Refugees and asylum seekers living in Australia are particularly vulnerable to self-harm and suicidal behaviours, but aren’t getting the specialised mental health care they need, according to a Spotlight Report published today by the National Mental Health Commission.
The report found that rates of depression, anxiety and post-traumatic stress disorder were between three and four times higher among Tamil asylum seekers in Australia than rates among other immigrants. And young refugees more broadly have an increased risk of depressive symptoms.
But this is just a snapshot; we still don’t have a clear picture of the mental health of immigrant and refugee communities in Australia. We sought to investigate the gaps in research, as well as whether mental health research pays adequate attention to the cultural and linguistic diversity in the Australian population.
Growing cultural diversity
As demographer Bob Birrell has noted, “like it or not, we’re more diverse than ever”, with census data showing “Australia is the developed-world champion” in terms of the proportion of the population born overseas. Australian Bureau of Statistics (ABS) data show 58% of immigrants who arrived between 2000 and 2010 were from Asia, North Africa and the Middle East.
The ABS predicts that by 2050, almost one-third (32%) of Australia’s population will be overseas-born.
The majority of recent immigrants and almost half of the longer-settled immigrants speak a language other than English at home. For longer-settled immigrants, Mandarin, Cantonese, Italian and Vietnamese were the most common languages other than English spoken at home, while for recent immigrants, Mandarin, Punjabi, Hindi and Arabic were most frequently spoken at home.
The question of how best to manage such diversity continues to preoccupy countries that receive large numbers of immigrants and refugees. How might society’s institutions, such as education and health systems, need to be transformed to reflect the multicultural reality and to ensure that cultural and linguistic minorities are not systematically disadvantaged?
In order to answer these questions, we should be able to draw on high-quality data, generated by national agencies such as the ABS and the Australian Institute of Health and Welfare and by independent research, much of which is publicly funded. But beyond country-of-birth, the data is generally not collected. And immigrants and refugees are too often excluded from mental health research studies, usually due to low English fluency.
Factors affecting mental health
We can only improve population mental health and provide effective treatment and social support services for people with mental illness if we have a good understanding of both risk and protective factors.
Some of these are very clear. Major psychological trauma prior to migration and prolonged detention of asylum seekers are bad for mental health. Access to decent housing and employment both protect against mental illness and are essential for recovery from mental illness.
But many important questions cannot be adequately answered, such as why some immigrant groups have very high – and others very low – rates of suicide. Knowing more about what protects some immigrant communities from suicide may be as useful in developing suicide prevention programs for the whole population.
Accessing the mental health system
Despite two decades of active mental health system reform, effective and culturally appropriate treatment and care for immigrant and refugees communities is hard to find.
A person with mental illness who does not speak fluent English may or may not have access to an interpreter, and will generally not have access to psychotherapy, rehabilitation and social support programs. For recent arrivals from Somalia, Sri Lanka or Myanmar it is unlikely that relevant cultural issues will be understood and incorporated into the treatment program.
Many communities, particularly Vietnamese and other Asian communities, access public mental health services at less than half the rate of the general population. It seems unlikely that this is because of lower rates of mental illness in these communities. However, inadequate information about mental illness rates in particular communities, and about the factors that influence decisions about help-seeking, makes it difficult to develop sensible policy and service system responses to such a fact.
There are virtually no data on quality of mental health service outcomes. We don’t know whether immigrants and refugees who come into contact with specialist mental health services have clinical and social outcomes that are better, worse or similar to those of the Australia-born.
Given problems in communication, and the fact that Australian mental health clinicians receive very little if any training in culturally appropriate assessment and treatment, one might expect that service outcomes will be worse.
Language and culture are important everywhere but nowhere more so than in understanding mental illness and providing effective mental health services.
The lack of relevant data is a serious obstacle to equity in health promotion and illness prevention efforts, and to provision of effective, equitable and affordable health services. It also systematically undermines capacity to implement and to evaluate health policies.
We need health agencies, research institutions, agencies that collect national data, and the major research funding agencies to collaborate to determine how immigrant and refugee communities can be effectively included in national data collections and in publicly funded research.