mental health care. When planning for culturally appropriate services, collaboration with internal services, such as multicultural specialist services, was the most frequently discussed facilitator, while limited resources were the most identified barrier. Clinicians’ cultural sensitivity and biases were identified as an important influence on service delivery. Participants identified significant gaps in evaluation and limited data collection to support the evaluation of cultural safety within services. The findings provide insight into systemic factors affecting culturally inclusive and safe practices in an Australian public mental health setting. Implications for research, policy, and practice are discussed. <b>What is already known about this topic:</b>Managers’ directly and indirectly promote values, norms, and biases from a top-down manner, which influence culturally safe care (Aggarwal et al., 2016; Mollah et al., 2018; Smedley et al., 2003).Managers perceive culturally sensitive practitioners who adopt the client’s cultural conceptualisation of illness and organisations that provide cultural safety training, are all facilitators to culturally safe care (Aggarwal et al., 2016; Colucci et al., 2015).Managers perceive limited time, large workloads, client’s fear of stigma, and a complex healthcare system as barriers to culturally safe care (Aggarwal et al., 2016; Colucci et al., 2015). Managers’ directly and indirectly promote values, norms, and biases from a top-down manner, which influence culturally safe care (Aggarwal et al., 2016; Mollah et al., 2018; Smedley et al., 2003). Managers perceive culturally sensitive practitioners who adopt the client’s cultural conceptualisation of illness and organisations that provide cultural safety training, are all facilitators to culturally safe care (Aggarwal et al., 2016; Colucci et al., 2015). Managers perceive limited time, large workloads, client’s fear of stigma, and a complex healthcare system as barriers to culturally safe care (Aggarwal et al., 2016; Colucci et al., 2015). <b>What this topic adds:</b>Managers highly value collaboration with, and outreach into, local communities, however, this is not translating into practice due to barriers outside of managerial control. An organisational and system level approach is required to effectively reduce barriers in service planning.Mental health services are not consistently collecting data and utilising feedback from multiple respondents to inform future planning, enhance client access, and guide intervention. Further work is needed to identify how this can be done more comprehensively and effectively within busy mental health services.A coordinated national approach is required to examine funding models, the effectiveness of cultural safety training, the efficacy of national standards and benchmarks of care, and quality assurance processes. Managers highly value collaboration with, and outreach into, local communities, however, this is not translating into practice due to barriers outside of managerial control. An organisational and system level approach is required to effectively reduce barriers in service planning. Mental health services are not consistently collecting data and utilising feedback from multiple respondents to inform future planning, enhance client access, and guide intervention. Further work is needed to identify how this can be done more comprehensively and effectively within busy mental health services. A coordinated national approach is required to examine funding models, the effectiveness of cultural safety training, the efficacy of national standards and benchmarks of care, and quality assurance processes.