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International Journal of Mental Health Systems

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Open Access 01-12-2016 | Research

Important considerations when providing mental health first aid to Iraqi refugees in Australia: a Delphi study

Authors: Maria Gabriela Uribe Guajardo, Shameran Slewa-Younan, Yvonne Santalucia, Anthony Francis Jorm

Published in: International Journal of Mental Health Systems | Issue 1/2016

Abstract

Background

Refugees are one of the most vulnerable groups in Australian society, presenting high levels of exposure to traumatic events and consequently high levels of severe psychological distress. While there is a need for professional help, only a small percentage will receive appropriate care for their mental health concerns. This study aimed to determine cultural considerations required when providing mental health first aid to Iraqi refugees experiencing mental health problems or crises.

Method

Using a Delphi method, 16 experts were presented with statements about possible culturally-appropriate first aid actions via questionnaires and were encouraged to suggest additional actions not covered by the questionnaire content. Statements were accepted for inclusion in a guideline if they were endorsed by ≥90 % of panellists as ‘Essential’ or ‘Important’.

Results

From a total of 65 statements, 38 were endorsed (17 for cultural awareness, 12 for cross-cultural communication, 7 for stigma associated with mental health problems, and 2 for barriers to seeking professional help).

Conclusion

Experts were able to reach consensus about how to provide culturally-appropriate first aid for mental health problems to Iraqi refugees, demonstrating the suitability of this methodology in developing cultural considerations guidelines. This specific refugee study provided potentially valuable cultural knowledge required to better equip members of the Australian public on how to respond to and assist Iraqi refugees experiencing mental health problems or crises.

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Australian Bureau of Statistics. Media release—National: Australia’s multicultural landscape is as diverse as ever following the release of 2011 census of population and housing data by the Australian Bureau of Statistics (ABS). 2011. http://abs.gov.au/websitedbs/censushome.nsf/home/CO-59. Accessed 14 Mar 2011.

Refugee Council of Australia: resources. 2014. http://www.refugeecouncil.org.au/resources/statistics/australias-refugee-and-humanitarian-program. Accessed 20 Apr 2105.

Department of Immigration and Border Protection: Australia’s offshore humanitarian program 2013–2014. In: Department of Immigration and Border Protection. 2014. https://www.immi.gov.au/pub-res/Documents/statistics/australia-offshore-humanitarian-program-2013-14.pdf. Accessed 1 Apr 2015.

Department of Immigration and Border Protection: Australia’s response to the Syrian and Iraqi humanitarian crisis. 2015. https://www.border.gov.au/Trav/Refu/response-syrian-humanitarian-crisis. Accessed 7 Mar 2016.

Mollica R, Wyshak G, Lavelle J. The psychosocial impact of war trauma and torture on Southeast Asian refugees. Am J Psychiatry. 1987;144:1567–72.CrossRefPubMed

Steel Z, Chey T, Silove D, Marnane C, Bryant R, Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009. doi:10.1001/jama.1132.PubMed

Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons. JAMA. 2005. doi:10.1001/jama.294.5.602.

Slewa-Younan S, Uribe MG, Heriseanu A, Hasan T. A systematic review of post-traumatic stress disorder and depression amongst Iraqi refugees located in western countries. J Immigr Minor Health. 2014. doi:10.1007/s10903-014-0046-3.

Uribe Guajardo MG, Slewa-Younan S, Smith M, Eagar S, Stone G. Psychological distress is influenced by length of stay in resettled Iraqi refugees in Australia. Int J Ment Health Syst. 2016. doi:10.1186/s13033-016-0036-z.PubMedPubMedCentral

10.

Correa-Velez I, Sundararajan V, Brown K, Gifford SM. Hospital utilisation among people born in refugee-source countries: an analysis of hospital admissions, Victoria, 1998–2004. Med J Aust. 2007;186(Suppl 11):577.PubMed

11.

Youssef J, Deane FP. Factors influencing mental-health help-seeking in Arabic-speaking communities in Sydney, Australia. Ment Health Relig Cult. 2006;9(Suppl 1):43–66.CrossRef

12.

Bolton P. Mental health in Iraq: issues and challenges. Lancet. 2013;381(Suppl 9870):879–81.CrossRefPubMed

13.

