Exploring resettlement stressors and help-seeking for mental health support with women from refugee backgrounds

Abstract

Despite the well-documented mental health risk factors for people with refugee backgrounds, there remain gaps in understanding resettlement stressors and barriers to help-seeking, and access to and use of mental health services for specific refugee communities in Australia. The overarching aim of this thesis was to explore resettlement stressors and barriers to help-seeking with women from two different refugee communities and to provide clinical implications for services working with these populations. This project was guided by postcolonial feminist theory, used a Community-Based Participatory Research (CBPR) approach, and was informed by Kleinman’s Explanatory Model (1978, 1980) and Andersen’s Model of Health Utilisation (Andersen & Newman, 1973). In exploring resettlement factors, the thesis also takes a Social Determinants of Health approach to understanding effects on health and wellbeing. Semi-structured interviews were conducted with three groups of people, including women from the Afghan (Hazara) community with refugee backgrounds (study 1), women and men from the South Sudanese community with refugee backgrounds (study 2 & 3), and service providers working with women from refugee backgrounds in mental health services (study 4). Interview data was transcribed verbatim and thematically analysed. In study 1, findings suggested that older women from the Afghan community may face multiple social and cultural barriers to help-seeking, including stigma regarding mental health, differences in cultural conceptualisations of mental health, racism, domestic violence, husbands acting as gatekeepers to help-seeking, language and communication difficulties, and informal help-seeking preferences. Initially, study 2 also had a focus on barriers to help-seeking, but participants instead prioritised speaking about resettlement stressors and challenges during interviews. As such, drawing on a CBPR framework, the second study explored these issues, with results indicating that dealing with practical concerns and resettlement stressors took precedence over accessing mental health services. In particular, results identified that concerns about the younger generation, racism and discrimination, social isolation, changing gender roles, and domestic violence were key factors in womens’ experiences in Australia and had ongoing effects on mental health. Stemming from the analysis of the same data, study 3 specifically discussed the impact of negative media and political depictions of the South Sudanese community on their psychological health and well-being. Participants discussed enduring experiences of racism and discrimination that had damaging effects on their sense of identity, mental health, and hope for the future in their resettlement country. Moreover, given the specific focus of media attention on South Sudanese youth, participants expressed considerable concern about the mental health and wellbeing of their children and future generations. Finally, study 4 focused on service providers’ perceptions of the social determinants of women with refugee background’s mental health and barriers to help-seeking. Barriers were identified as existing at the individual (language, gender), interpersonal (stigma, conceptualisation of mental health, isolation, racism), organisational (child protection, missed opportunity for service provision, lack of accessibility, expectations, differences in perception of need), and policy levels of the Social-Ecological Model. Overall, thesis results indicated that women from different refugee communities face barriers to help-seeking and enduring resettlement stressors at times long after arrival in Australia. However, accessing mental health services may be a low priority for some women, who may instead prioritise practical concerns. Results highlighted the complex intersections between gender, race, and refugee status faced by women with refugee backgrounds. These intersections created multiple challenges to resettlement, empowerment, and belonging within the broader Australian community. Participants from both communities described the way in which racism, patriarchy, language and communication barriers, economic disadvantages, and refugee status created enduring layers of inequality that structured the relative positions of women and men in their community and the broader Australian society. Implications and recommendations include more inclusive public policy, the inclusion of consideration of social determinants of health in mental health care, culturally responsive programs for women and men regarding domestic violence, and the involvement of community partners in research teams.