Asian clients with complex mental health needs

Abstract

The mental health needs of migrants can vary: from simple routine needs, seen in any normal population, to complex needs, more specific to Asian and other migrant populations. Though the small numbers of refugees, asylum seekers and those migrating on a family reunion would form the most vulnerable group compared to that of a voluntary, planned migration of skilled professionals, workers and students with robust, motivated personalities; there may be hidden, within the latter category, many who are migrating due to persecution, threat, violence or trauma but use the regular channels. Psychosocial risk factors that have been identified include a drop in personal socioeconomic status following migration, a lack of English proficiency or communication difficulties; separation from family, neurotic personality and loss of self-esteem; alcohol consumption, risky behaviour; experience of racism and discrimination; alienation or isolation from cultural networks; past experience of flight and trauma; adolescent or senior age at time of migration; past psychiatric illness, inadequate knowledge and awareness of existing services, and cultural differences in the assessment and treatment of mental illness. Complex mental health problems would arise from the context of a multitude of such interrelated and interactive factors in addition to a diagnosable psychiatric condition. This paper uses qualitative data from participatory observation (migration process) and in-depth interviews of Asian clients from detention centres admitted to Glenside Hospital and the Supporting Survivors of Torture and Trauma (STTARS) in Adelaide, Australia to explore these factors and discuss psychosocial interventions. Protective factors are family and social support; host society policies and public attitudes towards immigrants and immigration; English proficiency; resilient personality; employment, housing and income; and cultural practices. At a primary health care level more can be done to increase awareness about mental health problems, provide information about services, how to access them and simple self help methods; allaying fears and misinformation; develop gender, family and culture sensitive services to cater to a variety of needs including interpreters and active listening, and understand Asian idioms of distress and explanatory beliefs. More can be done to promote better attitudes among clients, general population and health professionals; institute preventive measures at the community level and improve identification, multidisciplinary interventions and referral systems. At a proactive level there is a need to advocate for more supportive policies, planning and provision of services. Appropriate specialized care for those with severe problems like traumatisation, depression, psychosis and substance abuse will need to be available. It is being increasingly recognized that clients with complex mental health problems do best through a multidisciplinary, integrated, holistic, long-term approach that address their physical, psychological, familial, economic, sociocultural and spiritual needs. Innovative, new approaches that have been found effective for preventive and therapeutic use at the individual and community levels for a range of physical and mental health problems include old, Asian cultural practices. For example, traditional relaxation techniques from Yoga and Mindfulness Based Cognitive Therapy (MBCT) has been found to be useful.