Introduction
The cultural diversity in Australia continues to widen due to net overseas migration. It has been estimated that 24 percent of the Australian population was born overseas (Mortensen, 2010). The small proportion of these migrants are refugees and asylum seekers (Amnesty International Australia, 2014). Most of the refugees have deteriorating health by the time they reach the host country due to various traumatic events experienced by them or relating to poor access to health care in their own country (Russell, 2015 and Pottie et al., 2011). The Australian Psychological Society (2011) has also acknowledged the vulnerability amongst the refugees for mental health disorders (Murray, Davidson, & Schweitzer, 2008). Moreover, their access
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to mental health services is also hurdled by various factors. Cultural issues and language as a barrier to health services will be addressed in this essay. Further, recommendations for dealing with these issues and delivering culturally competent care using one of the frameworks will be discussed. Overview of the cultural group Generally, the terms refugee and asylum seeker are used wrongly interchangeably. Phillips explains that an asylum seeker is a one looking for international protection but not been given the status of refugee yet. On the other hand, refugee is an asylum seeker who has been successful in getting the refugee status (2013). Many reasons can be attributed for people leaving their home country and seeking asylum in other countries, some of which includes natural disaster, war, threats, violence or violations of human rights (Holland & Hogg, 2010). As refugee population is composed of people from various different nationalities (The Salvation Army, 2013), they are also referred to as ‘Culturally and Linguistically Diverse’ (CALD) population when they establish themselves in the community. Apart from communication, they may have various religious beliefs and rituals that could act as a barrier to effective delivery of healthcare services. Templeman (2013) in her reflection wrote about the condoms being viewed as abortion in Catholic Church in Ghana. Similarly, people from other religious backgrounds may held diverse beliefs to food, dress, mental health, and hygiene, compromising efficient healthcare delivery (Holland & Hogg, 2010). Health services Pottie and colleagues regarded refugees at the highest risk of health disorders amongst the immigrants as they have been forced ‘out’ of their country and made to live in unsanitary conditions in refugee camps (2011).
So in regard of this heightened physiological and psychological risk, Non-Government Organisations (NGO) and the state governments of Australia has put up various services for refugees in their respective state or territories. Access to health services is also one of the social determinants to health, which according to Helen are considered as the best predictors to one’s health (2012).
Victoria hosts the most number of refugees as compared to other states. The state delivers various services like refugee health nurse program, refugee health clinic, refugee health fellows program and many more. Similarly, the government of Western Australia (WA) has put up Humanitarian Entrant Health Services (HEHS). HEHS is entry point into healthcare system for newly arrived refugee and humanitarian entrants. After initial screening and follow up, clients are referred to local community health centre (Department of health,
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2011). To cater to the needs of mental health disorders specifically, one of the services in Victoria named torture and trauma counselling, provides mental health services and health promotion to the victims of trauma, torture and sexual abuse (Russell, 2015). On the contrary, transcultural mental health centre provides its mental health services in WA to refugees and people from CALD backgrounds (Department of health, 2011). The main services in this tertiary centre are now rendered to people who came to Australia under the Humanitarian programs. The centre also gives advice on cultural competent care, when asked, to various rural health centres and NGOs’ (Dale, 2014). Issues affecting access to healthcare The refugees face many barricades pertaining to achieving optimal healthcare services in Australia. The refugee’s group is composed of a multicultural population having various cultural concepts of illness. They have some stigma associated with mental disorders and often hold suspicious views about western medicine which impedes their access to the health care services (Drummond, Mizan, Brocx & Wright, 2011). Nyagua and Harris describes in their research article about common West African beliefs that could be some of the potential areas which arises misapprehension in the clinical settings. These were ancestral influences, spirit possession, sorcery and witchcraft, affliction by God and family influences (2008). They also found that the traditional healers are usually their first point of contact for the illnesses. In a research by Drummond et al., it was found that the refugee women experienced interpersonal issues such as, fear of being judged, fear of being hospitalised or embarrassment, as a barrier to mental health services. Likewise, people from refugee groups are linguistically diverse and a study by Barber et al. found that nearly one-fourth of Australia’s population have limited health literacy and even more succinct in communities are from linguistically diverse background (2009). A study in 2008 pointed to the concerns regarding lack of clarity about drugs and their uses in CALD group and subsequent issues of medication adherence (Williams, Manias & Walker). Hesitancy of the clinicians in using the interpretation services due to various reasons was evident and consequently, this hampers the development of a therapeutic relationship (Henley & Robinson, 2011). There is also a strong link between language and reported stress levels. Additionally, increased risk of social isolation was also found in people who are less proficient in English language (Mental health in multicultural Australia, 2014). Research report by Lewig, Arney and Salveron noted that refugees instead of addressing their mental health issues, may look after to more imperative needs of housing or employment (2009). All these challenges becomes a barrier to refugees in achieving optimal health standards. Recommendations Cultural competency is a core competency standard for the registered nurses in Australia (Nursing and Midwifery Board of Australia, 2010, p.3). To deal with the increasing evidence that the people from CALD background receive lower standard of health care services, several frameworks of cultural competency has been developed (Mortensen, 2010). The most commonly used frameworks are transcultural model of health, developed by Leininger (Dayer-Berenson, 2014). Mortenson criticises the use of transcultural model in Australasia, mainly because of it being simplistic in nature. While on the other hand, Harding argues regarding the usage of any western model as they are developed on the western paradigms and encompasses their beliefs. However, for the purpose of this paper, the cultural safety framework will be utilised which is by far broader in concept (Williamson & Harrison, 2014). This model was developed by Ramsden in early 21st century (Mortensen, 2010). The main practises of this model are cultural awareness and cultural sensitivity which ensures a cultural safety (Crisp, Taylor, Douglas & Rebeiro, 2013) The refugees are usually considered as undiversified population as everybody having the same needs (Holland & Hogg, 2010).
