Since 1945, Australia has resettled eight hundred thousand refugees and displaced persons into the country. Included in this number are the nine out of every ten asylum seekers who are ultimately found to be of refugee status (Australian Human Rights Commission 2014). ‘What’s the difference between a refugee and asylum seeker?’ you may ask.
An asylum seekers is: ‘A person who has left their country and asks to be recognised as a refugee and to be protected. They may stay in an immigration centre while their situation is assessed’ (Commonwealth of Australia 2010).
A refugee is: ‘A person who has left their country of origin because of a fear that they will be harmed or discriminated against on the basis of their race, religion, political opinion or being a member of a particular social group’ (Commonwealth of Australia 2010).
Refugees and Their Experiences Of Trauma
Refugees and asylum seekers are at a high risk of mental health problems. This can be due to a variety of reasons including their general experience of being a refugee, the displacement from their country, and the stress and anxiety of waiting for the decision to be determined on their migration status (Mindframe 2014).
Refugees may also be experiencing the psychological effects from any trauma they experienced prior to resettlement which may include post-traumatic stress disorder (PTSD) (Murray et al. 2008). Other psychological symptoms of trauma may include feelings of fear, sadness, guilt and anger, which may result in depression, anxiety and substance misuse (Murray et al. 2008).
If the refugee has spent time in mandatory detention, this can exacerbate the impacts of any traumatic experiences and is generally a negative socialisation experience (Murray et al. 2008). Those in mandatory detention experience much higher levels of suicidal behaviour and psychiatric illnesses than the general population. Suicidal behaviour for men in mandatory detention is forty one times higher than the national average and roughly two times higher than men in jail (Murray et al 2008).
The Mental Health Of Refugees During Resettlement
Mental health problems can occur during both the refugee’s time in detention and following that, during their resettlement phase which can make it difficult for the individuals to begin their new life.
Some of the barriers which they may need to overcome during their resettlement process include:
- Losing their family and social supports
- Unemployment as well as a lack of recognition of any professional qualifications and therefore a drop in socioeconomic status
- Language barriers
- Isolation from individuals with a similar cultural background
- Any experiences of trauma before and after settlement
(Government of Western Australia Mental Health Commission 2010).
These barriers can result in the refugee experiencing grief, anxiety and feelings of loss, which can have huge implications for the individual’s mental health.
What Happens After Resettlement?
Following resettlement, there are differences seen in the experience of loss between different refugees. Individuals with higher education qualifications, or those who now have a lower socioeconomic status in resettlement have been seen to have worse mental health problems than others in regards to their experience of loss.
Refugees who also report lower levels of daily activity, are unemployed, facing economic hardship, are socially isolated and have had a loss of meaningful social roles are also at risk of worse mental health outcomes than other refugees (Murray et al 2008).
Refugees are also confronted by the differences in life and culture in general in their new country. They experience a cultural gap in which they are exposed to a new language, cultural values, world views, foods, traditions, paperwork, systems of business and currency overnight (Murray et al. 2008). This change can leave the refugees to experience a sudden loss of identity and can result in conflict as individuals take on new social roles and responsibilities within the community (Murray et al. 2008).
The mental health problems that refugees and asylum seekers are likely to experience include anxiety disorders such as PTSD, depression and chronic grief (Mindframe 2014). They can also further display agoraphobia, panic attacks, self-harm, violent behavior, alcohol or drug abuse, sleeping disorders, eating disorders and psychosomatic illnesses (Mindframe 2014).
What Can We, As Nurses, Do To Help?
There can be many obstacles for refugees to overcome to access the appropriate treatment for mental health problems during and following their resettlement. The number of refugees suffering from different forms of mental health problems has been found to decrease over the course of resettlement (Murray et al. 2008). However this may be contraindicated in those refugees who experienced high levels of trauma prior to resettlement.
Services for refuges need to be appropriate to their culture, therefore as nurses and health professionals we need to:
- Respect the individual’s culture and beliefs
- Be open-minded
- Ask questions about things we don’t know and about a person’s culture and beliefs and show respect towards their plight
- Ensure expectations are shared between the patient and health professional
- Allow more time to support people when using interpreters
- Work with communities to address any stigma and increase mental health awareness
(Government of Western Australia Mental Health Commission 2010).
Nurses play an important role in supporting refugees during and following their resettlement process. Support is essential during this time and will positively impact on their well-being. There are also specialised services available for refugees and asylum seekers such as community health programs, counseling services specific for torture and trauma experiences, multicultural health and support services, language services, health translations directory and access arrangements (The Department of Health and Human Services 2015).
- Australian Human Rights Commission 2014, Face the facts: Asylum seekers and refugees, retrieved from: <https://www.humanrights.gov.au/face-facts-asylum-seekers-and-refugees
- Commonwealth of Australia 2010, Refugees and Mental Health, retrieved from http://www.responseability.org/…al-Health.pdf
- Government of Western Australia Mental Health Commission 2010, Migrant and refugee mental health, retrieved from: <http://www.mentalhealth.wa.gov.au/mental_ill…nt.aspx
- Mindframe 2014, Culturally and linguistically diverse populations, retrieved from: <http://www.mindframe-media.info/for-me…tions
- Murray, K, Davidson, GR & Schweitzer, RD 2008, Psychological wellbeing of refugees resettling in Australia: A literature review prepared for the Australian Psychological Society
- The Department of Health and Human Services 2015, Refugee and asylum seeker health and wellbeing, retrieved from <https://www2.health.vic.gov.au…ealth