Research Commentary  April 2017
Apr 1, 2017
Our focus for this month is on refugee youth and mental health. The research reviewed shows that refugee youth are at risk of developing mental illness and experiencing co-morbid disorders, such as depression and anxiety (Pumariega, Rothe & Pumariega, 2005; Schweitzer, Melville, Steel & Lacherez, 2006; Te Pou, 2008). Studies show that refugee children and young people are at Increased risk of mental illness due to: pre-migration experiences, including: war, physical injury and sexual assault, family separation, refugee camp life with its daily struggle for survival, disempowerment and decreased safety, violence and atrocities, extreme poverty and deprivation; immigration and re-settlement experiences, including: abandonment of home land, cultural differences, limited language abilities, lack of social supports, a new set of behaviours and expectations and; adolescent developmental challenges, including: adjusting to ongoing life stressors, maintaining the family system, negotiating educational systems, and manoeuvring through impersonal social and health service systems.
Pumariega, A.J., Rothe, E. & Pumariega, J.B. (2005). Mental Health of Immigrants and Refugees. Community Ment Health J, 41 (5), 581–597.
Schweitzer, R., Melville, F., Steel, Z. & Lacherez, P. (2006). Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. Australian & New Zealand Journal of Psychiatry, 40(2), 179–187.
Te Pou (2008). Developing culturally responsive services for working with refugee youth with mental health concerns. Auckland: Te Pou. Retrieved from: http://www.tepou.co.nz/uploads/files/resource-assets/Developing-Culturally-Responsive-Services-for-Working-with-Refugee-Youth-with-Mental-Health-Concerns.pdf.
Commentary provided by Dr Annette Mortensen, eCALD® Project Manager: Research & Development.
The articles reviewed are as follows:
Article 1: In or out? Barriers and facilitators to refugee-background young people accessing mental health services
Refugee young people have been identified as a group with high risk for mental health problems, due to their experience of trauma, forced migration, and stressors associated with settlement. A high prevalence of mental health problems is reported in this group; however some research suggests refugee young people have low rates of mental health service access. There is little information available on barriers and facilitators to mental service delivery for this group. Using data from 15 focus groups and five key informant interviews with a total of 115 service providers from 12 agencies in Melbourne, Australia, this paper explores barriers and facilitators to engaging young people from refugee backgrounds with mental health services. Eight key themes emerged: cultural concepts of mental health, illness, and treatment; service accessibility; trust; working with interpreters; engaging family and community; the style and approach of mental health providers; advocacy; and continuity of care. Consistent with previous literature on culturally competent mental health services (Minas, 2001, 2007), this study found that key aspects of engaging refugee young people included understanding of the young person’s ethno-cultural background, migration pathway and possible trauma, and consideration of cultural interpretations of health and illness.
Authors: Erminia Coluci, Harry Minas, Josef szwarc, Carmel Guerra, Georgia Paxton.
Citation: Colucci, E., Minas, H., Szwarc, J. & Guerra, C. (2015). In or out? Barriers and facilitators to refugee-background young people accessing mental health services. Transcultural Psychiatry, 52 (6) 766–790.
Article 2: Ethnic differences in DSM-classifications in youth mental health care practice
In community youth mental health care (YMHC), patients are mostly diagnosed according to the clinical judgment of professionals. Because validated instruments are hardly used, this process may be influenced by other factors than the diagnostic criteria, such as the ethnic background of the patient. The goal of this study was to assess differences between ethnic groups in the received clinical diagnoses. The sample consisted of children (n=1940) and adolescents (n=2484) admitted to a Dutch YMHC center. Ethnic background was specified based on the country of birth of the parents. Odds ratios on clinical diagnoses for non-native patients were calculated with the native patients as reference. The results showed that native patients more often received specific psychiatric disorders and co-morbid diagnoses on Axis I, while ethnic minority children more often received V-codes only, indicating that there was insufficient information to determine a psychiatric disorder. The authors therefore assume that it is harder to recognise psychiatric disorders when non-native patients are diagnosed. This could imply that immigrant children and adolescents are not adequately treated for their disorders in YMHC. The authors recommend that YMHC professionals should reflect on the potential biasing effect of the patient's ethnic background in diagnostic procedures.
