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CRITICAL ANALYSIS – IRAQI REFUGEES
This report is going to recognize, analyze and discuss the risks associated with mental health of Refugees in Australia. The primary risk factors will be identified in mental health for this population. The report will also discuss the practice dilemmas and will also highlight the challenges that arise in delivering appropriate nursing care to this population. This report will also identify and critique that available support services, and will provide the recommendation for the practice.
Mental health disorders are prevalent in Australia, and are considered as the third most extensive physical health issue in the country. Mental health of an individual affects his financial, personal and social life. According to the definition given by WHO, mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (WHO, 2001d, p.1). The mental health of a person is also associated with various personal and environmental factors that may pose risk for the mental health of an individual. Thus, it is important to understand these risk factors, by understanding the mental health belief of the Refugees population.
Culture is something that requires to be understood before understanding the belief of people. It is because culture is also the major determinant of belief, customs and morals, which consequently impacts the behavior of people. According to some authors, culture is also considered as the total construct of defining total body of belief. According to Sadock and Sadock (2007), culture consists of common beliefs, values and attitudes, which are manifested through customs, rituals and law. It clearly affects the mental health belief of a person, by impacting their attitudes, values, spirituality and customs. When assessing the mental health status of the Iraqi refugees, it is important to understand their cultural perspective of mental health. Iraqi often consider the person as ‘crazy’, if they talk about their mental health concerns, as they have negative attitude toward mental health problems. Thus, social and emotional well-being among the people and community are considered as good mental health for them and healthcare practitioners should respect their belief.
Iraqi refugees are considered as the most vulnerable group in the society of Australia. These groups also have high level of exposure to severe and traumatic events, which lead them to serious psychological distress. Due to widespread sectarian violence, these refugees had to leave their country. The mental health of the refugees can be defined as their psychological health concerns found in the people, who have been forcibly displaced from their country. According to the report of Refugee Council of Australia (2011), around “108, 000 refugees were resettled in Australia in the years between 2001 and 2010.” Women are found to be more affected by mental health problems than man. War and displacement are among the major reasons of vulnerability and mental health problems in this population. They are at the highest risk of being affected by depression, post-traumatic stress disorder (PTSD), and war trauma. Trauma is defined as the life threatening situation where a person is exposed to serious injury, death of a close family member, or sexual violence. This situation affects the social, emotional and physical functioning of the individuals. The war situation has impacted the mental health of these refugees. Iraq has been a patriarchal society, where the role of men is very prominent in relation to providing financial support, security and safety of the family. Their settlement in less patriarchal society like Australia men report losing their role in family, which leads them to depression as well. This situation could also be correlated with increased family violence, alcoholism and substance abuse, broken traditional family structure, loss of spiritual identity and culture, reduced self-esteem, and increased physical and mental health problems. According to Australian Bureau of Statistics the major mental health problems found in this population are depressive behavior, pacic attacks, violent behavior, self-harm sleeping and eating disorders and psychosomatic illness (ABS, 2014). According to Slewa-Younan et al (2014), trauma related disorders are highly prevalent in this population, and there is very low uptake of the metal health services. This is due to the reason of low mental health literacy, cultural issue, unemployment and low living conditions. The feeling of grief occurred due to separation from own culture, country, and social support are also risk factors associated with mental health of Iraqi refugees. Language barriers and feeling of isolation leads the population to vulnerability of mental disorders. Guajardo et al (2016), states that “compared to other refugee groups, Iraqi refugees tend to have poorer general health and greater exposure to war-related mental and physical trauma.” The Iraqi refugees were found to be suffering with mental distress and more significantly PTSD.
