Mental Health Among Refugees in Australia - Case Study Example

Social determinants of health: Mental Health Among refugees in Australia Name Institution Table of Contents Table of Contents 2 Introduction 3 Selected Population: African refugees in Australia 3 Concept of Social determinants of health (SDH) explained 4 The impacts of social exclusion/discrimination on refugees 4 Addressing the impact of the SDH 7 Conclusion 10 References 10 Introduction While Australia has strict anti-discrimination laws, their benefits to social groups that are at risk of discrimination remain uncertain. This is particularly the case for recent arrivals in the country from culturally and linguistically diverse (CALD) backgrounds, such as the African refugees. On the other hand, the spotlight on social exclusion and discrimination in Australia has, during the recent decade, shifted from Asians, who currently settle in Australia under the business or skilled migration class, to individuals from Middle East and Africa (MEA), who arrive as refugees (Holman, 2015). This paper selects discrimination/social exclusion as the social determinants of health to review the situation of refugees in Australia. It also examines the impact of discrimination and social exclusion on refugees. Lastly, it recommends strategies that can be used to address discrimination and social exclusion. Selected Population: African refugees in Australia The African refugees in Australia, which forms a minority population in Australia, are selected for review. The United Nations High Commissioner for Refugees defines a refugee as an individual who, because of a well-founded fear of persecution on grounds of religion, race, nationality, ethnicity or by virtue of being a member of a certain social group, lives outside the country of origin or nationality to seek the protective advantages of a host country (Colic-Peisker & Tilbury, 2007). Currently, Africans comprise the largest population segment of the Australian humanitarian intake. A majority of racist perspectives regarding their ‘unassimilability’ have in recent times re-emerged in public. In spite of the fact that the Australian population has become gradually more ethnically and racially diverse during the recent decades, the Anglo-Celtic foundations of contemporary Australia still consider Australia to be a ‘white’ and ‘Anglo’ nation. According to the Australian Bureau of Statistics (ABS), some 58 percent of Australian immigrants who arrived from 2000 to 2010 originated from Africa, Asia, and the Middle East. The refugees form a minority group in Australia. Since 1975, the amount of offshore refugee category visas that the Australian government has granted to refugees has significantly varied, with the highest ever being during the 1980s, when 20,795 visas were granted. Since 2000, the Australian government has limitedly increased the yearly quota of refugee visas to the present amount of about 6,000 visas. However, in 2012, the number of refugee visas given was nearly 12,000 (Karlsen, 2015). Concept of Social determinants of health (SDH) explained The social determinants of health consist of the conditions within a social world that affect the health and wellbeing of certain segments of the population. According to Woolf and Braveman (2011), the social determinants of health include the social factors with strong influence on mortality and morbidity; discrimination based on ethnicity, sexual orientation, race, gender, or norms, language traditions and beliefs. For instance, the social determinants of mental health are income status, gender, socio-economic class, education level, racism and ethnicity, and employment status. The concept of ‘social determinant of health’ has been found to be a major cause of certain health conditions (Woolf & Braveman, 2011; Beltran et al., 2011). The impacts of social exclusion/discrimination on refugees Social exclusion and discrimination of the refugees is strongly understood to be a major cause of the prevalent mental disorders among the refugees (Centre for Multicultural Youth, 2014; Colic-Peisker & Tilbury 2007; Minas, 2015). In Australia, the individuals from CALD backgrounds, particularly the refugees, have higher rates of socially determined risk factors for mental illnesses. In addition, they share certain experiences that render them specifically vulnerable. Such experiences include acculturative stress, migration, racism, and language barriers (Tayloer, 2004). A recent survey by Minas et al. (2013) to determine the relevance of health policies in Commonwealth, State, and Territory established that there was a high variable level of attention to matters relating to immigrant and refugee communities. Despite this, the under-represented areas include provision of information that promotes access to language services, and coordinating health care. For instance, studies have established that populations that experience low-income levels also tend to possess lower education levels. They also live in areas that are densely populated and with limited access to gainful employment and healthier food outlets. In addition, they also witness poorer health outcomes, and lack sufficient health insurance (Woolf & Braveman, 2011; Beltran et al., 2011). Current studies have consistently established that the refugees in Australia are specifically at risk of suicidal behaviours and self-harm due to mental disorder that result from their low income status, gender, social exclusion, socio-economic