Refugee Mental Health Survey
Summary
The majority of refugees and asylum seekers arriving in Australia come from severely impoverished circumstances where even basic resources such as safe drinking water are scarce. As well, most will have experienced traumatic events such as human rights abuses and loss of family members. A significant proportion of refugees and asylum seekers to Australia settle in south east metropolitan Melbourne. The refugee and asylum seeker population is recognized as a priority for Monash Health service delivery and specific refugee health clinics have been established as a significant element of response to this. Services at these clinics are in the process of expanding to specifically address the mental health needs of patients. However, while it is acknowledged that mental health problems are expected to be significant in the refugee community, the precise extent and nature of their needs are not known making it difficult to plan for their care. This project recruitedeligible attendees at the refugee health clinic based at Casey Cardinia Community Health Service and invited participation in a brief survey of mental health needs. Prevalence rates of psychiatric disorders will be compared to a sample of Australian-born residents extracted from the 2007 NSMHWB matched on demographics and service utilization.
Background
The United Nations High commissioner for Refugees (UNHCR) defines a refugee as a person who is outside of their country of nationality due to a well-founded fear of persecution for reasons of race, religion, nationality, particular social group membership or political opinion and is unable or unwilling to avail themselves of the protection of their country or return to it [1]. The majority of refugees arriving in Australia come from severely impoverished circumstances where even basic resources such as safe drinking water are scarce. As well, most will have experienced traumatic events such as human rights abuses, loss of identity and culture, and loss of family members. Such experiences have a direct dose-response relationship to psychological symptoms both at individual and family levels [2]. Furthermore, post migration living difficulties contribute further to mental health symptomatology [3]. Not surprisingly, the rate of long-term medical and psychological conditions is higher compared to other migrants while access to family and community support is lower [4].
The needs of the refugee population have also been recognized as a priority for Monash Health service delivery. Monash Health is the largest public health care provider in Victoria providing services to the South-Eastern suburbs of Melbourne and covering a population of over 750,000. Most notably, its catchment area includes the City of Greater Dandenong, the most culturally diverse municipality in Victoria and the area which receives the largest percentage of newly arrived refugees in Victoria – nearly a quarter of all arrivals to metropolitan areas - as well as Casey which also receives a sizable inflow [4]. In total, the South East metropolitan region of Melbourne resettles around 8% of the nation’s refugees each year. Specific refugee health clinics have been established as a significant element of response to the needs of the local refugee population. In March 2007, Dandenong Hospital partnered with local GPs and the refugee health nurse at Greater Dandenong Community Health Centre to form a refugee health clinic at Dandenong Hospital outpatients. The Dandenong Hospital clinic is complemented by a community centre based refugee health service at the Cardinia-Casey Community Health Service - Doveton Clinic site.
Services at the Monash Health Refugee Health Service are in the process of expanding to specifically address the mental health needs of patients. However, while it is acknowledged that mental health problems are expected to be significant in the refugee community, the precise extent and nature of the needs of attendees at the Refugee Health Service are not known making it difficult to plan for their care.Consistent with the broader literature, a review of the available qualitative literature relating to the healthcare needs of refugees in this region indicates that refugees encounter serious mental health problems as a result of pre-migration experiences and well as difficulties encountered after arrival in Australia. Unfortunately, only patchy information is available about the nature of these problems andlittle is known about the mental health needs of local refugees from the perspective of the refugee clients themselves.In order to address these critical gaps in knowledge Southern Synergy was commissioned to conduct a survey of the mental health needs of clients attending the Refugee Health Service.
Aim of project
PrimaryAim
In relation to service users at the Monash Health Refugee Health Clinic, the primary aim of this study is to determine:
- an overall estimate of the prevalence of psychiatric disorders,using high degrees of psychological distress as a proxy.
- the specific prevalence of post-traumatic stress disorder.
- the perceived need and unmet need for mental health treatment
Secondary Aim
The secondary aim of the study is to compare the findings for 1 and 2 with an Australian-born matched control group from the National Survey of Mental Health and Well-Being (NSMHWB) 2007 in order to establish relative risks.
Significance of study
The recent primary healthcare needs assessment recently conducted in South East metropolitan Melbourne has demonstrated a large burden of both high and low prevalence mental health disorders [5]. However little is known about the nature and impact of these problems and their demographic context. In order to plan effectively for the mental health needs of the large numbers of refugees arriving each year to this region, it is important that data be collected to examine the prevalence of mental disorders within this group and their perceived need for treatment. This project will provide such data which will support expert opinion regarding treatment and policy responses that are most likely to be effective within the Monash Health Refugee Health Service.
More broadly, this study could also be considered as a prototype for what is possible within regular services seeking to plan for and deliver high quality mental health care to refugees, as this becomes a growing issue in countries around the world. The design described here enables a rapid method of collecting key information, including demographics, prevalence of mental disorders and perceived need for mental health care, using a representative sample of refugees from a local community health service population. A novel project output will be the creation and dissemination of a new epidemiological methodology to reliably compare mental health status in a relatively small target sample (refugee’s in our case) with multiple matched controls from the NSMHWB. The new methodology is anticipated to be used by future researchers and health services to reduce costs and when large target samples are not viable such as existing small numbers within the community.
Project Team
Lead investigator: Professor Graham Meadows1
Sponsor:Anne Doherty2
Project Manager:Dr Frances Shawyer1
Expert advisors:Associate Professor Andrew Block3,4, Dr I-Hao Cheng5
Cultural advisors:Dr Sayed Wahidi5, Dr Zoya Shivanand3
Field work interviewers:Simon Acott6, Michael Riches1, Lenore Wambeek7,
Statistical advisor:Dr Joanne Enticott1,5
1Department of Psychiatry, Faculty of Medicine, Nursing and Health Science, Monash University
2Mental Health Program, Monash Health
3Department of General Medicine, Monash Health
4Southern Clinical School, Monash University
5School of Primary Health Care, Faculty of Medicine, Nursing and Health Science Monash University
6School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Science, Monash University
7Transition to Mental Health Nursing Program, Monash Health
Funding
Monash Health
Acknowledgements
Cardinia-Casey Community Health Service staff
- Jacquie McBride (manager)
- Razia Ali (bi-cultural welfare worker)
- Catherine Fulgoni (team leader)
The many volunteers who willingly gave their time and experience to participate in this survey.
References
1.UNHCR.: Convention and protocol relating to the status of refugees. Geneva: UNHCR; 1996.
2.Nickerson A, Bryant RA, Brooks R, Steel Z, Silove D, Chen J: The familial influence of loss and trauma on refugee mental health: A multilevel path analysis. Journal of Traumatic Stress 2011, 24(1):25-33.
3.Schweitzer RD, Brough M, Vromans L, Asic-Kobe M: Mental health of newly arrived Burmese refugees in Australia: contributions of pre-migration and post-migration experience. Australian and New Zealand Journal of Psychiatry 2011, 45(4):299-307.
4.Department of Human Services: Refugee Health and Wellbeing Action Plan 2008-2010. In. Victoria: Department of Human Services; 2008.
5.Cheng I-H, Russell GM, Bailes M, Block A: An Evaluation of the Primary Healthcare Needs of Refugees in South East Metropolitan Melbourne. A report by the Southern Academic Primary Care Research Unit to the Refugee Health Research Consortium. Melbourne: Southern Academic Primary Care Research Unit; 2011.