Mental health help-seeking and refugee adolescents: Qualitative findings from a mixed-methods investigation

Abstract

There is general agreement in Australia and other Western resettlement countries that many refugee adolescents with social, behavioural, and mental health problems are not accessing mental health care. There is, however, a paucity of research on refugee adolescent mental health service utilisation and help-seeking. Most research to date has centred on adolescents in the general population, and even then is still very limited. This paper presents the findings of 13 focus groups held with 85 refugee adolescents aged 13-17 years from Afghanistan, Bosnia, Iran, Iraq, Liberia, Serbia, and Sudan. The study was part of a wider investigation of mental health service utilisation by refugee parents of children aged 4-17 years, and by adolescents aged 13-17 years. With respect to adolescents, the focus group findings indicate that most are very reluctant to venture beyond their close friendship networks for help with their psychosocial problems due to a range of individual, cultural, and service-related barriers. Implications for mental health policymakers, service planners, and service providers are discussed.

In or out? Barriers and facilitators to refugee-background young people accessing mental health services

“…Leavey, Guvenir, Haase-Casanovas and Dein (2007) suggested families should be engaged because they play a pivotal role in the nature and timing of help-seeking. In contrast, de Anstiss and Ziaian (2010) highlighted that young people may not feel comfortable discussing personal issues with their parents and Ellis and collaborators (2010) found that youth were concerned that telling their parents -who had already many other significant worries associated with war and resettlement -about their problems, would unduly burden them. As suggested by the service providers in this study, best practice may be asking the young person what role they would like their family to play.…”

“…Participants noted refugee young people (and their families) frequently balance competing settlement priorities, and dealing with clients' immediate needs can provide an entry into a therapeutic relationship. This was suggested as particularly important in the context of mental health being considered a low priority (Behnia, 2003;de Anstiss & Ziaian, 2010;Palmer, 2006). Previous literature supported the concept of taking an advocacy role, addressing also practical concerns, and a holistic approach (Behnia, 2003;Cleveland, Rousseau, & Guzder, 2014;de Anstiss & Ziaian, 2010;Hodes, 2002;McColl & Johnson, 2006;Misra, et al, 2006;Palmer, 2006;Ward & Palmer, 2005;Watters & Ingleby, 2004;Woodland, Burgner, Paxton, & Zwi, 2010).…”

Applying the ADAPT Psychosocial Model to War-Affected Children and Adolescents

“…Caregivers may also be traumatized by violence, injustice, and instability (Klingman, 2006;Saile et al, 2014). Reports of traumatized and emotionally unavailable caregivers are found in studies of war-affected children (Al-Mashat et al, 2006;Almqvist & Brandell-Forsberg, 1997;Anstiss & Ziaian, 2010;Dyregrov et al, 2002;Hadi & Llabre, 1998;Henley & Robinson, 2011;Laor et al, 1997;Paardekooper et al, 1999;Qouta et al, 2003;Saile et al, 2014;Thabet et al, 2008). Various studies have found that there is a higher rate of mental health problems within refugee parent populations as opposed to civilian populations (McFarlane et al, 2011).…”

“…However, several other maladaptive responses are potentially linked with safety violations. Psychosomatic complaints (McFarlane et al, 2011;Paardekooper et al, 1999;Sezibera et al, 2009), guilt (Goldstein et al, 1997;McFarlane et al, 2011), neuroticism (Punamäki et al, 2001), underreporting of post-traumatic symptoms due to fear of stigma (Anstiss & Ziaian, 2010;Colucci, Minas, Szwarc, Paxton, & Guerra, 2012;Servan-Schreiber et al, 1998;Thabet & Vostanis, 2000), and developing an external locus of control (Kuterovac-Jagodic, 2003) are also described in groups of children following wartrauma. In total, these maladaptive responses likely contribute to adjustment difficulties for children and adolescents as they seek to begin new lives following war.…”

“…For example, Dyregrov et al (2002) reported that it was common practice in Iraq for parents to tell their children to forget what had happened. Furthermore, refugee parents may be unwilling to utilize mental health services for their children because of the stigma associated with mental health issues (Anstiss & Ziaian, 2010;Henley & Robinson, 2011).…”