Mental Health in Refugee Populations
Updated: Feb 1
What is a literature review? In public health a literature review is undertaken to construct a foundation for research of program implementation. In undertaking this process, any related publications are reviewed to establish why the research or program should be done, who it will benefit, and what outcomes could be expected.
In a recent assessment task I was required to identify a public health issue in a particular demographic within the Australian population, in line with the defunct National Health Priority Areas. I decided to use this as an opportunity to take a deep dive into how mental illness impacts vulnerable people, and settled upon focusing my literature review on women of a refugee background. In order to allow me to develop this review into a research program for later assessment tasks, I opted to focus on the City of Darebin given their high refugee settlement and public welcoming to all people of all backgrounds. I felt strongly that this view aligned with my desire to study this topic, and so it was therefore a good fit.
This is not my full submission, but an excerpt I thought interesting and would like to share.
Examining the effects of involvement in established community run gardens on the mental health of young women of a refugee background in the City of Darebin.
45% of Australians are estimated to experience mental illness within their adult lifetimes, and for some of the most vulnerable population groups, notably refugees resettled across the nation, the risk is high (AIHW, 2018). Contributing to this risk is a diverse range of factors, including exposure to trauma in pre-migration and resettlement, culture shock, experiences of racism, language barriers, and social isolation. Refugees do not often utilise mental health care services, and statistics for mental illness are limited (Vasey & Manderson, 2017). With consideration to such, this research project intends to identify the barriers enforced by such factors, through interpreting the influence of involvement in community run initiatives on the mental well being of refugee women in the City of Darebin .
The aim of this research project is to examine what the effects of participation in a community garden in the City of Darebin are for young women of a refugee background. This research will investigate mental health status, service utilisation and accessibility, and social inclusion to analyse whether community coordinated programs are influential on mental health status and service utilisation for this population group.
As the third highest contributor to the burden of disease in Australia, mental illness is a significant health issue throughout the population (AIHW, 2018). Some demographics, however, experience particular vulnerabilities that others are not exposed to. For refugees in the setting of resettlement in Australia, the risk of mental illness is high (Women’s Health West, 2017).
This research project is tailored to investigating the determinants of mental health for refugees through utilising a community based setting, notably community gardens, for the purposes of information collation and analysis. It has a specific focus on young women of a refugee background and is set in The City of Darebin, however is intended to be applicable in municipalities nationwide upon its completion.
In its implementation, this research will endeavor to identify barriers inhibiting accessibility to primary mental health care services for participants. Further, it will work to determine whether involvement in community based programs is beneficial in addressing social isolation as a contributor to mental illness in young women of a refugee background, while simultaneously ascertaining the mental health status of participants, providing primary mental health care referral where required.
It is expected that through undertaking this research, the project will isolate specific determinants of mental health and barriers to mental health care utilisation for young women of a refugee background, namely factors contributing to and associated with social isolation and community involvement. Simultaneously, it is expected that participants will develop a stronger mental health vocabulary and that communities will have an enhanced ability to identify and act upon the signs and symptoms of mental illness. Ultimately, it is expected through analysis of findings, this research will contribute to enhancing the interaction between young women of a refugee background and primary mental health care services.
In determining such, the following questions have been tailored:
How accessible are community gardens to young women of a refugee background in the City of Darebin?
How does participation in the community garden increase social inclusion and connection in young women of a refugee background in the City of Darebin?
How does participation in the community garden influence the utilisation of mental health services in young women of a refugee background in the City of Darebin?
A review of related published literature, alongside government and non-government resources, identified that women of a refugee background in Australia endure a high risk of mental illness, notably comorbid post traumatic stress disorder, depression, anxiety (Women’s Health West, 2017; Shannon, et a., 2015). This is causal to the presence of a combination of specific determinants of health, including language barriers, racism, socio-economic instability, stigma, and insufficient culturally relevant or accessible mental health services inhibiting resource access (Khwaja, McCarthy, Braddock & Dunne, 2013; Vasey & Manderson, 2012). Exacerbating this risk is the influence of social and cultural integration - augmenting factors to the risk of social isolation and subsequently mental illness in refugees when lacking (Vasey & Manderson, 2012; National Survey of Mental Health and Wellbeing, 2007).