However, the refugee population is heterogeneous as they originate from different parts of the world, hence requiring individualised care. Considering the psychological aspect, it is very important to differentiate between client’s traditional beliefs about spirit possession or sorcery and actual psychiatric symptoms. Due to cultural beliefs, these can be misunderstood as psychiatric symptoms and wrongly diagnosed as one of mental health disorders (Nyagua & Harris 2008). Here the cultural safety model can be used to understand and identify the differences of African and Australian
culture. Using bilingual healthcare workers in the delivery of medications or using translated material have proved to be successful in CALD groups. These actions ensure the cultural safety aspect. In addition to that, increased usage of interpreters and longer consultations for CALD people can improve self-efficacy in their medication regime (Williams, Manias, Liew, Gock, & Gorelik, 2012). Lee, Sulaiman-Hill and Thompson advises to use religious communities and ethnic newspapers or radios for the purpose of health promotion. Conclusion The continuation of the migration of the refugees in Australia makes it even more important to engulf the concept the culturally competent care, in nursing. As the awareness about the vulnerability of the refugee population spread, various multicultural health care institutions came into existence. These institutions were successful in catering to the needs of people from CALD background and even giving advice about cultural nuances to other institutions. Although, several traditions from other cultures may seem pointless to western eyes, they play an integral role in the determining the health’s status or such people. To prevent such issues from becoming a barrier to health care services, various frameworks came into existence. Despite the limitations in the frameworks, they still provide us the direction for the development of cultural competency and prevent prejudice and stereotyping to come to existence in nursing.
Uba, L. (1992). Cultural barriers to health care for southeast asian refugees. Public Health Reports (Washington, D.C.: 1974), 107(5), 544-548. Retrieved from http://proxy.samuelmerritt.edu:2106/pmc/articles/PMC1403696/
Phillips, J. (2011), ‘Asylum seekers and refugees: What are the facts?’, Background note, Parliamentry library, Canberra.
There are significant health disparities that exist between Indigenous and Non-Indigenous Australians. Being an Indigenous Australian means the person is and identifies as an Indigenous Australian, acknowledges their Indigenous heritage and is accepted as such in the community they live in (Daly, Speedy, & Jackson, 2010). Compared with Non-Indigenous Australians, Aboriginal people die at much younger ages, have more disability and experience a reduced quality of life because of ill health. This difference in health status is why Indigenous Australians health is often described as “Third World health in a First World nation” (Carson, Dunbar, Chenhall, & Bailie, 2007, p.xxi). Aboriginal health care in the present and future should encompass a holistic approach which includes social, emotional, spiritual and cultural wellbeing in order to be culturally suitable to improve Indigenous Health. There are three dimensions of health- physical, social and mental- that all interrelate to determine an individual’s overall health. If one of these dimensions is compromised, it affects how the other two dimensions function, and overall affects an individual’s health status. The social determinants of health are conditions in which people are born, grow, live, work and age which includes education, economics, social gradient, stress, early life, social inclusion, employment, transport, food, and social supports (Gruis, 2014). The social determinants that are specifically negatively impacting on Indigenous Australians health include poverty, social class, racism, education, employment, country/land and housing (Isaacs, 2014). If these social determinants inequalities are remedied, Indigenous Australians will have the same opportunities as Non-Ind...
Aboriginal and Torres Strait Islanders have some of the worst health outcomes in comparison to any other indigenous community in the world (AIHW, 2011). According to United Nations official Anand Grover, Aboriginal health conditions are even worse than some Third World countries (Arup & Sharp, 2009), which is astonishing, considering Australia is one of the worlds wealthiest countries. Thoroughly identifying the causes and analysing every aspect behind poor health of indigenous Australians, and Australian health in general, is near impossible due to the complexity and abundant layers of this issue. Even within the category of social determinants, it is hard to distinguish just one factor, due to so many which interrelate and correspond with each other. The aim of this essay is to firstly identify and analyse components of the social determinants of health that impact the wellbeing of Aboriginals and Torres Strait Islanders, and demonstrate how they overlap with each other. By analysing the inequalities in health of Aboriginal and non-indigenous Australians, positive health interventions will then be addressed. Racism and the consequences it has on Indigenous health and wellbeing will be discussed, followed by an analysis of how and why social class and status is considered a determining factor when studying the health of the Aboriginal population. The issue relating ...
