Week 2 Lecture 2a & 2b Indigenous & refugee mental health Flashcards
What are some issues in history that have impacted on Indigenous Australians?
- Land theft
- Massacres 19th Century
- Stolen children
- Missionization
- Forced movement and resettlement
- Restricted movement on reserves
- it was hoped they would eventually die out
- impact of that on personal identity of Indigenous Australians today
- Impact on their capacity to feel worth while
Who does the term Indigenous apply to?
- Not just Australians
- Native people living on the land, not part of a state who became subjects of Colonisation
- e.g., Native Americans, Native Canadians, Greenlanders (Denmark), Khoisan people in South Africa, Peru, Argentina
How have the many years of discrimination impacted Indigenous Australians?
- Consistent social pathologies in entire communities
- Many pathologically related behaviours have been almost institutionalised amongst indigenous populations (i.e., almost expected)
How does Forced Movement impact on people’s well being
*Control - not allowed to leave
*Concentrating populations
*alienation from land, language, culture - brutality
peoples sense of self & worth systematically erased
*Refugees of 20th Century
*QLD: ppl moved all over the place into missions - no-one could visit them without police (Sherberg Mission) forced to walk - often for months (40 different language groups) others shipped off to palm island
What happened in 1966 for Aboriginal Australians?
- Included in Census
- Prior to that held less worth than Kangaroo & Koalas (flora & fauna)
- Sustained discrimination is a legacy of this policy
Continuing history of alienation & discrimination has contributed to…
- Drugs, alcohol, petrol sniffing
- Sexual violence and the abuse of children
- Other interpersonal violence
- Homelessness (e.g., parkies)
- Unemployment
- Poverty
- Boredom
- Poor services/ no integration of services
What are some of the reasons for “Closing the Gap” policies?
- Almost half of Aboriginal men and over a third of women die before they turn 45
- Indigenous people 18 years and older twice as likely to feel high or very high levels of psychological distress
- Twice as likely to be hospitalised for mental and behavioural disorders than other Australians in 2008-09
- Men were 5.8 times more likely and women 3.1 times more likely to die from these disorders in 2001-2005 than other Australians
- 77% of Indigenous people (59% all) experienced 1 or more significant stressors in the previous 12 months: ‘death of a family member or friend’, ‘alcohol or drug related problem’, ‘trouble with police’, and ‘witness to violence’
- One in five Indigenous people had member of the family sent to jail in the previous 12 months
Though the media often focuses on alcohol abuse in indigenous communities, what is the real situation with regard alcohol consumption?
- Indigenous Australians are less likely to drink alcohol at all compared to non-indigenous Australians (exception Indigenous Greenlanders of Denmark)
- But those that do - drink to excess i.e. at dangerous levels
- -48% of Aboriginal mothers drink while pregnant - High rates of foetal alcohol syndrome
What is the prevalence of Fetal Alcohol Syndrome globally?
- The most widely used summary prevalence estimate of FAS is 1 to 1.5 cases per 1000 live births worldwide
- Between one and two-thirds of all children with special educational needs are children who have been affected by their mothers’ alcohol intake during pregnancy.
- South Africa has one of the highest incidences of FAS globally
- One study in the Western Cape (with large Khoi and San populations) identified 65.2-74.2 per 1,000 children in the first grade population – 33-148 times greater than U.S. estimates and higher than in a previous cohort study in this same community (40.5-46.4 per 1,000).
- Alaska: 0.20 - 0.30/1000, non-native; 3.00 - 5.20 Alaska Native
- In WA (2002) WA Birth Defects Registry reported 0.02/1000 for non-Aboriginal children, with 2.76/1000 Aboriginal children
What are the childhood & Youth suicide figures for indigenous peoples?
*Canadian Aboriginal population suicide is twice as likely among First Nation communities
*Inuit —6 to 11 times > general population.
Suicide accounts for 1/3 all deaths of Aboriginal youth
*Youth on reserves aged 10-29 years are 5 to 6 times more likely to die of suicide than peers in general population.
*United States: a Native American 62% more likely to commit suicide than the general population.
*Australia: 2001-2006, NT suicide rate for those aged 15 to 24 was 3.5 times that in the rest of the nation
*Very young ages and rising No. of women – 75% of suicides of children 2007- 2011 in NT are Aboriginal *The suicide rate doubled for youth between ages 10-17 which is up from 18.8% to 30.1% per 100,000 2007-2011 – in contrast to non-Aboriginal youth suicides down from 4.1% to 2.6%.
Why are young indigenous people at greater risk of suicide?
- because they are not integrated into society
- self medicating on drugs or alcohol
- likely to be living with parents who have emotional problems
- parents rate their own children as having emotional problems
- 7/10 children are exposed to 3 or more major stressors annually
- 2/10 children are exposed to 7 or more major stressors annually
- Together these all impact on mental health & sense of security
What immediate distress & intergenerational trauma resulted from the discrimination experienced by indigenous people?