When considering that a refugee is someone who has been forced to flee their home country as a result of racial, religious, political or social persecution, with associated war or violence, cumulative exposure to trauma is a major risk factor in a refugees predisposition to mental illness (UNHCR, 2019; Khawaja, et al., 2013; Shannon, et al., 2015). There is some evidence to suggest that trauma experienced by refugees is intergenerational, causing the risk of mental illness to be an open-ended issue that affects entire refugee communities (Khawaja, et al., 2013).
In response to the consolidation of these factors, Shannon et al,. forecast their research titled ‘Characteristics of Successful and Unsuccessful Mental Health Referrals’, on the premise that community based interventions in group settings have been known to improve mental health outcomes for refugees, through the construction of supportive, culturally relevant networks (2015). Community gardens, for example, are typically established initiatives known to enhance social inclusion and community involvement in an educational and health based environment within Australian communities. Many public housing estates, which have a high proportion of refugee residents, have established community gardens that should be acknowledged as useful tools in securing social connection through shared experiences of cultural identity, heritage and integration; all factors that could be utilised to overcome the barriers preventing social inclusion and utilisation of mental health care services for refugees (Thompson, Corkey & Judd, 2007; Shannon., et al., 2015).
Despite the efficiency of community based initiatives in identifying mental illness and combating the causal factors, the Australian Institute of Health and Welfare acknowledge there is a lack of information on the activities of non-government community mental health organisations being used to support Australians with mental health issues across the greater population (2018). In further review of literature, Nithianandan, et al., highlight that specific epidemiology identifying mental illness in refugee populations in Australia is poor in their study titled ‘Factors Affecting Implementation of Perinatal Mental Health Screening in Women of Refugee Background’ (2016). This contributes to a distinct research gap targeted to establishing the incidence of mental health care service utilisation, and research dedicated to identifying factors to assist in overcoming the associated cultural and social determinants of mental health within this population group (Nithianandan, et al., 2016; Vasey & Manderson, 2012).
AIHW. (2018). Australia’s Health. Retrieved 28/6/2019, from: https://www.aihw.gov.au/getmedia/7c42913d-295f-4bc9-9c24-4e44eff4a04a/aihw-aus-221.pdf.aspx?inline=true
Beyond Blue. (2019). Anxiety and Depression checklist (K10). Retrieved 15/8/2019, from: https://www.beyondblue.org.au/the-facts/anxiety-and-depression-checklist-k10
Nithianandan, N., Gibson-Helm, M., McBride, J., Binny, A., Gray, K., East, C., & Boyle, J. (2016). Factors affecting implementation of perinatal mental health screening in women of refugee background. Implementation Science, 11(1). Retrieved 28/6/2019, from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116191/
Shannon, P., Vinson, G., Cook, T., & Lennon, E. (2015). Characteristics of Successful and Unsuccessful Mental Health Referrals of Refugees. Administration And Policy In Mental Health And Mental Health Services Research, 43(4), 555-568. Retrieved 28/6/2019, from: https://www.ncbi.nlm.nih.gov/pubmed/25735618
Thompson, Susan & Corkery, Linda & Judd, Bruce. (2007). The Role of Community Gardens in Sustaining Healthy Communities. Retrieved 25th August 2019, from https://www.researchgate.net/publication/252793565_The_Role_of_Community_Gardens_in_Sustaining_Healthy_Communities
Women’s Health West. (2017). Integrated Health Promotion Plan. Retrieved 22/6/2019, from: https://whwest.org.au/wp-content/uploads/2018/01/Womens-Health-West_IHP-plan_2017-2021_final.pdf
United Nations Refugee Council. (2019). What is a refugee. Retrieved 10th August 2019, from: https://www.unrefugees.org/refugee-facts/what-is-a-refugee/
Vasey, K., & Manderson, L. (2012). Regionalizing Immigration, Health and Inequality: Iraqi Refugees in Australia. Administrative Sciences, 2(1), 47-62. Retrieved 28/6/2019, from: https://www.mdpi.com/2076-3387/2/1/47