class, education level, racism and ethnicity, and employment status, yet they do not get specialised mental health care they require (Tayloer, 2004; Colic-Peisker & Tilbury, 2007; Minas, 2015). A report by the National Mental Health Commission recently established that the rates of anxiety, depression, as well as post-traumatic stress disorder ranged between three and four times higher among refugees living in Australia than rates among other immigrants. The young refugees were also cited to be specifically at greater risk of depressive symptoms. Social exclusion, therefore, contributes to mental disorders among the refugees. The refugee experience may vary from having witnessed or experienced violence, imprisonment, torture, and abuse from the host country (Tayloer, 2004). The Refugees tend to encounter perilous lives in refugee camps after being separated from their family members. Such distressing experiences have been found to affect their mental health and wellbeing, as a result putting them at greater risks of exhibiting posttraumatic stress disorder (PTSD). At the same time, studies have showed a strong relationship between experiencing violence and developing PTSD (Tayloer, 2004; Craig, 2010). According to the Centre for Multicultural Youth (2014), refugees are at greater risk of several mental disorders and suicide because of inequitable access to mental health case due to discrimination. In Australia, it is estimated that some 40 percent of the refugees in Australia have experienced violence, yet cannot access healthcare (Mental Health in Multicultural Australia, 2013). Additionally, a third of the refugee population in Australia has witnessed combat fire while more than 20 percent have witnessed disappearance of their family members. Consequently, they are given to witness culture shock, grief, sleeplessness, dissociation, and chronic hypervigilance, which are bound to be aggravated by social determinant factors like poor access to better mental healthcare because of their low-income status (Centre for Multicultural Youth, 2014). Poor assimilation, or acculturation, which is encouraged by social exclusion, has also been found to cause also mental illness among the refugees (Colic-Peisker & Tilbury, 2007; Minas, 2015). Assimilation refers to the processes based on which the refugees attempt to adjust socially and emotionally to their new surroundings (Mental Health in Multicultural Australia, 2013). In the course of assimilation, the refugees have been cited by literature as experiencing high levels of stress, which is a significant mental health risk factor for the group. The stresses include migration status, such as reasons for migration, cognitive and personality factors, age and gender, response to immigrants in their new environment and cultural distance. The acculturative stress cause higher rates of depression and anxiety. According to Colic-Peisker and Tilbury (2007), such effects may be experienced throughout their generations or lifetime. Racial discrimination also significantly affects the mental health and wellbeing of refugees. According to Craig (2010), the individuals experiencing racism and discrimination tended to report greater levels of emotional distress, depression, and psychosis. Research literature has also showed a clear relationship between coming from a stigmatised community and poor mental health status. Racial discrimination among the immigrants has also been found to reduce rates at which people participate in a range of social activities that may act as protective factors for mental health (Mental Health in Multicultural Australia, 2013). Language barrier is also vital structural obstacle capable of preventing individuals from accessing mental health care, or achieving better health status. A study by Craig (2010) showed that there is a strong link between language barrier and mental distress. The refugees with low English language proficiency were found to be more likely to report mental health problems from primary care. Addressing the impact of the SDH The Australian government and its national health system lack the capacity to respond adequately to the inequities to prevent the social determinants of health affecting the refugees. In reality, Australia’s refugee policies have been criticised by human rights organisations for being racist. For instance, Australia builds walls and fences around remote detention camps where refugees and asylum seekers are detained (Dyer, 2013). This reflects the country’s uninspiring efforts in resettling refugees in its onshore detention camps. Indeed, statistics by the Department of Immigration and Border Protection shows that refugees in Australia spent averagely 445 days in the detention camp (Loewenstein, 2016). Therefore, an underlying assumption is that achieving better population health demands greater emphasis should be given to the individual's control, including mitigating the social and economic factors that cause poor health. Therefore, it is recommended that: Inclusion and social empowerment of the refugees is recommended, as it can play an instrumental role in reducing the social inequities. Therefore, addressing the factors that encourage successful assimilation of the refugees can assist people and their communities to attain improved mental health outcomes (Woolf & Braveman, 2011). For this reason, the host culture should be encourage to play a significant role in assisting the immigrant or refugees to assimilate by initiating a multicultural community, which can readily accept and a well as appreciate cultural diversity. The mental health services should as well examine the manner in which they offer culturally responsive services or encourage cultural diversity. This intervention is likely to encourage the refugees to integrate with the local neighbourhood or participate in community networks and their willingness to access health services (Mental Health in Multicultural Australia, 2013). Greater levels of social and cultural inclusion may also counteract the effects of racism and racial discrimination. By working jointly with the CALD communities and the major stakeholders, the mental health services may lead to efficient identification of local problems.  