Strategies for Refugees to Lead Full and Meaningful Lives in Australia - Case Study Example

CULTURE PERSPECTIVE HEALTH REPORT by Student’s Name Code + Course Name Professor University City/State Date Executive Summary African refugees from war torn countries constitute a susceptible group in terms of mental health due post-migration stressors and pre-migration trauma. As a result, there is need for effective strategies that will facilitate care and support for ensuring their mental well-being. This report puts forward strategies for ensuring that the refugees lead full and meaningful lives in Australia, free from poor mental health. Comprehensive culturally sensitive care that encompasses the social, economic, and psychological needs of the refugees is recommended. The recommended interventions for addressing poor mental health include improving access to mental health services and trauma-informed treatment; and offering comprehensive culturally competent care and services. In addition, helping refugees to resettle and easily access services. The costs incurred will include training costs as well as costs for hiring various locations for the delivering mental health services. Implementation will entail first involving the refugee in the adoption phase; training the personnel that will implement the strategies; evaluating the strategies fit to the existing needs of the African war refugees. The strategies will be monitored carefully on an ongoing basis. Improved mental wellbeing of war refugees will indicate the success of the program. Adequate training of the implementers and active involvement of the refugees will ensure success of the proposed strategies. Introduction Background Numerous scholars have noted that refugees from war and violence affected African nations face various traumatic experiences that considerably affect their mental wellbeing. The refugees experience lack of basic needs, undergo various human rights violation such as rape whereas others lose their loved ones. All these negative experiences affect their mental wellbeing and this problem is further aggravated by the fact that they continue facing challenges such as lack of employment and isolation. The mental wellbeing of African war refugees living in Australia is greatly affected by the challenge of disruption of social and cultural system as well as isolation from family members. It is thus important to draft and implement strategies that will ensure that the refugees receive the care and support needed in overcoming their past traumatic experiences in order to safeguard their mental well being. Aim The aim of this report is to present strategies to the ‘United Mental Health Services Agency’ (UMHSA) to improve the mental health of African war refugees living in Australia. The health professionals hired by the UMHSA will work with the refugees and will help them to receive the required care and support. The report will be founded on the principle that the refugees can benefit from enhanced mental well-being and health, while taking into consideration that they will need special supports and services. The objective will be to ensure that the refugees are afforded an opportunity for leading full and meaningful lives in the respective communities, free from discrimination. The key actions will include supporting the primary health care system to function in a more effective manner with the refugees and to recognize signs of poor mental well being in the refugees. The report will raise awareness of mental health promotion among the refugees. It will reduce the levels of mental health problems and mental distress amongst the refugees. It will increase help seeking among the refugees experiencing or those at risk of developing mental health issues and increase awareness of the trauma experienced and needs of the African war refugee. Most important, it seeks to improve the responsiveness of services to the mental health needs of the refugees and also decrease the risk of interactions with services that compound the impacts of trauma that the refugees have already experienced. Scope The literature reviewed on African war refugees suggested that they can benefit from provision of comprehensive care, services and support to overcome their past traumatic experiences. This covers the social, economic, and psychological needs of the refugees. This report presents various interventions required to address these needs. They comprise strategies for improving access to mental health services to help deal with their problems and trauma-informed treatment. Secondly, offering comprehensive culturally competent care and services and thirdly helping refugees to resettle and easily access services. The three strategies are the “key ingredients” that are relevant for addressing the social, economic and psychological needs of the African war refugees. This report emphasizes the significance of attending to all the three components in the overall intervention plan. Methodology A literature review was conducted to determine what is known about the efficacy of each of the three intervention strategies with refugees in Australia and other countries. The intention was to categorize any empirical substantiation for specific approaches that can be employed as constituents of an all-inclusive services model for African war refugees. In a bid to identify the best interventions for improving the mental health of the refugees, roundtable discussions were also held with mental health experts to identify priority areas. The expert agreed that the identified three areas would improve the general mental well being of the refugees. Mental Health Interventions’ Providing Access to Mental Health Most African refugees do not benefit from mental health services and they hardly utilize them. The refugees face numerous barriers to receiving care, for instance, lack of health insurance. Vergara, Miller, Martin, and Cookson (2003) survey of refugee health plans in nine regions in the United States discovered that mental healthcare was offered in 78% of the sites, however only 33% of these sites assessed the mental health condition of the refugees. This shows that refugees suffering from poor mental health are not likely to be identified and hence do not receive required treatment. This indicates that strategies that promote access as well as engagement in mental health services for the African War refugees are required. Importance of Comprehensive Culturally Competent Services Davies and Webb (2000) argued that the need of refugees’ families and children can be effectively tackled through “a coordinated programme working closely with those who can help shape a culturally sensitive position.” (p. 551). The authors stressed the inadequacies of the current service arrangements that refer the refugees to the usual