Merging perspectives: obstacles to recovery for youth from refugee backgrounds with comorbidity

Posselt, Miriam; Procter, Nicholas; Crespigny, Charlotte de; Galletly, Cherrie

doi:10.1177/1039856215584512

Cited by 12 publications

(39 citation statements)

References 20 publications

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“…The National Comorbidity Clinical Guidelines also argue that clients with complex needs such as comorbidity require a holistic approach to treatment and that clinicians should assist with other needs where possible [4]. We have previously emphasised the importance of a holistic approach to this particular client group [54]. Flexibility with regards to appointment location was identified by participants as a critical aspect of engagement and also has the potential to reduce the perception of stigma for the young person requiring the service.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…This is of particular concern; it makes for a complex set of circumstances contributing to risk of family and intimate partner violence, alcohol and substance use, self‐harm and suicidal behaviour (Al‐Modallal ; Posselt et al . ; Vijayakumar ). If this situation worsens, so too will the corollaries of hopelessness and being a perpetual outlander (Anderson ; Border Crossing Observatory ; Davey ; Doherty & Hekmat ; Hekmat ; Laughland ; Milligan ; Shine ).…”

Section: Designmentioning

confidence: 99%

Lethal hopelessness: Understanding and responding to asylum seeker distress and mental deterioration

Procter

Kenny

Eaton

et al. 2017

Int J Mental Health Nurs

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The mental deterioration of the so called ‘legacy caseload’ (asylum seekers who arrived in Australia by boat between August 2012–December 2013) has become a national concern and is garnering international attention. Prolonged uncertainty is contributing to mental deterioration and despair. There have been at least 11 deaths by suicide since June 2014. Social support services have been limited and legal assistance in short supply; this is associated with lengthy delays with visa applications. Thwarted belongingness, purpose and identity, a shortage of available services, and barriers to legal support for processes attendant upon Refugee Status Determination increase the likelihood that the mental health of asylum seekers will deteriorate further, potentially developing into worsening decline, which will lead to increased self‐harm and suicide. This article summarises recent suicide deaths in Australia, positing practical assistance and support for asylum seekers living in the community. Therapeutic engagement should be trauma‐informed wherever possible, helping asylum seekers to reframe their sense of lethal hopelessness.

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“…At the same time, however, it is important for health education approaches to remain cognisant of the limits to too simple a focus on developing children's capacities and strengths and to recognise and respond to the disabling effects of social context on migrant children's opportunities for health. Forms of health education that acknowledge, and successfully address, the socially located barriers to children's health-enhancing practices (including experiences of stigma, discrimination and social exclusion) may prove helpful in enhancing social integration and wellbeing of young migrants (Brun, 2001;Due et al, 2016;Fernandes et al, 2014;Posselt et al, 2015;Sampson and Gifford, 2010). Research from Europe highlights the crucial role health care professionals and providers play in shaping attitudes towards migrants and their engagement with health care services (Dias et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, in a study of young refugees to Australia from Afghanistan, Africa and Bhutan experiencing mental health and substance misuse, Posselt et al (2015) highlighted how young migrants' concerns centre on broader social and economic factors, including access to education, employment and housing. Of particular significance to these young people were the disorientating effects of social disconnection to their experiences of well-being (Posselt et al, 2015). Fostering opportunities to maximise opportunities for social inclusion and belonging are thus paramount to young people's health-related experiences.…”

Section: Health Experiencesmentioning

confidence: 99%

Health experiences of children and young people who migrate – Opportunities for health education

Spencer

Smith

Thompson

et al. 2018

Health Education Journal

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Research on migration and health is gaining significant ground, with a focus on the adverse physical and mental health outcomes experienced by migrants. The health-related experiences of children and young people who migrate, however, are relatively absent, with children's migration and health status often conflated with that of their parents. The omission of children's own perspectives limits knowledge about how health is understood and experienced by child migrants, including the identification of best ways to support their health. Drawing on the empirical literature on child migrants and health from the World Health Organization's (WHO) Western Pacific Region, we adopt a critical perspective to examine how the research to date supports a particular way of understanding and investigating the health of children and young people who migrate. Specifically, we highlight how a dominant focus on parents' migration status, (negative) health outcomes and patterns of risk behaviours limits, rather than aids, the understanding of migrant children's health. In doing so, we illustrate how much of the evidence base upholds Westernised biomedical notions of health and privileges the use of particular methodologies to assess health outcomes and reduce health risks. These preferences, in turn, shape the subsequent range of 'appropriate' forms of health education for, rather than with, children. We conclude by drawing on some exceptions and consider the opportunities these provide for developing health education in line with children's own understandings of healthcrucially underscoring the importance migrant children and young people attach to the more social aspects of their health and migration experiences.

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Merging perspectives: obstacles to recovery for youth from refugee backgrounds with comorbidity

Cited by 12 publications

References 20 publications

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

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

Lethal hopelessness: Understanding and responding to asylum seeker distress and mental deterioration

Health experiences of children and young people who migrate – Opportunities for health education

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