Report prepared by Heather Gridley FAPS and Emma Sampson, APS National Office*

Community psychologists are well placed to respond to the Australian Government's health reform agenda, which identifies as key priorities: (1) prevention (refocusing primary healthcare towards prevention); (2) engagement with communities (to inform, enable and support people to make healthy choices); and (3) the reduction of inequity through targeting disadvantage (NHHRC, 2009). Community psychologists play a vital role in addressing systemic barriers to good health and wellbeing. While they do work to support behaviour change with individuals and groups, fundamental to their approach is also working at a broader level to reduce inequality and build systems and structures that enable and empower communities. This work recognises the social determinants of health that lie in disadvantage and exclusion. The role of community psychologists is not always explicitly recognised (as they do not always work within an ‘expert model' and thus may not be employed under that title), but they can be found in urban and rural settings, developing and implementing interventions at a national, State and/or local community level in areas such as local government, education, community health, within local neighbourhoods and in non-government organisations. Three key roles for community psychologists in the health arena are profiled below.

Roles in preventative health

Prevention is a foundational platform of community psychology, which positions it well to respond to the Government's goal of embedding prevention and early intervention into every aspect of the health system. As well as working to prevent health issues in high profile national programs, such as improving the mental health and wellbeing of young people (headspace) or primary school children (KidsMatter), community psychologists also work at a local level by implementing programs with at-risk groups.

The Mothers Living Well project at Knox Community Health Service in Victoria is one example of a community health sector preventative project, with one of the lead project workers being a community psychologist. By focusing on physical activity as part of everyday life, the project has worked successfully to bring about environmental and cultural changes to support increased active transport and social connectedness. The project is embedded within a community psychology research and practice tradition that operationalises concepts such as sense of community, community empowerment and participatory action research.

The project exemplifies how community psychologists address broader systemic barriers to good health. With its focus on engaging a disadvantaged group (mothers in a lower socioeconomic community) and on identifying structural elements that drive healthy behavior (community safety, child and youth friendly places, and adequate infrastructure), Mothers Living Well has resulted in a local neighbourhood action group, enhanced streetscape facilities, development of local leadership capacity and increased volunteer participation opportunities.

Another place-based participatory project in the area of prevention and early intervention is the Communities for Children project in Broadmeadows, a disadvantaged community in the outer suburbs of Melbourne. This initiative helps children aged 0-5 years to have the best possible start in life by providing practical assistance to their families and communities. Local initiatives are determined by local needs. After extensive community consultation, a range of needs and responses were identified. For example, based on the language needs of local children, a speech pathologist was engaged to improve the skills of children from culturally and linguistically diverse backgrounds, in preparation for school. Similarly, following feedback from parents affected by anxiety and depression, a supported playgroup has been established for parents with a mental illness, called the ‘Rising Stars'. And again, the project manager is a community psychologist.

At the other end of the spectrum, the importance of community psychology in the integration of health and aged care services is evidenced by an initiative led by a community psychologist and a health psychologist at the Healthy Ageing Research Unit at Monash University. In partnership with the Ethnic Communities Council of Victoria, the Practising Positive Partnerships project seeks to deepen partnerships across the multicultural community sector to inform advocacy and policy work and ensure that the ageing multicultural population continues to access key services. The project has been commended by key stakeholders for its extensive and positive impact on the Victorian aged care sector.

These initiatives demonstrate the crucial role community psychology can play in ensuring that health policy and prevention initiatives are developed and delivered based on the particular needs of local communities and individuals across the lifespan.

Reference

National Health and Hospitals Reform Commission (2009). A Healthier Future For All Australians - Final Report of the National Health and Hospitals Reform Commission. Canberra: Commonwealth of Australia.

Advocacy for minority groups

Advocating for the needs of marginalised groups and for equitable access to health services and resources is a key task of community psychologists. They are committed and skilled at working alongside the most disadvantaged people in our society, including Indigenous Australians, young homeless people, newly arrived migrants, rural and remote communities, and people living with a disability and their carers. Through their engagement with such groups, community psychologists work to ensure that people facing major health challenges and barriers to service uptake have a better chance of equitable health outcomes.

