Among Australia's diverse population, no-one is excluded from the impact of mental illness. Can cultural understanding improve the way we approach mental health care?
When Kali Paxinos' husband Stan told friends at the local Ithacan social club that their son had been diagnosed with schizophrenia, he was met with awkward silence.
"Not one person got up and said anything," Kali said.
"And he came home and he cried. He could never forgive his mates."
Stan passed away in 2004 having never reached an understanding with his local community about his son's condition.
The stigma of mental illness is a factor across many cultures. Increasingly, cultural awareness is understood as key to successful diagnosis and treatment.
Radhika Santhanam-Martin is an education and service development consultant for Victorian Transcultural Mental Health (VTMH), an organisation that works with service providers to improve their capacity to meet the needs of culturally and linguistically diverse Australians.
"That one-size-fits-all [approach to] mental health has to change," Radhika said.
"We [have to] understand the totality of an experience rather than just [narrow it] down to a category like depression or anxiety or sleeplessness, because it's much bigger than that."
Reaching out to carers
Since her youngest son Perri's diagnosis with schizophrenia in 1980, Kali Paxinos — now 90 years old — has reached out to migrant communities in Australia to help them understand mental illness and empower them to support their loved ones.
"I had made it my business to learn for my own self and for my children," Kali explained.
"I realised that I had an asset that a lot of other people didn't have — I had those experiences, I had those opportunities — and part of me wanted to be able to give some support to these families."
Kali was born in Australia to Greek migrant parents and grew up bilingual. Although in the process of retiring by the time Perri was diagnosed, Kali's work as a teacher's aide for migrant students had prepared her for the challenge of helping carers from diverse backgrounds.
"A lot of the multicultural families — and there were Italian, Greek, Vietnamese I mixed with — they all couldn't understand that change that was going on in the [person's] behaviour," she said.
'Every migrant family wants to project an image of being successful'
Suchitra Chari's mental health declined to a crisis point about 15 years after coming to Australia from India. It was a therapist who shared her cultural background who managed to reach her.
"I think he could sense from where I was coming," Suchitra said.
"So, I found his nurturing and supportive care pretty crucial in my continuing [treatment]."
Suchitra had experienced many years of domestic violence before being diagnosed with post-traumatic stress disorder and major depressive disorder. It put a strain on her relationship with her community.
"I think every migrant family wants to project an image of being successful," she said.
"For me, I have fallen from some level of status as being in a professional working family to somebody who was coming out disclosing domestic violence. I had become separated and then divorced, and then I was having mental illness. So, all these were layer upon layer of stigma."
Suchitra said that many in her ethnic community turned their backs on her.
Having a therapist who understood that stigma and the pressure she was under from her family to return to India after the divorce helped.
"He knew the available [mental health] treatment options here, so he didn't encourage me to go back [to India]," she said.
"I felt I didn't have to explain everything."
The uniqueness of the individual
Despite this cultural connection helping with her recovery, Suchitra hastened to add that making generalisations about mental health based on ethnicity can be problematic.
"I think, like any normal population, there can be differences between individuals within that culture," she said.
"Saying that this is a typical cultural group and this is how they experience it … is risky. I would rather see every individual … treated with the respect and uniqueness that their experience actually deserves."
It's a sentiment echoed by VTMH's Susan McDonough.
"There is a history of this area [transcultural mental health] being interested in the wellbeing and the mental health of migrant and refugee communities — and we still have a real focus on and interest in that area — but I think what's changed is that there's more of an interest in the idea of vulnerable communities more broadly," she said.
"We have to be really careful to not stereotype or say that their issues are the same for all people, or even for all groups.
If you are feeling distressed, or need advice or support, you should consult your local medical professional. If you're in Australia, support is available via Lifeline 13 11 14 and SANE Australia 1800 18 SANE (7263).