Multicultural Mental Health Forum

Recognising and responding to Mental health concerns in young people from

multicultural backgroundsBy David Keegan

DEFINITION

A mental illness is a diagnosable illness which causes major changes in a person’s thinking, emotional state and behaviour, and disrupts the person’s ability to study or work and carry on their usual personal relationships.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) Washington DC: American Psychiatric Association

What is a mental illness?

PERCENTAGE OF AUSTRALIANSWITH A MENTAL ILLNESS IN ONE

YEAR

% MALE % FEMALE % TOTAL

16-24 16-85 16-24 16-85 16-24 16-85

Any Anxiety Disorder 11.0 18.0 14.4

Any DepressiveDisorder 5.3 7.1 6.2

Any Substance Use Disorder 7.0 3.3 5.1

Any Common Mental Disorder 18.0 22.0 20.0

15.5

22.8

4.3

9.3

9.8

30.1

8.4

21.7

12.7

26.4

6.3

15.4

Australian Bureau of Statistics. 2007 National Survey of Mental Health and Wellbeing: Summary of Results. (Document 4326.0) Canberra: ABS 2008

Multicultural Statistics

There is very little data about prevalence within multicultural communities

ABS data suggests similar rates for overseas born Australians

Data suggests high prevalence amongst indigenous people

Outline of Common Mental Illnesses

Depression

– unusually sad mood characterised by persistent symptoms over a period of at least 2 weeks (5 or more symptoms needed)

- Main treatments for youth include CBT and anti-depressants in some cases

Anxiety

– an unusually and persistently anxious response to common situations or to particular triggers. Includes phobias, PTSD, OCD and Panic attacks.

- Main treatments for youth include relaxation, meditation and CBT type therapies

Outline of Common Mental Illnesses

Psychosis

– a loss of reality characterised by delusions and hallucinations. Includes schizophrenia, bipolar disorder and drug induced psychosis

Substance Use Disorder

– Severe addiction to alcohol or other drugs (AOD)

Eating disorders

– characterised by distorted view of self and control through food (includes Anorexia, Bulimia, Binge Eating disorder)

Other disorders include personality disorders which are hard to understand and treat.

Factors/Determinants affecting the

quality of refugee youth settlement

experience

age on arrival

gender

Extent of proactive Familial

support on arrival

network of services

available in settlemet

area

socio-economic capacity

response of host

community

cultural background Religious

affiliation

Ethnicity

experiences of racism

entry unaccompani

ed or with family

Degree of Psychological Trauma and

sequele

Degree of Physical injury or disability

Visa Class (202, 204,

200)

Risk Factors

•Search for own identity/culture•Anxiety, depression, Isolation, alienation•Difficulty to be understood and form new relationships •Language and communication issues•Adolescence/personal issues•Relationships with peers•Feeling of guilt of being here with family and loved ones back in camps or country of origin•Dealing with individual rights of a child/young adult

•Juggling cultures/expectations within family•Loss of family members(due to being killed or going missing in home country).•Reorganization of family hierarchy•Reshaping power to young person -Changes in family roles where young people are expected to adopt adult roles, such as advocating on behalf of the family due to their stronger English language skills;•Pressure to succeed•Family conflict and support: Inter-generational conflict within families due to changing values and expectations;•Changes in family make-up and dynamics as families are reunified after many years of separation, or young people are sponsored out to Australia by distant relatives;•Contributing to family finances including repaying pre-arrival airfare debts;•Need to send money back home•Pressure to maintain religious/cultural tradition at home•Overcrowded housing and a lack of study space

•Adapting to peer influences•Feel frustrated with speed to learn the language for Communication•Different value system•Difficulty feeling accepted•Negative media portrayal•Understanding law/authority challenging if they were perpetrators in country of origin•Employability poor due to unrecognized skills•Racism and stereotyping in the broader community (including in schools and the media);• Access to culturally-appropriate sport and recreation opportunities;• Opportunities for meaningful participation in community debates, structures, groups and environments.

Source: Hunt, D. (2000), Refugee Adaptation in the Resettlement Process (pp. 17-20), and the Minnesota Centre for Victims of Torture.Hunt, D. (2000), Refugee Adaptation in the Resettlement Process. In The National Alliance for Multicultural Mental Health. Lessons from the Field: Issues and Resources in Refugee Mental Health. (pp. 17-20).

Multicultural Experiences of MH

There are many ways that people understand mental illness.

For example….

- A result of past wrongs in the family or by the individual

- A curse

- Demon possessed

- Shame/denial

- Some cultural practices can be confused for mental illness

Cultural barriers to help seeking

• Australia has a very medical approach to Mental Health

• Language and terminology

• Shame

• Spiritual and personality based understanding of mental health

• Lack of culturally appropriate healing and support options

Social Determinants of Mental Health

Some factors promote good mental health regardless of culture

• Social and family connectedness• Positive self esteem• Knowledge about coping strategies and how to

get help early• Sense of purpose and belonging

Cultural Competence

Being culturally competent when providing assistance involves:

• Being aware that a person’s culture will shape how they understand health and ill-health

• Learning about the specific cultural beliefs that surround mental illness in the person’s community

• Learning how mental illness is described in the person’s community (knowing what words and ideas are used to talk about the symptoms or behaviours)

• Being aware of what concepts, behaviours or language are taboo (knowing what might cause shame)

Cultural Safety

Practicing cultural safety means:

• Respecting the culture of the community by using the appropriate language and behaviour

• Never doing anything that causes the person to feel shame

• Supporting the person’s right to make decisions about seeking culturally-based care

Further info

Mental Health First Aid Guidelines - http://www.mhfa.com.au/Guidelines.shtml

Youth Beyond Blue – http://www.ybblue.com.au

Transcultural Mental Health - http://www.dhi.gov.au/Transcultural-Mental-Health-Centre/Transcultural-Mental-Health-Centre-Home/default.aspx

Multicultural Mental Health Australia - http://www.dhi.gov.au/Multicultural-Mental-Health-Australia/home/default.aspx

References

Aboriginal Mental Health First Aid Training and Research Program. Cultural Considerations & Communication Techniques : Guidelines for providing Mental Health First Aid to an Aboriginal or Torres Strait Islander Person. Melbourne: Orygen Youth Health Research Centre, University of Melbourne and beyondblue, the national depression initiative; 2008.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) Washington DC: American Psychiatric Association

Arsenault-Lapierre G, Kim C, Turecki G. Psychiatric diagnosies in 3275 suicides: a meta analysis. BMC Psychiatry 2004; 4:37

Australian Bureau of Statistics. 2007 National Survey of Mental Health and Wellbeing: Summary of Results. (Document 4326.0) Canberra: ABS 2008

Hunt, D. (2000), Refugee Adaptation in the Resettlement Process. In The National Alliance for Multicultural Mental Health. Lessons from the Field: Issues and Resources in Refugee Mental Health. (pp. 17-20).

Kelly CM, Kitchener BA, Jorm AF (2010). Youth Mental Health First Aid: a manual for adults assisting young people. 2nd ed. Orygen Youth Health Research Centre, Melbourne, Australia

Wickramage, K., Versha, A., Gurrum, D., Sankoh, F., Bah, S., Verma, N. (2008) “Un(settled) voices” Project: Perceptions and experiences of young refugees on re-settlement in Western Sydney