outpatient mental health clinic without any experience in handling migration or cultural matters with organizations working in relative isolation in approaches determined by their individual limited expert viewpoints. As a result, it is important to use a harmonized all-inclusive treatment plan in order to ensure that the varied needs of the refugees are met and are more acceptable to them, Especially since refugees mostly see economic and general survival matters as more important than their psychological needs. There is need to offer responsive, integrated, and comprehensive social care and mental health services using a culturally-based approach. Levin, Petrila and Hennessy (2004) argued that there has been increased attention in comprehensive mental health services in mental health literature and such literature has provided evidence that they are effective with some groups. African refugees require comprehensive service models as they have wide-ranging needs which may be contributors of poor mental health. Comprehensive services in this care will encompass the social, psychological, and economic needs of the refugees. Generally, the intent will be to offer multi-modal treatment strategy that addresses the wide range of needs that the refugees face in a seamless manner. The strategy will incorporate an aspect of outreach to assist engage the refugees as they face numerous barriers to accessing care. Comprehensive services for the refugees will entail addressing the refugees mental health problems within the milieu of their social context, for instance, within the family and school. This approach will help address the complex needs that the traumatized refugees present. Benson (2004) suggested that interventions that offer mental health services to refugees provide or coordinate various multiple services for the families and also engage in expansive outreach. Providing comprehensive service will require staff, funding and infrastructure. This will be an overall service delivery framework. Culturally competent services will help to improve the overall mental health of the African war refugees. Lack of culturally sensitive services is one of the key obstacles to service delivery for refugees’ families. The existing mental health services match the customs and values of the national culture of the refugees. As a result, to increase the extent to which African war refugees’ use and benefit from the mental health services provided, linguistically and culturally informed mental health services will be required. The providers need to become highly sensitive to cultural nuances in dealing with issues of beliefs, and language difference. In provision of mental health treatment and prevention services to the African refugees, it will be extremely important that the exchange relations be developed in a symmetrical manner, as trust development in an important component. Cultural factors influence human behavior, and the understanding of human behaviors. It is thus important to identify the impacts of such cultural influences in working with the diverse population constituting the African war refugees. The refugees face daily struggles to meet their basic needs of health care, employment and housing and this largely contributes to poor mental health. In addition, they face such challenges within the laws and norms of a new civilization and in a new language. They are also frequently separated from their extended network of friends and families. Nonetheless, numerous researchers have highlighted the significance of social support in enabling refugees adjustment (Simish, Beiser and Mawani 2003; Emmelkamp, Komproe and Van Ommeren et al. 2002). Thus, a comprehensive care model will cater for social support and help address the economic needs of the refugees. Improving Access to Mental Health Services and Trauma-Informed Treatment Most African war refugees suffer from anxiety, depression and trauma due to the traumatic war experiences. As a result, most of them are usually mentally unstable even after they settle as they continue experiencing these stressors of life each day of their lives (Steel, Silove and Phan et al. 2002, p.69). As a result, there is need to enhance access to mental health services and trauma-informed treatment to help the refugees cope. Various evidence-based interventions help to address trauma. This report proposes the use of an intervention approach used by Weine et al. (2003) and Weine et al. (2004). The authors’ research was in a refugee situation and focused on the impact of a multi-family intervention strategy; focus was on ensuring refugees from Bosnia and Kosovor received mental health services. The aim of CAFES (Coffee and Family Enhancement Services) was to enable adult Bosnian refugees with symptoms of post traumatic depression to access mental health services. Bicultural/bilingual project personnel contacted the refugees’ families and planned a home visit where they invited families to take part in the study and randomly assigned them to control or intervention. This intervention primarily comprised of multi-family sets that were held at a community organization every week. A trained bilingual/bicultural worker helped to conduct about nine sessions every week following a manual curriculum. The goals of this intervention were to increase social support for the refugees, educate them on mental health and trauma issues and to promote access to mental health services. Hence, the aim of the strategy was not only to improve mental health. The authors undertook longitudinal assessment every six months for one and a half years. The findings of the study indicated that the CAFES group played a very important role in family engagement, facilitation of use of mental health services, reducing depression symptoms, and promoting family interface compared with the control group. In addition, the intervention also increased social support for the men that took part in the study. The other suggested approach for improving access and engagement of the refugees will entail the use of alternative service setting in order to improve mental health outcomes. According to the Surgeon General’s Report (2001), settings such as medical offices and schools are more comfortable locations for the refugees to visit for services relative to the conventional mental health facilities. Schools serve as a central place for offering mental health services to the refugee children (Hordes 2002; Bemak and Cornely 2002). Hence, a range of family and psychological interventions should be provided by the personnel in school, including interventions with families, children alone, and with teachers. These interventions will help to improve the mental health of the refugees as they will reduce pre-migration trauma and post-migration stressors. Helping refugees to resettle