Mental Health

 [ Migrants ] [ Refugees ] [ Detention ] [ Women & Children ] [ Key Terms ]

Migrants and mental health

• Over a quarter of a million first generation adult Australians from culturally and linguistically diverse backgrounds are estimated to experience some form of mental disorder in a 12 month period¹.

• There are a number of sources of stress that may impact on the mental health of migrants. These include pre-migration experiences, the process of resettlement, and the individual's response to the stressors of the dominant culture.

• In 2004-2005, significant psychological distress - especially related to war and conflict, but also to the disruption of moving and leaving friends and family - was observed among some migrant groups. The ability of migrants to negotiate the resettlement process is a factor that may play a part in the future mental health and wellbeing of migrants².

• The characteristics of the host culture impact upon the mental wellbeing of immigrants, such as the level of racial discrimination, unemployment, or dealing with immigration officials³.

• The conceptualisation of mental illness differs from culture to culture. In less industrialised cultures mental illness may be interpreted as being caused by external forces. For example, in South-western Greece inhabitants are more likely to attribute causes of psychotic illnesses to a metaphysical beliefs of a magico-religious nature (eg: satanic interference). Latin Americans are more likely to conceptualise psychiatric symptoms physically (somaticisation)⁴.

• The impact of language around mental illness may be different in other cultures. For example, in Islamic culture being labelled as 'insane' can carry positive connotations. The individual might be seen to be innovative, original, and creative or attempting to find alternatives to static and stagnant modes of living⁵.

• The somaticisation of psychological problems in some communities may result in the misdiagnosis of the illness and subsequent inappropriate treatment.

• Migrant communities do not access mental health services as often as the mainstream population. In addition, the hospitalisation rate for immigrants with a mental illness who speak a language other than English is markedly lower than that of the overall community⁶.

• In 2005, overseas-born people who were recent arrivals or whose main language at home was one other than English were less likely to report mental health or behavioural problems than were Australian-born people, overseas-born people who arrived before 1996, or overseas-born people who spoke English as their main language at home⁷.

• Overseas-born people are less likely to be hospitalised for a number of mental disorders, including schizophrenia, depressive episodes and sleep disorders⁸.

• Older migrants are at an increased risk of depressive disorders and suicide. Factors contributing to this risk include: loss, physical illness or disability or the onset of disorders such as dementia, which often results in a loss of competency in English. Nostalgia and loss of hope of returning to the homeland and increased inter-generational conflict are particular stressors in the later years of life of migrants in Australia⁹.

• New and emerging communities are at a disadvantage as they generally lack completed family and social networks. These communities are often in need of highly targeted and specialised services but lack knowledge of existing health and mental health services¹⁰.

• People from diverse backgrounds settling in rural and remote areas may face increased isolation due to language and communication barriers, remoteness from culturally appropriate services, lack of adequate social networks, alienation and discrimination¹¹.

• During the school years, children from diverse backgrounds may be confronted by perceived differences from the mainstream culture, by language difficulties and a range of issues related to the cultural contexts of family life, education, and values about child behaviour¹².

• Adolescents and young adults from diverse backgrounds may experience heightened uncertainty related to cultural identity, discrimination, peer relations, cultural views on sexuality and sexual identity and work and family
  demands¹³.

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Refugees and mental health

• Refugees and asylum seekers are at high risk of mental health problems as a direct result of the refugee experience and displacement. In addition, they come from a range of countries and cultures, and have a wide range of experiences that may affect their mental health.

• There is substantial evidence that trauma and loss may have profound and ongoing effects on people who migrate to Australia as refugees.

• The mental health problems that refugees and asylum seekers may experience are anxiety disorders including post-traumatic stress disorder, depression and chronic grief.

• The most serious mental health problems for refugees may manifest themselves in severe depressive behaviour, agoraphobia, panic attacks, self-harm, violent or disruptive behaviour, alcohol or drug abuse, sleeping disorders, eating disorders, and psychosomatic illness.

• Refugees who have a mental illness face many obstacles in accessing treatment for psychological trauma and mental illness in both the pre and post migration period.

• Wartime and flight presents little opportunity for treating mental illness. Countries of first asylum rarely have the services available to deal with the mental health problems of large numbers of refugees and settlement in a foreign country may mean an absence of culturally, linguistically, and spiritually appropriate means of addressing psychological and emotional pain¹⁴.

• Refugee women can face many dangers while fleeing their country of origin, or in places of settlement, including physical and sexual violence, abduction, forced prostitution and forced sale of children.

• Stressors that may accompany the post-migration period for refugees include: uprooting which may include loss of family, friends and possessions; poverty; and experiencing marginalisation and racism in the host country.

• Experiences that exert a negative effect on children during war are: the violent death of a parent, witnessing murders or torture of family members, separation from family, migration, terrorist attacks, child soldier activity, bombardments and shelling, physical injuries and famine.