Figure 1: Risk factors of Mental health problems in Iraqi Refugees in Australia (adapted from Guajardo et al, (2016) :
Practice Dilemmas in providing Nursing Care
Gorman & Cross, (2011) writes that culture affects the values and belief of individuals, and the perception of mental health is different in every culture. While providing appropriate nursing care, it is important that professionals must work in culturally sensitive manner. Many people like Iraqi population migrate to Australia due to various traumatic circumstances. Mental health requirement in such population is very high. Iraq has been under the trauma of war since more than four decades, due to which many people migrated to Australia in search of healthy and safe living. After resettlement of these people, they go through various mental disorders. The post displacement period is very difficult for Iraqi refugees, as they have experienced severe traumatic event, torture and loss (Redmond, M., Rooney, & Bishop, 2006). Post displacement challenges that occur are language barriers, lack of food and housing and low education. To overcome these barriers is very difficult for them and thus, they are exposed to mental disorders. Practice dilemmas are the situations, where nursing professionals are stuck between the two alternatives of providing care to patients.
Mental Health Literacy
Mental health literacy is the term, which is used to define the level of literacy of an individual to understand the mental health treatment and procedures. Mental health literacy is very important, so that receivers may understand the need of the treatment and may cooperate with the professional (Kabranian-Melkonian, 2015). Iraqi refugees are mainly from Islamic background, and from such country where they have face scarcity of food resources, lack of clean water and proper housing facilities. With all such deprivations, they are generally low educated and also face language barriers in re-settlement places. Such situation could bring a practice dilemma for the nursing professional, as this population may not understand the severity of their condition and communication barrier can make it difficult for the nursing professionals to communicate the procedure (Kabranian-Melkonian, 2015). For the purpose of communication interpreters may be required. The practice dilemma could arise if the interpreter is from the refugee group may also be in close relationship with the individual seeking mental healthcare. Thus, in such situation it is important for the healthcare professional to ensure that interpreter is trained in ethical boundaries and for maintaining the confidentiality of the patient.
The most important component of maintaining ethical practice with Iraqi refugee is to understand and maintain therapeutic boundaries. Iraqi people come from patriarchal and orthodox background. These people have their own limits and some of the practices may not be appropriate for them. For example, practice dilemma for the nursing and healthcare professionals could arise, when they are dealing with a female mental disorder patient. Physical touch is often prohibited in the culture of this population. The impact of their cultural belief is very strong on their behavior, which can cause dilemma for the professionals (Kabranian-Melkonian, 2015). Thus, it is important that nursing professionals must respect their values and beliefs, and must have strong knowledge of their cultural attitude. It would be better that female nursing professionals may communicate with female care seekers, so as to maintain therapeutic relationship with them. Appropriate boundaries are also important, so as to avoid any kind of human right violation.
According to Mackenzie, McDowell, & Pittaway, (2007), informed consent could be very difficult to be obtained from Iraqi refugees. The major barrier for providing quality mental healthcare to this population is to get informed consent from the patient. This population comes from the Islamic country, where the decision maker is always male of the family. Children and women seeking mental health may not be able to provide their consent for the treatment, without approval of their male family members. Such practice dilemma could hinder the way of quality
care. For overcoming such dilemma it is important for the professionals to talk about the issue to the male member or to the respectable member of the community.
Providing quality and appropriate nursing care for the Iraqi refugees could be a very challenging task for the healthcare professionals. The major barriers towards providing care are the language barriers, stigma, and negative attitudes in seeking professional help.
The professionals may not be able to understand the causes and certainty of the mental health issue due to language problems. Miscommunication can lead to misdiagnosis of the issue and mistreatment as well. Due to language barrier often professionals use language interpreter (Rickwood, Thomas and Bradford, 2012). If the interpreter is not well trained than they are unlikely to understand the medical terms; and may not be able to communicate in proper manner (Guajardo et al, 2016). This could also be a major issue for the client, as they might not be able to talk about personal problems in front of family members, community workers or bilingual workers. Untrained interpreter may be exposed to sensitive information about the client and may risk their confidentiality. To overcome communication barrier, professional interpreters are trained with multi-languages and communication skills (Elder, Evans & Nizette, 2008). These interpreters are bound with the ethical code of conduct, which mainly emphasize on the confidentiality. Thus it is imperative that mental health professionals continually develop the cross-cultural communication skills, in order to provide culturally safe care.
