Improving the provision of services to young people from refugee backgrounds with comorbid mental health and substance use problems: addressing the barriers

Abstract

BackgroundSouth Australia (SA) has resettled 151,134 refugees in the last ten years (Department of Immigration and Border Protection, Settlement reporting facility, 2014). Northern metropolitan Adelaide, an area which experiences significant social disadvantage, has received a significant number of (predominantly young) refugees. Research indicates that refugee youth are at elevated risk of mental health (MH) and alcohol and other drug (AOD) problems. These factors, along with the low socio-economic status of northern Adelaide, the number of refugee youth residing there, and the added complexity of treating comorbid MH and AOD problems (comorbidity) prompted this research. We investigated the barriers and facilitators to culturally responsive comorbidity care for these youth and whether the MH and AOD services were equipped to provide such support.MethodsThis mixed-methods study employed semi-structured interviews with refugee youth and service providers and an online survey with managers of services. Thirty participants (15 refugee youth, 15 service providers) took part in the semi-structured interviews and 56 (40 complete, 16 partially-complete) in the survey.ResultsThematic analysis of the interview data revealed the most commonly reported barriers related to four broad areas: (1) organisational and structural, (2) access and engagement, (3) treatment and service delivery, and (4) training and resources. Survey data supported the barriers identified in the qualitative findings.ConclusionsThis research highlights significant gaps in the response of MH and AOD services to refugee youth with comorbidity. Based on the findings, ways of overcoming the barriers are discussed, and are of particular relevance to policy makers, organisations and clinicians.

Challenges of Refugee Health Care: Perspectives of Medical Interpreters, Case Managers, and Pharmacists

“…Delivering quality care and support for refugee patients, especially around sensitive health care needs including mental health, 25 requires the development of trust and rapport between the patient and provider. Although a growing literature underscores the high-risk factors and complexity of mental health disorders among refugees, health care providers are generally not equipped in providing appropriate mental health screening within this population, making it very challenging to identify and consequently treat.…”

Advancing mental health equality: a mapping review of interventions, economic evaluations and barriers and facilitators

“…Older people, ethnic minorities • Reliance on informal supports and poor knowledge about services available [116,147] • Ignorance about services [57] • Lack of understanding from staff about types of care available and who these are designed for [57] • Lack of education about available services and what treatment entails [44,57] • Lack of knowledge about the healthcare system and about informal networks of healthcare professionals [148] • Making campaigns more relevant and effective, use of simpler, more positive language, use of less individualistic language (e.g. 'me'), respecting different beliefs [45] • Community engagement [46] • Primary care professionals to map community activities [46] • Engaging the local targeted community (including members of the religious community, e.g.…”

“…• Patient cultural views and/or perceptions of the clinician's culture [49] • Anxiety and/or lack of confidence in asking for help [50] • Fear of medical services [33,127] • Confidentiality concerns [40,147] • Negative past experiences with services [147] • Past experience of punitive or forced mental health care making patients unwilling to take up treatment [57] • Concerns about privacy [66] • Decision to seek help from a traditional or religious healer [36] • Fear of 'asylums' [45] • Distrust of social workers and doctors, fear of being asked too many questions, lack of trust in measures to protect confidentiality [45,116] • Facilitation of opportunities for disclosure through tele-mental health methods [48] • Building trusting relationships [37] Appropriateness of available services Aboriginal communities, ethnic minorities, immigrants, children and young people…”

“…• Patient cultural views [49] • Limited culturally appropriate services [34,116] • Diagnostic overshadowing [57] • Provision of culturally appropriate alternatives to mainstream care [33] • Cultural and linguistic competence of staff; cultural reference points [34] literature did not make any further distinctions, once again limiting our ability to draw distinct conclusions for each component group. This approach limits the practical applicability of academic research concerning these communities and highlights a further pervasive inequality to which they are subjected.…”

Living a Healthy Life in Australia: Exploring Influences on Health for Refugees from Myanmar

“…People from refugee backgrounds have poorer health outcomes than those from non-refugee backgrounds [6][7][8][9][11][12][13]. Lack of access to health services in their new home country [10,14,15] presents an additional challenge that is influenced by language barriers, lack of transport, and unfamiliar health service systems [2,[16][17][18][19][20]. Several studies suggest that people from refugee backgrounds have low health literacy, which poses both a barrier and a deterrent to accessing health services [16,[21][22][23][24][25][26][27].…”