The stolen generation
- separation from families (foster care)
- 30 or more homes moved around foster care system breaching trust, sense of security, safety
- 1/4 people 15 yrs & over = victims of violence
What influence do cultural factors have on mental health?
Cultural factors:
- may predispose people to mental illness
- can influence the frequency, nature & distribution of mental illness
- may influence societal attitudes towards mental health
- influence care & treatment of mental health
- influence approaches to treatment
- design & evaluation of mental health services may be different in multicultural societies
What do we need to consider when studying culture & psychopathology?
- What is the role of cultural variables in the etiology of psychopathology?
- What are the cultural variations in standards of normality and abnormality?
- What are the cultural variations in the classification and diagnosis of psychopathology?
- What psychometric factors must be considered in the assessment of psychopathology across cultures?
- How can we measure these??
What are the more basic questions we need to address in order to appropriately address mental health through a cultural lens?
- What are the cultural variations in the phenomenological experience, manifestation, course and outcome of psychopathology?
- To what extent are psychiatric disorders culture-bound?
- Are there cultural variations in therapy systems?
- How do we design and offer mental health services that are culturally appropriate?
What is the explanatory model of illness?
- The explanatory model elicits the lay person (or patient’s) view of :
- The cause of the condition: what has happened and how or why?
- The timing of symptom onset: why this has occurred now?
- Pathophysiological processes: what the condition does to the body?
- The natural history of the malady: its anticipated course and effects if left untreated
- Appropriate treatments: what the patient thinks should be done?
- Complications of stigma, fear, access to care - this goes through to family members not wishing to access care for their family members
What are some of the vulnerabilities faced by new migrants (who have come to Australia by choice, under a skilled migrant program - [like Catherine])?
- Low or reduced socioeconomic status
- Low educational status
- Unemployment after migration
- Lack of recognition of work qualifications and/or experience
- Experience of prejudice or discrimination
- Migrating when elderly
- Experience of torture or trauma
Reduced self worth as can no longer work at the skill level they had in their own country
What are some of the barriers to settlement faced by new migrants that are considerably more challenging for women due to gender differences?
- Cultural isolation -women not leaving their house
- Difficulty in adjusting
- Language difficulties
- Separating from family
- Insecure housing - severe overcrowding
- Poverty
- Lack of transport
- Family violence
- Continued fear
What are some of the issues faced by refugee migrants specifically?
- Extreme and sustained experiences of torture
- Moderate experience of torture and associated trauma
- Oppressive practices which create trauma
- Structural and/or institutionalised violence
- War and deprivation
- Sustained terror
- Gender-based violence (incl. m/m sexual violence)
What were some of the findings and recommendations for Displaced Refugee Youth in the 2012 Lancet article?
*Duration of the child’s captivity was predictive of the scores for post-traumatic stress disorder
*Children who had all three adverse exposures—ie, violence, deprivation, and relocation—had higher scores for post-traumatic stress disorder than did those who had two or fewer of these exposures
*Higher prevalence estimates of psychological problems in refugees cf local populations, esp anxiety, depression, and post-traumatic stress disorder.
*Darfur and Chad - both boys and girls reported having been raped, usually while collecting firewood.
> 75% of children interviewed in internally displaced persons (IDP) camps in Darfur met the diagnostic criteria for posttraumatic stress disorder and 38% had depression.
Cultural and linguistic diversity leads to a number of important challenges, what are these?
- issues of national, regional, community and personal identity
- the legitimate role of government
- distribution of resources
- the purposes, structure and operations of social institutions - such as health systems
- Multiculturalism and racism
What is racism or ethnocentrism?
- A habitual, and often unconscious, tendency or disposition to evaluate foreign people and cultures by standards and practices of one’s own ethnocultural group.
- An inclination to view one’s own way of life as the only proper or moral way with a resulting sense of personal and cultural superiority.
- A sense that one’s own way of believing or behaving is the “true” or “best” way
What should cultural responses for treating mental health issues take into account?
- Need to develop expertise working with people from different cultural backgrounds
- While it is impossible to learn everything there is to know about a particular culture, the experience of their clinical interactions with a particular population can help provide appropriate care
- Challenge of avoiding stereotyping and not accounting for change
- Difference in care in local community settings and on migration
- Appropriateness of group counselling
- Attitudes to psychotherapy
What should be considered when meeting standards for people from non-English speaking (NES) backgrounds or Culturally & linguistically diverse backgrounds (CALD)?
- Access to accredited interpreters & printed general information in number of language
- Rights
- Cultural awareness & Sensitivity to cultural needs
- Safety
- Delivery of care
- Specific information provided to communities
- Promoting community acceptance