Authors: Anna M. de Haan, Albert E. Boon, Robert R.J.M. Vermeiren and Joop T.V.M. de Jong.
Citation: de Haan, A.M., Boon, A.E., Vermeiren, R.R. J.M. & de Jong, J. T.V.M. (2014). Ethnic differences in DSM-classifications in youth mental health care practice. International Journal of Culture and Mental Health, 7 (3), 284-296. http://dx.doi.org/10.1080/17542863.2013.789918
Article 3: Vietnamese American families' perceptions of children's mental health: how culture impacts utilization of mental health services
More research is needed in the area of counselling children (Thompson, 2007) and specifically with ethnic minority children. Despite the large population and higher prevalence of mental health concerns due to refugee and immigrant status compared to the overall American population, the Vietnamese American population underutilizes mental health services. The current study expands on existing research using a constructivist lens and multiple case study approach. Semi-structured interviews were conducted with four Vietnamese American mothers who had children 12 and under who had or are currently using mental health services. Two primarily were Vietnamese speaking and two were primarily English speaking. Participants shared perceptions of mental health for Vietnamese American children, and described their experiences with mental health services for their children. The findings of this study indicate that Vietnamese beliefs and values, perceptions of problems, perceptions of factors contributing to mental health, approaches to addressing mental health concerns, and experiences of treatment all impacted the participants perceptions of their children’s mental health service use.
The study highlighted the need for culturally relevant interventions which reflected the client and their family’s acculturation processes. Parental acculturation impacted on their help-seeking behaviours for their child and their engagement with the treatment offered by mental health services.
Authors: Nancy Hieu Nguyen and Dr Elizabeth Mellin.
Citation: Nguyen, N.H. & Mellin, E.A. (2014). Vietnamese American families' perceptions of children's mental health: how culture impacts utilization of mental health services. Ann Arbor, Mich.: ProQuest.
Article 4: "It comes down to just how human someone can be": A qualitative study with young people from refugee backgrounds about their experiences of Australian mental health services.
While much literature documents the mental health needs of young people from refugee backgrounds, and the barriers they face in accessing mental health services, researchers have yet to document the perspectives of service users from this population about their contacts with clinicians and services. The authors individually interviewed 16 young people (aged 18–25 years) who were refugees about their experiences of seeing mental health professionals. Participants were born in 9 different countries and had lived in Australia for an average of 5.2 years. They placed most emphasis on in-session factors, and particularly on interpersonal considerations. Among the main themes identified via thematic analysis were the practitioner's sensitivity to the young person's cultural background and to the stressors affecting him or her, including traumatic refugee experiences, and the therapeutic relationship—especially the qualities of trust, understanding, respect, and a caring connection. The participants had diverse reactions to treatment strategies. They emphasised the role of their preconceptions around mental health services, and called for systematic mental health awareness-raising for young people from refugee backgrounds.
The findings highlighted In particular, the need for practitioners to attend to their clients' experiences of sessions, to adopt an attuned, contextualised, systemic approach, and especially to take a nuanced approach to cultural sensitivity. Participants valued accessible practitioners who combined content expertise with interpersonal qualities to make clients feel listened to openly, responded to aptly, and recognised as individuals affected by their circumstances (including cultural influences as well as past and present stressors). Participants’ perspectives on good mental health practice broadly agree with systemic approaches to working with young refugees (Watters, 2008), and suggest that program delivery needs to integrate both trauma-informed approaches and systems focused approaches (Kaplan, 2013).
Authors: Madeleine C. Valibhoy, Ida Kaplan, Josef Szwarc.
Citation: Valibhoy, M., Kaplan, I. & Szwarc, J. (2015), “It comes down to just how human someone can be”: A qualitative study with young people from refugee backgrounds about their experiences of Australian mental health services. Melbourne: Victorian Foundation for Survivors of Torture (Foundation House).