Slewa-Younan S, Mond J, Bussion E, Mohammad Y, Uribe Guajardo MG, Smith M, et al. Mental health literacy of resettled Iraqi refugees in Australia: knowledge about posttraumatic stress disorder and beliefs about helpfulness of interventions. BMC Psychiatry. 2014. doi:10.1186/s12888-014-0320-x.PubMedPubMedCentral

14.

Murray K, Davidson G, Schweitzer R. Psychological wellbeing of refugees resettling in Australia. In: The Australian Psychological Society. 2008. https://www.psychology.org.au/assets/files/refugee-lit-review.pdf. Accessed 4 Aug 2015.

15.

Kitchener B, Jorm A. Mental health first aid training for the public: evaluation of effects on knowledge, attitudes and helping behaviour. BMC Psychiatry. 2000;2(Suppl 1):10.

16.

Hadlaczky G, Hökby S, Mkrtchian A, Carli V, Wasserman D. Mental health first aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: a meta-analysis. Int Rev Psychiatry. 2014. doi:10.3109/09540261.2014.924910.PubMed

17.

Kitchener BA, Jorm AF. Mental health first aid: an international programme for early intervention. Early Interv Psychiatry. 2008. doi:10.1111/j.1751-7893.2007.00056.x.PubMed

18.

Mendenhall AN, Jackson SC, Hase S. Mental health first aid USA in a rural community: perceived impact on knowledge, attitudes and behavior. Soc Work Ment Health. 2013. doi:10.1080/15332985.2013.812542.

19.

Svennson B, Hansson L. Effectiveness of mental health first aid training in Sweden. A randomized controlled trial with a six-month and two-year follow-up. PLoS One. 2014. doi:10.1371/journal.pone.0100911.

20.

Jensen KB, Morthorst BR, Vendsborg PB, Hjortoj C, Nordentoft M. Effectiveness of MHFA training in Denmark: a randomized trial in waitlist design. Soc Psychiatry Psychiatr Epidemiol. 2016. doi:10.1007/s00127-016-1176-9.PubMed

21.

Kitchener B, Jorm A, Kelly C. Mental Health First Aid International manual. Melbourne: Mental Health First Aid International; 2015.

22.

Jorm AF. Using the Delphi expert consensus method in mental health research. Aust N Z J Psychiatry. 2015. doi:10.1177/000486741560089.

23.

Hart L, Jorm AF, Kanowski L, Kelly C, Langlands R. Mental health first aid for Indigenous Australians: using Delphi consensus studies to develop guidelines for culturally appropriate responses to mental health problems. BMC Psychiatry. 2009. doi:10.1186/1471-244X-9-47.

24.

Chalmers K, Bond K, Jorm AF, Kelly C, Kitchener B, Williams-Tchen A. Providing culturally appropriate mental health first aid to an Aboriginal or Torres Strait Islander adolescent: development of expert consensus guidelines. Int J Ment Health Syst. 2014. doi:10.1186/1752-4458-8-6.PubMedPubMedCentral

25.

Minas H, Jorm AF. Where there is no evidence: use of expert consensus methods to fill the evidence gap in low-income countries and cultural minorities. Int J Ment Health Syst. 2010. doi:10.1186/1752-4458-4-33.

26.

Summerfield D. A critique of seven assumptions behind psychological trauma programmes in war-affected areas. Soc Sci Med. 1999. doi:10.1016/S0277-9536(98)00450-X.PubMed

27.

Minas H, Kakuma R, San Too L, Vayani H, Orapeleng S, Prasad-IIdes R, et al. Mental health research and evaluation in multicultural Australia: developing a culture of inclusion. Int J Ment Health Syst. 2013. doi:10.1186/1752-4458-7-23.PubMedPubMedCentral

28.

May S, Rapee RM, Coello M, Momartin S, Aroche J. Mental health literacy among refugee communities: differences between the Australian lay public and the Iraqi and Sudanese refugee communities. Soc Psychiatry Psychiatr Epidemiol. 2014. doi:10.1007/s00127-013-0793-9.PubMed

29.

Yaser A, Slewa-Younan S, Smith C, Olsen R, Uribe Guajardo MG, Mond J. Beliefs and knowledge about post-traumatic stress disorder amongst resettled Afghan refugees in Australia. Int J Ment Health Syst. 2016. doi:10.1186/s13033-016-0065-7.PubMedPubMedCentral

30.

Reavley N, Jorm AF: National survey of mental health literacy and stigma. In: Department of Health and Ageing. 2011. http://pmhg.unimelb.edu.au/research_settings/general_community/?a=636496. Accessed 20 May 2016.