Additionally, advocacy support in the health system is viewed to be critical for the refugees, when their health statuses are compounded by cultural and language barriers. Such requirements cannot solely be supported by language services. Alternatively, the hospitals should always ensure that interpreters are made available to refugees with language problems, as this would enable them to confidently express themselves (Minas, 2015). Within the hospital settings, providing the medical practitioners with cross-cultural competency skills is significant, as this will enable them to communicate and interact effectively with the refugees with CALD background. At this rate, emphasis should be given to individual refugees’ experience and cultural background (Tayloer, 2004). This would call for advocacy support for refugees who cannot communicate effectively because of cultural and language barrier. The training content should contain knowledge of the culture and history of different refugees from across the globe, as well as how to handle health emergency events for refugees who are torture survivors and those having trauma (Mental Health in Multicultural Australia, 2013)). The Commonwealth government should engage state and territory governments providing educational opportunities for refugees who have been given visas. This will play a critical role in empowering them (Mental Health in Multicultural Australia, 2013). The local governments in Australia should also be engaged in coordinating healthcare systems for the refugees, as they can play an instrumental role in increasing primary healthcare access for refugees with mental health. Additionally, the Australian employers or companies should be engaged to reserve some employment opportunities for the refugees. Job opportunities would save the refugees from the stresses associated with low-income status. Conclusion As established, the refugees who live in Australia are specifically at risk of suicidal behaviours and self-harm due to mental disorder that result from their low socio-economic class, social segregation, racism and ethnicity, language barrier, and unemployment status, and inequitable access to health case. However, the Australian government and its national health system lack the capacity to respond adequately to the inequities to prevent the social determinants of health affecting the refugees because of its policies that are aimed at segregating the refugees. However, inclusion and social empowerment can play an instrumental role in reducing the social inequities. Greater levels of social and cultural inclusion may also counteract the effects of racism and racial discrimination. Additionally, advocacy support in the health system is viewed to be critical for the refugees, when their health statuses are compounded by cultural and language barriers. The Commonwealth government should also engage state and territory governments providing educational opportunities for refugees who have been given visas. References Beltran, V., Harrison, K., Hall, I. & Dean, H. (2011). Collection of social determinant of health measures in U.S. National Surveillance Systems for HIV, Viral Hepatitis, STDs, and TB. Public Health Rep,126(3): 41–53. Centre for Multicultural Youth. (2014). Mind matters the mental health and wellbeing of young people from diverse cultural backgrounds. Retrieved: Colic-Peisker, V. & Tilbury, F. (2007). Refugees and 90 Employment: The effect of visible difference on discrimination. Murdoch: Murdoch University Craig, T. (2010). Mental health of refugees and asylum seekers. Oxford: Oxford University Press Dyer, G. (2013). The problem with Australia’s refugee problem. The Japan Times. Retrieved: Holman, S. (2015). Beholden: Religion, Global health, and human rights. Oxford: Oxford University Press Karlsen, E. (2015). Refugee resettlement to Australia: what are the facts? retrieved: Loewenstein, A. (2016). Australia's refugee policies: a global inspiration for all the wrong reasons. The Guardian. Retrieved: Mental Health in Multicultural Australia. (2013). Risk and protective factors. Retrieved: Minas, H. (2015). “Getting the facts about refugee and migrant mental health in Australia." The Conversation. Retrieved: Minas, H., Kakuma, R., Vayani, H., Orapeleng, S., Prasad, R.. Turner, G., Proctor, N. & Oehm, D. (2013). Mental health research and evaluation in multicultural Australia: developing a culture of inclusion. Int J Ment Health Syst. 7(23), 1 Tayloer, J. (2004). Refugees and social exclusion: What the literature says. Migration Action, 24(2), 16-31 Woolf, S. & Braveman, P. (2011). Where Health Disparities Begin: The role of social and economic determinants—and why current policies may make matters worse. Health Affairs, 30(10), 1852-1859 Read More