Young people with mental health problems

Specifically, community psychologists are well placed to progress the Government's focus on encouraging good mental health in young people through the national implementation of youth-friendly, community-based services. For example, with community psychology input in planning and evaluation, the St Kilda Youth Service (SKYS) developed an outreach counselling service in response to the complex needs and situations of young people with mental health issues. These young people have often experienced domestic violence and/or sexual assault and are at risk of homelessness, as well as being disengaged from education, training and employment. The SKYS outreach model was highly successful in engaging and assisting such young people. It provides an example of a community psychology framework applied at an individual level, providing practical support and developing trust and rapport, while at a broader level advocating and raising community awareness about the systems that inhibit effective pathways for disadvantaged young people.

People in rural and remote communities

The ability of community psychologists to adopt a broader, more complex, systems level approach and to work with risk and protective factors at multiple levels is particularly effective in small rural, regional and remote community settings. In both public sector and private practice contexts, community psychologists are valued for their capacity to work in partnership with a range of stakeholders to empower families and communities to address risk factors impacting on their health and well-being. This capacity is particularly important for psychologists working with Aboriginal and Torres Strait Islander clients where it is essential to develop respectful partnerships and to work at an individual, family and community level in order to develop the trust, relationships and cultural competence required to deliver effective interventions. Community psychologists thus have a role in achieving equity in mental health outcomes for rural and remote communities and in closing the gap in social and emotional well-being and mental health for Aboriginal and Torres Strait Islander populations and communities.

Migrants, refugees and asylum seekers

Community psychologists also work to improve health outcomes for migrants, refugees and asylum seekers by advocating for equitable access to health services, as well as being involved in direct service provision. For example, in Melbourne's outer north-west, a region with high cultural diversity and significant disadvantage, several community psychologists in different organisations have been involved in engaging migrant and refugee communities. Through a migrant specific agency (the Migrant Resource Centre), they supported refugee youth to participate in health and sporting programs, while also increasing access to employment for refugee parents. These approaches are based on a preventative, holistic model of care, which strengthens the connections of newly arrived migrants and refugees to their communities, assisting in reducing health problems by encouraging engagement, for example through sport and employment. Others have worked in mainstream organisations to ensure migrant families can actively participate in the provision of health services through volunteering opportunities, and by developing health initiatives that address the identified needs of culturally and linguistically diverse parents and children.

More specifically, the counselling program at the Asylum Seeker Resource Centre (ASRC) in West Melbourne is based on community psychology principles (strengthening personal values, building confidence and hope, and encouraging connectedness to relevant social and support groups to improve a sense of safety and wellbeing). The program operates under a multidisciplinary model of care, and utilises experienced psychologists, social workers and psychiatrists (pro bono) to provide early intervention for traumatised refugees at the individual and family level. The counsellors (and adjunct caseworkers) help connect members to a range of support services such as employment and health, create pathways to participation in social networks, and provide opportunities to contribute to the work of the ASRC. The multidisciplinary team of workers and volunteers is coordinated by a community psychologist.

Asylum seekers are often escaping persecution, war and trauma, leaving behind family, a familiar language and culture, and social supports. Even when feeling safe in a third country, they are often denied respect and basic rights, and left in limbo for extended periods of time. The ASRC counselling program provides a place for asylum seekers to find safety and respect, and to begin to experience a sense of belonging. The program uses a community psychology framework of participation and empowerment that seeks to promote wellness, opportunity and self-determination, while also acting as a springboard for the ASRC's broader charter of advocacy at a public and political level.