31.

Reavy K, Hobbs J, Hereford M, Crosby K. A new clinic model for refugee health care: adaptation of cultural safety. Rural Remote Health. 2012;12:1826.PubMed

32.

Uitterhaegen B. Psycho-education and psychosocial support in the Netherlands: a program by and for refugees. Intervention. 2005;3(Suppl 2):141–7.

33.

Hart LM, Bourchier SJ, Jorm AF, Kanowski LG, Kingston AH, Stanley D, Lubman DI. Development of mental health first aid guidelines for Aboriginal and Torres Strait Islander people experiencing problems with substance use: a Delphi study. BMC Psychiatry. 2010. doi:10.1186/1471-244X-10-78.PubMedPubMedCentral

34.

Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009. doi:10.1001/jama.2009.1132.PubMed

35.

Sulaiman-Hill CM, Thompson SC. Thinking too much: psychological distress, sources of stress and coping strategies of resettled Afghan and Kurdish refugees. J Muslim Health. 2012;6(Suppl 2):63–86.

36.

Jones J, Hunter D. Consensus methods for medical and health services research. BMJ. 1995;311(Suppl 7001):376–80.CrossRefPubMedPubMedCentral

37.

Van De Ven A, Delbecq A. The effectiveness of nominal, Delphi, and interacting group decision making processes. Acad Manag J. 1974;17(Suppl 4):605–21.

38.

Hardy DJ, O’Brien AP, Gaskin CJ, O’Brien Morrison-Ngatai E, Skews G, et al. Practical application of the Delphi technique in a bicultural mental health nursing study in New Zealand. J Adv Nurs. 2004. doi:10.1111/j.1365-2648.2003.02969.x.PubMed

39.

Redmond M, Rooney R, Bishop B. Unipolar depression across cultures: a Delphi analysis of the methodological and conceptual issues confronting the cross-cultural study of depression. AeJAMH. 2006. doi:10.5172/jamh.5.2.113.

40.

Akins R, Tolson H, Cole B. Stability of response characteristics of a Delphi panel: application of bootstrap data expansion. BMC Med Res Methodol. 2005;5(Suppl 1):37.CrossRefPubMedPubMedCentral

41.

Parcesepe A, Cabassa L. Public stigma of mental illness in the United States: a systematic literature review. Adm Policy Ment Health. 2013. doi:10.1007/s10488-012-0430-z.PubMedPubMedCentral

42.

Chong S, Verma S, Vaingankar J, Huak Chan Y, Yin Wong L, Heng B. Perception of the public towards the mentally ill in developed Asian country. Soc Psychiatry Psychiatr Epidemiol. 2007;42(Suppl 9):734–9.CrossRefPubMed

43.

Iversen A, van Staden L, Hughes J, Greenberg N, Hotopf M, Rona R, et al. The stigma of mental health problems and other barriers to care in the UK Armed Forces. BMC Health Serv Res. 2011. doi:10.1186/1472-6963-11-31.

44.

Rickwood D, Thomas K, Bradford S. Review of help-seeking measures in mental health: an evidence check rapid review brokered by the Sax Institute for beyondblue. Sax Institute. 2012. https://www.saxinstitute.org.au/wp-content/uploads/02_Help-seeking-measures-in-mental-health.pdf. Accessed 7 Aug 2016.

45.

Fenta H, Hyman I, Noh S. Mental health service utilization by Ethiopian immigrants and refugees in Toronto. J Nerv Ment Dis. 2006. doi:10.1097/01.nmd.0000249109.71776.58.PubMed

46.

Sulaiman-Hill CM, Thompson SC. Selecting instruments for assessing psychological wellbeing in Afghan and Kurdish refugee groups. BMC Res Notes. 2010. doi:10.1186/1756-0500-3-237.PubMedPubMedCentral

Title: Important considerations when providing mental health first aid to Iraqi refugees in Australia: a Delphi study
Authors: Maria Gabriela Uribe Guajardo
Shameran Slewa-Younan
Yvonne Santalucia
Anthony Francis Jorm
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: International Journal of Mental Health Systems / Issue 1/2016
Electronic ISSN: 1752-4458
DOI: https://doi.org/10.1186/s13033-016-0087-1

At a glance: The STEP trials

Springer Medicine

Important considerations when providing mental health first aid to Iraqi refugees in Australia: a Delphi study

Abstract

Background

Method

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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