and Easily Access Services Most refugees are not able to easily access employment easily and most go for many days without accessing basic needs (Steel, Silove and Phan et al. 2002). From the literature review, it was evident that the main challenge that African refugees face in Australia is lack of support and lack of other psychosocial factors, which help them in forgetting and healing their tortured and traumatized states of mind. Social support and employment will play an important role in restoring the mental wellbeing of the refugees. Helping the refugees to resettle and to easily access employment and other services would significantly improve their mental health. There is need to ensure that the programs afford services in ways that are engaging, effective and acceptable for the refugee populations. Various theoretical frameworks and models have been put forward to ensure cultural competence in mental health interventions (Misra-Hebert 2003; Cole and Bird 2000). These models highlight the need for integrating attention to language and culture in mental health strategies. The service providers and programs for assisting African war refugees can ensure cultural competence by improving the extent to which they recognize cultural matters and are knowledgeable about their culture. Providers will be trained to ensure existing services incorporate strategies that are more “culturally sensitive”. The refugees will collaborate with the mental health professionals; they will be actively engaged. Costing The costs involved in implementing the three strategies will include training costs for the personnel to be culturally competent; costs for hiring various locations for the delivering mental health services. Implementation In the pre-adoption phase of the three proposed strategies, the refugees will be actively involved in the decision making process. Before implementation, the implementers will receive adequate training so that they are confident and knowledgeable about the cultural issues of the African war refugees. The strategies will be evaluated at this stage for their fit to the existing needs of the African war refugees. The implementation of this program will be greatly improved by a problem-solving and supporting setting that will allow for discussion; it will facilitate the resolution of difficulties. Once the strategies that are implement, they will be monitored carefully on an ongoing basis. A positive atmosphere with the African refugees will be maintained in which free exchange of ideas, and open communication will be endorsed while delivering mental health services. Evaluation The success of the proposed strategies will be assessed through the mental health outcomes of the African war refugees; improved mental wellbeing of war refugees will indicate the success of the program. Conclusion It is evident that war refugees in Australia experience numerous post-migration stressors and pre-migration trauma that adversely affect the mental health of the refugees. There is thus need for strategies that ensure refugees receive the care and support for ensuring their mental well being. The report of this objective is to ensure that the refugees are afforded an opportunity to lead full and meaningful lives in the respective communities, free from poor mental health. It covers the social, economic, and psychological needs of the refugees. This report presents various types of intervention for addressing poor mental health; improving access to mental health services and trauma-informed treatment; and offering comprehensive culturally competent care and services. Lastly, helping refugees to resettle and easily access services. The costs incurred will include training costs as well as costs for hiring various locations for the delivering mental health services. Implementation will entail first involving the refugee in the adoption phase; training the personnel that will implement the strategies; evaluating the strategies fit to the existing needs of the African war refugees. The strategies will be monitored carefully on an ongoing basis. Improved mental wellbeing of war refugees will indicate the success of the program. Recommendation Active involvement of the African war refugees and adequately training the implementers will ensure success of the proposed strategies. Reference List Bemak, F & Cornely, L2002, ‘The SAFI model as a critical link between marginalized families and schools: A literature review and strategies for school counselors’, Journal of ounseling & Development, vol. 80, no. 3, pp.322-331. Benson, M 2004, Survey of National Refugee Working Group Sites 2004: Summary Report: National Child Traumatic Stress Network, Refugee Working Group, Boston, MA. Cole, S & Bird, J 2000, The medical interview: the three function approach, Mosby Inc, St Louis. Davies, M & Webb, E 2000, ‘Promoting the psychological well-being of refugee children’, Clinical Child Psychology & Psychiatry, vol. 5, no. 4, pp.541-554. Emmelkamp, J, Komproe, I, Van Ommeren, M, & Schagen, S 2002, ‘The relation between coping, social support and psychological and somatic symptoms among torture survivors in Nepal’, Psychological Medicine, vol. 32, no. 8, pp.1465-1470. Hodes, M 2002, ‘Three key issues for young refugees' mental health’, Transcultural Psychiatry, vol. 39, no. 2, pp.196-213. Levin, B, Petrila, J & Hennessy, K 2004, Mental health services: A public health perspectives, Oxford University Press, New York. Simich, L, Beiser, M & Mawani, F 2003, ‘Social Support and the Significance of Shared Experience in Refugee Migration and Resettlement’, Western Journal of Nursing Research, vol. 25, no.7, pp. 872-891. Misra-Hebert, A2003, ‘Physician cultural competence: cross cultural competence improves care’, The Cleveland Clinic Journal of Medicine, vol. 70, no. 4, pp. 289-303. Steel, Z, Silove, D, Phan, T, & Bauman, A 2002, ‘Long term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population based study’, The Lancet, vol. 360, pp. 1056-1062. Surgeon General's Report 2001, Mental Health: Culture, Race, and Ethnicity, A Supplement to Mental Health: A Report of the Surgeon Genera. Vergara, A, Miller, J, Martin, D, & Cookson, S 2003, ‘A survey of refugee health assessments in the United States, Journal of Immigrant Health, vol. 5, no. 2, pp.67-73. Weine, S, Feetham, S, Kulauzovic, Y, Besic, S, Lezic, A, Mujagic, A, et al 2004, Family interventions in a services research framework with refugee communities, In K. E. Miller & L. Rasco (Eds.), From Clinic to Community: Ecological Approaches to Refugee Mental Health. Lawrence Erlbaum. Weine, S, Raina, D, Zhubi, M, Delesi, M, Huseni, D, & Feetham, S et al 2003, ‘The TAFES multi-family group intervention for Kosovar refugees: A feasibility study’, Journal of Nervous & Mental Disease, vol. 191, no. 2, pp.100-107. Read More