Mental Health Stigma
Ciftci, Jones, and Corrigan (2013) states that Mental Health stigma continues to be the major barrier for the refugees, who seek mental health care. The stigma is associated with wide range of factors, such as, discrimination, prejudices, attitudes, public stigma, and stigma of being labeled. These are the reasons for which people from Iraqi community do not refer to seek mental health treatment (Parcesepe, and Cabassa, 2013). Stigma not only hurts the individual,
but it also hurts the community. Stigma creates injustice for the people seeking treatment and can also pose devastating consequences. Stigma is the situation, where an individual is completely disqualified from the community, or who is not socially accepted (Ciftci, Jones, and Corrigan, 2013). According to the study of Bolton (2013), social isolation and stigma of mental illness extends to the immediate family members and occurs in the form of shame. The study further states that Iraqi refugees can be considered as “crazy”, by the members of their community and may be completely isolated. Thus, to the save these people from the feeling of shame, it is important that healthcare providers may keep the mental health status of the clients as a secret. Professionals should also develop trustful relationships with client in order to save them from stigma (Guajardo et al, 2016).
Negative Attitudes towards Seeking Professional Help
Seeking professional help can be defined as receiving assistance from the professionals, who have legitimate professionals skills and are recognized for proving professional help. These professionals include general and specialist health care providers (Rickwood, Thomas, and Bradford, 2012). The studies have shown that only few Iraqi refugees seek professional help, and others other believe in receiving non-professional help at the time of mental crisis. This is because of the negative attitude towards the professionals and professional help. This situation mainly arises with men from this population, who from the fear of being considered as weak do not opt for professional care. According to their cultural belief, men are expected to be strong and supportive towards their families (Guajardo et al, 2016). This traditional belief prevents Iraqi refugees to receive mental healthcare. Thus, it is imperative for the professionals to understand the traditional culture of the community and understand that this community is patriarchal Bolton (2013). The gender roles are very strongly adhered, which can stop men from professional help seeking. Thus, these people must be provided with psychological education about mental health issues and must promote community education programs. For this religious organizations and community health workers can also be involved (Slewa-Younan et al, 2014).
Figure 2: Different treatment and activities for improving the mental health condition of Iraqi Refugees in Australia. Adopted from Slewa-Younan et al, (2014)
The mental healthcare services available for the Iraqi refugees are very limited. The programs do not target this population completely, but all refugee groups as a whole. The mental health services and programs require identifying the problems and barriers associated with their condition. However, services and programs lack proper application and identification of barriers (Vasey and Manderson, 2012).
For improving the mental health of the Iraqi refugees, number of factors can be recommended on the basis of critical analysis of this report. Firstly, it is very essential to understand the factors that affect the mental health and well-being of the Iraqi refugees in Australia. People from this group do not have accessible services and programs that basically focus on them. Thus, the programs and services, which can be mainly focused on the Iraqi refugees, must be developed. These people have great influence of their culture on their attitudes, beliefs and values. Mental health is also associated with their culture. Thus, it is imperative that mental healthcare providers must have “cultural awareness” (Guajardo et al, 2016) towards the culture of this population. These people also have lack of knowledge and understanding of the mental health programs and treatments. Thus, it is required that more educational programs must be designed that target the whole community, in order to promote mental health literacy. These people have lack of knowledge about the available treatments in the host country, and go through severe mental health problems after re-settlement. More initiatives are required in this way to enhance their knowledge. Delphi studies have been conducted to understand the major mental health risks for this population. These studies require more considerations.
The report identified and discussed the major mental health risks and risks associated with the mental health of Iraqi refugees in Australia. This population has faced the most severe destruction and trauma of war. Many emotional, mental and physical traumas are associated with their condition. These people suffer from various problems such as grief, loss, displacement and war. These factors have exposed them to sever mental health conditions such as, depression, panic attacks and post-traumatic stress disorder (PTSD). The report also discussed the available
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