We Are Being Swamped: Less than 16,000 (15,800) people claim asylum in Australia each year. While this may seem like a lot, Australia receives less than two percent of the total asylum claims made globally.
Poor living conditions are a major health determinant throughout the indigenous population. Most Indigenous Australians are known to live in rural parts of Australia which are commonly not close to major cities and services. People living in these areas generally have poorer health than others living in the cities and other parts of Australia. These individuals do not have as much access to health services and good quality housing. In 2006 roughly 14% of indigenous households in Australia were overcrowded unlike 5% of other households (AIHW, 2009a). Overcrowded and poor quality houses are commonly associated with poor physical and mental health between the people living in them. The indigenous are n...
They have been found to have detrimental psychological effects, as they leave refugees in a state of limbo, fearing their imminent forced return, where they are unable to integrate into society. This emotional distress is often compounded by the fact that refugees on TPVs in Australia are not able to apply for family reunification nor are they able to leave the country. Family reunification is a well-established right in Sweden, as well as most western countries. Moreover, it is a human right protected under the ICCPR whereby refugees have the right to family (Article 23) and the right to freedom from arbitrary interference with family life (Article 17). As a result of living in a state of uncertainty and heartache caused by family separation, refugees on TPVs face a “700 percent increased risk of developing depression and post-traumatic stress disorder in comparison with PPV (permanent protection visa) refugees (Mansouri et al. 2009, pp. 145). Denial of family reunification under TPVs is likely to cause more asylum seekers to engage in illegal means to arrive in
Since colonialism after the invasion, Australia indigenous peoples have experienced a great deal of loss of identity, loss, disempowerment, cultural alienation, grief. Many indigenous people's mental and physical health impaired. Suicide, family violence, drug abuse and unemployment rates is higher than the Australian average(Berry et al. 2012). That is complicated to contributing to develop and support sustainable mental health and social wellbeing for Australian aboriginals staying in rural areas ,related to much diversity involved in and between individuals and communities (Guerin & Guerin 2012).
There should therefore be emphasis placed on assessing the mental health of these kids because of the adverse experiences in their home countries and the distress experienced in an alien country or culture in which they find themselves. Weaver and Burns (2001) thus argue that social workers need a greater understanding of the impact of trauma to be effective with asylum seekers in general and UASC. However, many people who are exposed to traumatic experiences do not necessarily develop mental issues so social workers should be cautious about making assumptions as studies shows that most asylum seekers point to social and economic factors as important rather than psychological
Asylum seeker issue is a complex and continuing struggle between the heart and the head. It will continue to haunt us as long as Australia shines to be an oasis of space, peace and prosperity in a global sea of overcrowding and escalating suffering.
War is the main cause in the creation of child refugee. It is also known that war is the primary cause of child injuries, death and loss of family members. Being born abroad in unknown places, also play a role in depriving children of a legal home. The trauma of being a refugee child can cause detrimental changes in the mental health of a child and over all development. This article focuses on the impact of the Syrian armed conflict on the mental health and psychosocial condition of Syrian refugees’ children. Also, this article explores the struggles of several refugees’ families and their children. It was determined that mental health services can be key to restoring basic psychological functioning to support resilience and positive coping
The Aboriginal and Torres Strait Islander People have undergone much change since the colonisation. They have seen their lands dispossessed, been subjected to murder, rape, been denied of their language, cultures and spiritual beliefs as well as being denied of any individuality. It is because of problems such as these that the Aboriginal and Torres Strait Islanders are experiencing rates of mental illness far above that of the national average. This essay aims to discuss some of the social, emotional and cultural aspects which are associated with the higher rates of mental illness and in particular suicide, as well as identifying evidence based strategies to address these higher rates.
Uba, L. (1992). Cultural barriers to health care for southeast asian refugees. Public health reports, 107, 544-548.
The social problem we have chosen to address is the mental health status of refugees. Refugees are exposed to a significant amount of trauma due to fear, war, persecution, torture, and relocating. The mental health illnesses that can affect refugees due to exposure to traumas include post-traumatic stress disorder, depression, and anxiety. Research indicated that refugees relocating from war-torn countries are particularly vulnerable to mental health concerns because many have experienced early traumas and face further post-traumas after relocation (Cummings, et al., 2011). However, despite the prevalence of mental health issues concerning refugees, mental health needs often go unrecognized and untreated.
In my readings, I have agreed with the term for culture in the book?? Cultural Diversity?? written by Jerry V. Filled. It states that "One 's culture becomes one?s paradigm, defining what is real and what is right.? in other words culture is taught to children by family it is a variety of learned behaviors, beliefs, values, traditions etc. All of which help shape a person and is a huge portion of who they are.