Flashcards in Week 2 Lecture 2B Immigrant & Refugee Mental Health (DN & Caff) Deck (23)
What influence do cultural factors have on mental health?
*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 does it mean to consider that explanatory models may co-exist?
*Signs, symptoms, & initial treatment might lead to a person seeks help from their healer to diagnose the cluster of symptoms,
*then the cause is identified via a secondary process (e.g. if you have psychosis because you've been affected by witchcraft will differ than if psychosis is from death of loved one)
*Some cultures believe treatment is curable others (ours) view mental health as life long
What is an important consideration when thinking about different approaches to mental health across culture
some cultures do not regard mental health as being recurrent.
e.g. schizophrenia wouldn't be viewed as recurrent, merely 2 or more distinct episodes across the lifetime
*People doctor shop: from healer, medical doctor, other healers and get treatment from a variety of sources
To what extent is PTSD a useful diagnosis?
PTSD has been seen as a normal response to an abnormal circumstance, so it's usefulness as a diagnosis is often in question with people being over pathologised for having experienced traumatic events?
How do Latin American Cultures view past traumas?
*Latin American Culture has the term
Ataque de nervios:
which is a culturally patterned dissociative reaction to stress arising in a person predisposed by exposure to trauma during childhood
- as though wiping the slate clean for every single event, rather than viewing past trauma as accumulating
How do Cambodian Refugees view past traumas?
“thinking too much” (like rumination)
- “small heart”
- broken-down heart/mind
Because of the experiences with the Khmer Rouge (Pol Pot) generations of Cambodians expect to have their lives and homes taken at any moment, this is passed down through generations
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 at all
*Difficulty in adjusting
*Separating from family
*Insecure housing - severe overcrowding - many families in one house
*Lack of transport
What are some of the factors that might contribute & exacerbate the development of mental health issues for migrants?
Rapid Personal and Social Change cultural change, collapse, abuse, disintegration, confusion
Social Stress and Confusion
e.g., family, community, work, school, government problems
Psychosocial Stress and Confusion marginalized, powerlessness, alienation, anomie
Psychobiological Changes: anger hopelessness, despair, fear
Identity, stress & confusion: Who am I?? (collapse of a civilisation for instance greatly impact someone's sense of being)
Behavioral Problems: Suicidality, alcohol, violence, substance abuse, delinquency
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
*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 post traumatic stress disorder and 38% had depression.
In 2004 what were the experiences of Refugee Children in their journey to Australia, and then in detention?
Journey to Australia:
*Chased by guards or police 54.3%;
*Separated from parents/ family 28.6%;
*Living quarters “ransacked” 80.0%;
*Witnessed self-harm 77.1%;
What were the some of the causes of mental health problems faced by refugee children?
*Not due to being a refugee (greater than for refugees who did not experience detention)
*Associated with parental distress and exposure to stressful events, both of which associated with being in detention
*Witnessing self-harm and suicidal behaviour
*Problems present two years after release
Is there hope for people who are refugees?
Resilience and adaptation following resettlement is generally good
What are some of the everyday problems faced by refugee families?
*Age in school
*Discontinuation of school
*Literacy and language competence
*Conflict with elders
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
When thinking of cultural competency in treatment people from different cultures, what should mental health professionals be aware of?
Mental health professionals . . . have a personal and professional responsibility to
(a) confront, become aware of, and take actions in dealing with our biases, stereotypes, values, and assumptions about human behavior,
(b) become aware of the culturally different client’s world view, values, biases, and assumptions about human behavior, and
(c) develop appropriate help-giving practices, intervention strategies, and structures that take into account the historical, cultural, and environmental experiences and influences of the culturally different client.
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