Fostering consumer involvement in health care

Community psychologists are particularly skilled and experienced at fostering community participation and empowering consumers to make fully informed health decisions. The involvement of consumers in decisions that impact on their health, including how and what health services are provided, is now recognised as key to ensuring relevant and accessible services, and enhancing the health system's ability to respond to emerging health challenges. As the examples below illustrate, community psychologists have long promoted consumer participation through family, peer and community networks, and at a broader, whole-of-community level.

Community psychology was among the first fields to acknowledge and champion the critical role of consumer and carer participation in health services, in terms of both personal support needs and health service evaluation and reform. The movement of large numbers of people from psychiatric hospitals in the 1960s changed the face of mental health services in Australia. Many psychologists realised their training in psychopathology and psychometric assessment left them ill-equipped to work in community settings. They found that helping people to adjust to community life after discharge from hospital was a more pressing concern, and that skills in counselling, community development and advocacy were needed (Smith & Gridley, 2006).

Community psychology in Australia emerged from this context, and community psychologists supported the growth of advocacy and support groups in the 1970s and 1980s. They have continued to work alongside groups such as GROW - one of the largest community mental health organisations - to strengthen the consumer voice. In Western Australia for example, a community psychologist's doctoral work, in collaboration with GROW, has made an important contribution to research on the positive recovery impact of mutual help groups for mental health, including raising the profile of these groups in Australia and emphasising the importance of recovery via empowerment and quality of life within a community context (Finn & Bishop, 2001).

Community psychologists have also supported opportunities for advocacy and real consumer input to improved service provision, and many people living with disabilities are now active in contributing to policy development and advocacy services. Community psychologists have long argued that any health professional entering the health workforce, or completing undergraduate or postgraduate mental health courses, should have the opportunity to be educated by consumers, their family and carers about their experiences of living with illness or disability, their requirements for adequate services and support, and their ability to work in partnership with mental health professionals.

The facilitation of service networks and involvement of families and communities in response to a public disaster such as a bushfire or a more private tragedy such as suicide is another example of how community psychology works to empower people to be actively involved in building stronger, healthier communities, even under highly distressing circumstances. In Western Australia community psychologists are playing an important role in addressing the gap in services and support for people bereaved by suicide. Active Response Bereavement Outreach (ARBOR) was established in WA as a postvention model that seeks to make contact with the bereaved as soon as possible after a suicide. The program aims to ensure people bereaved by suicide are supported in their grief journey through a caring community network of peers and professionals.¹ By actively engaging those affected by suicide to work alongside professionals in supporting other families who have also experienced suicide (in a peer support model), communities are able to use their knowledge, skills and experience to assist in the recovery process. This ensures supports are relevant to the needs of families and builds stronger community connections. Community psychologists have been involved in both the implementation and evaluation components of this program.

Community psychologists are familiar with the International Association of Public Participation (IAP2) model, and facilitate community participation, consultation and engagement processes that are led by, and relevant to each local community. For example, under the leadership of community psychologists, the municipalities of Port Phillip, Whitehorse and Whittlesea in Melbourne developed community engagement frameworks that were driven by the needs, aspirations and experiences of local communities. These frameworks have been used by the local health systems, and in turn have influenced health policy and the development of community participation opportunities.

Working at multiple levels, community psychologists are well placed to facilitate consumer and community participation at the service development, delivery and evaluation points. Their role in ensuring meaningful opportunities for consumer participation has led to more relevant services and better health outcomes for consumers, the health system and the broader community.

¹For more information on ARBOR, see www.ichr.uwa.edu.au/preventingsuicide/arbor.

References

Finn, L., & Bishop, B. (2001). Mutual help: An important gateway to wellbeing and mental health. Journal of Psychosocial Rehabilitation, 13-17.

International Association for Public Participation. (2004). The IAP2 Public Participation Toolbox. Accessed on 11 May 2010 from www.iap2.org.au/sitebuilder/resources/knowledge/asset/files/36/iap2spectrum.pdf.

Smith, M., & Gridley, H. (2006). Living with mental illness in Australia: Changes in policy and practice affecting mental health service consumers. Australian Psychologist, 41(2), 130-139.