• One of the unique post-migration challenges faced by refugee children and youth is differential rates of acculturation between themselves and other members of their families.

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The effect of detention on mental health

• Since 1991, Australia has had a policy of mandatory detention of onshore asylum seekers while applications for refugee status are processed.

• An inquiry undertaken by the Human Rights and Equal Opportunity Commission (HREOC)¹⁵ found that; 
  
  
  • Mental distress in varying degrees is common in detained asylum seekers, with 'a large number of detainees experiencing mental health problems'.
  • Factors regarded as increasing the risk of mental distress included: prior experiences of torture or other forms of persecution in the country of origin; the stresses created by the length and conditions of detention; and the feelings of anxiety and desperation in those whose refugee claims are rejected;
  • There is 'considerable tension created by the regime of control necessary to implement the policy of mandatory detention' and the indeterminate nature of the detention made it considerably more difficult to endure;
  • Prolonged detention has harmful effects on the mental health of adults and development of children and
    adolescents.
  • Institutionalisation of children has a negative impact on their mental health. Children in immigration detention centres may suffer from anxiety, distress, bed-wetting, suicidal ideation and self-destructive behaviour including attempted and actual self-harm¹⁶.
  • The longer children are in detention the more likely it is for them to suffer serious mental harm¹⁷.

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Refugee women and children

• Women and children make up 80% of the world's refugees and displaced persons¹⁸.

• For many women refugees, the violent situations that cause them to flee their home countries is the beginning of a path which may itself present many dangers such as physical abuse, rape and abduction¹⁹.

• Many refugee women are widowed or become separated from their husbands during flight and they become the sole adult responsible for their dependent children. This responsibility and the potential isolation and stress on the mother increases her risk for mental illness²⁰.

• A consistent finding from studies is that separation from family members was perceived as more distressing to children than air raids or bombings²¹.

• Research has shown that the way in which trauma is experienced is related to the age and developmental stage of the child. Preschool children, who are particularly dependent on their parents, may react to trauma with anxious attachment behaviour, while school-age children may change radically following a traumatic event. Adolescents may lose impulse control and engage in antisocial acts.

• Post-traumatic stress disorder (PTSD) among children and adolescents may become chronic when factors such as a lack of supportive parents or other adult attachment figures, inadequate mental health services and ongoing trauma persist. On the other hand, maintenance of attachment relationships and enabling adults to support traumatised children has been found to protect children from the development of chronic PTSD.

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References

1. Commonwealth Department of Health and Aged Care. (2004). Framework for the Implementation of the National Mental Health Plan 2003-2008 in Multicultural Australia. Canberra, ACT: Commonwealth of Australia. 
2. AIHW. (2008). Australia's Health 2008. Canberra: AIHW.
3.Ritsner, M., Ponizovsky, A. & Ginath, Y. (1997). Changing patterns of distress during the adjustment of recent immigrants: a 1-year follow-up study. Acta Psychiatrica Scandinavica, 95, 494-499.
4. De Leo, D. & Spathonis, K. (2003). Culture, society and suicide. Australian Mosaic, 4, 27-30.
5. Okasha, A. (1999). Mental health in the Middle East: An Egyptian perspective. Clinical Psychology Review, 19, 917-933.
6. McDonald, B., & Steel, S. (1997). Immigrants and Mental Health: An epidemiological analysis. Sydney: Transcultural Mental Health Centre.
7.  AIWH. (2008). Op cit
8.  Ibid
9. Commonwealth Department of Health and Aged Care. (2004). Op cit
10. Ibid
11. Ibid
12. Ibid
13. Ibid
14. Kemp, A. Mental Health: Culture health refugees immigrants. Retrieved May 15, 2005 from http://www3.baylor.edu/~Charles_Kemp/refugee_mental_health.htm.
15. Human Rights and Equal Opportunities Commission. (1998). Those Who've Come Across the Seas: The report of the Commission's Inquiry into the detention of unauthorised arrivals. Canberra, ACT: HRECO.; Steel, Z. & Silove, D. (2001). The mental health implications of detaining asylum seekers. Medical Journal of Australia, 175, 596-599.
16. Human Rights and Equal Opportunities Commission. (2004). A last resort? The national inquiry into children in immigration detention. Canberra, ACT: HREOC.
17. Ibid
18. NSW Refugee Health Service. Fact Sheet 5: Refugee women. Retrieved May 17, 2005 from http://www.swsahs.nsw.gov.au/areaser/refugeehs/main.asp.
19. United Nations High Commissioner for Refugees. (1991). Guidelines on the protection of refugee women. UNHCR: Geneva.
20. Ibid
21. Barnes, D. (2003). Asylum Seekers and Refugees in Australia: Issues of mental health and wellbeing. Sydney: Transcultural Mental Health Centre.
 

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