A six-year descriptive analysis of hospitalisations for ambulatory care sensitive conditions among people born in refugee-source countries

Background: Hospitalisation for ambulatory care sensitive conditions (ACSHs) has become a recognised tool to measure access to primary care. Timely and effective outpatient care is highly relevant to refugee populations given the past exposure to torture and trauma, and poor access to adequate health care in their countries of origin and during flight. Little is known about ACSHs among resettled refugee populations. With the aim of examining the hypothesis that people from refugee backgrounds have higher ACSHs than people born in the country of hospitalisation, this study analysed a six-year state-wide hospital discharge dataset to estimate ACSH rates for residents born in refugee-source countries and compared them with the Australia-born population. Methods: Hospital discharge data between 1 July 1998 and 30 June 2004 from the Victorian Admitted Episodes Dataset were used to assess ACSH rates among residents born in eight refugee-source countries, and compare them with the Australia-born average. Rate ratios and 95% confidence levels were used to illustrate these comparisons. Four categories of ambulatory care sensitive conditions were measured: total, acute, chronic and vaccine-preventable. Country of birth was used as a proxy indicator of refugee status. Results: When compared with the Australia-born population, hospitalisations for total and acute ambulatory care sensitive conditions were lower among refugee-born persons over the six-year period. Chronic and vaccine-preventable ACSHs were largely similar between the two population groups. Conclusion: Contrary to our hypothesis, preventable hospitalisation rates among people born in refugee-source countries were no higher than Australia-born population averages. More research is needed to elucidate whether low rates of preventable hospitalisation indicate better health status, appropriate health habits, timely and effective care-seeking behaviour and outpatient care, or overall low levels of health care-seeking due to other more pressing needs during the initial period of resettlement. It is important to unpack dimensions of health status and health care access in refugee populations through ad-hoc surveys as the refugee population is not a homogenous group despite sharing a common experience of forced displacement and violence-related trauma.

Hospital utilisation among people born in refugee-source countries : an analysis of hospital admissions, Victoria, 1998–2004

Objective: To investigate whether hospital utilisation and health outcomes in Victoria differ between people born in refugee-source countries and those born in Australia. Design and setting: Analysis of a statewide hospital discharge dataset for the 6 financial years from 1 July 1998 to 30 June 2004. Hospital admissions of people born in eight countries for which the majority of entrants to Australia arrived as refugees were included in the analysis. Main outcome measures: Age-standardised rates and rate ratios for: total hospital admissions; emergency admissions; surgical admissions; total days in hospital; discharge at own risk; hospital deaths; admissions due to infectious and parasitic diseases; and admissions due to mental and behavioural disorders. Results: In 2003–04, compared with the Australia-born Victorian population, people born in refugee-source countries had lower rates of surgical admission (rate ratio [RR], 0.85; 95% CI, 0.81–0.88), total days in hospital (RR, 0.74; 95% CI, 0.73–0.75), and admission due to mental and behavioural disorders (RR, 0.70; 95% CI, 0.65–0.76). Over the 6-year period, rates of total days in hospital and rates of admission due to mental and behavioural disorders for people born in refugee-source countries increased towards Australian-born averages, while rates of total admissions, emergency admissions, and admissions due to infectious and parasitic diseases increased above the Australian-born averages. Conclusions: Use of hospital services among people born in refugee-source countries is not higher than that of the Australian-born population and shows a trend towards Australian-born averages. Our findings indicate that the Refugee and Humanitarian Program does not currently place a burden on the Australian hospital system.

Review of refugee mental health interventions following resettlement : best practice and recommendations

There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement.

Refugee Mental Health Interventions

There is great diversity in the type of interventions carried out under the rubric of “refugee mental health.” This is partly due to the holistic ecological and psychosocial approaches that have come to dominate research and humanitarian understandings of refugee mental health. The diverse application of psychosocial principles in refugee mental health is also extended by the many varied locations in which such interventions are carried out. Guidelines have been developed to aid would-be practitioners of mental health care amongst refugee communities. However, challenges remain in demonstrating the effectiveness of the approaches used. The maxim “do no harm” which must guide all interventions in this area has nonetheless been threatened at times by well-meaning, yet misguided actions. Despite these issues, there is much promise that together with refugees themselves, steps can be taken to promote well-being and relieve distress in communities of people displaced by conflict.

Characteristics of culturally and linguistically diverse mental health clients

The present study examined Queensland Transcultural Mental Health Centre (QTMHC) client characteristics in order to provide a better understanding for development of future health service delivery models. Archived data that was collected for 1499 clients over two years period (2007-2009) was analysed using descriptive statistics and Chi squares. The results indicated that clients were referred from a range of sources and were generally adults. There were more women than men, who sought services. At least half of the clients had language barriers and relied on bilingual workers. Most frequently expressed mental health issues were mood disorder symptoms, followed by symptoms of schizophrenia and psychosis and anxiety. Acculturation strains and stressors were described as the most common psychosocial issues. Mental health and psychosocial issues differed for age, gender and world regions from which the CALD clients originated. The findings provided an understanding of clients who seek services at QTMHC. Various ways in which transcultural services and data bases can be further improved are discussed.

Climate Change and Human Displacement

This paper will focus on the legal issues associated with people displaced as a result of water scarcity. Human displacement can lead to internal displacement (displacement of people within their country) and external displacement (displacement of people into another country). If the displacement takes place as a result of climate change these people may be referred to as climate refugees. The majority of work on climate refugees has focused on those people that will lose their homes as a result of sea –level rise. The number of people that could be displaced as a result of prolonged drought and lack of adequate water supplies is likely to be far more significant in number. There are estimates that around 2.8 billion people will suffer water shortages by 2025 and many of these people are at increased risk of internal or external displacement. Certain groups are more likely to be displaced as a result of prolonged drought or water scarcity. These groups include indigenous and minorities groups living in areas that are more susceptible to climate change and groups living in areas with a history of water shortage and supply issues. People displaced as a result of water scarcity are at increased risks of malnutrition and of dehydration. Furthermore the lack of adequate water supplies in such areas increases the risk and spread of disease among the population. In certain instances internal and external displacement may lead to escalation of conflict and competition for water resources in newly settled territories. This paper will use case studies from Australia (indigenous groups and rural landholders) and East Africa (Ethiopia, Sudan and Kenya) to demonstrate the significance of human displacement arising as a result of water scarcity. Climate adaptation policy frameworks will need to address a number of legal issues, arising as a result of climate displacement from water scarcity. There are a number of unresolved legal issues for both categories of environmental displaced people. The major legal issue for externally environmentally displaced people is lack of international recognition and support for these people. The Climate Change Convention, the Refugee Convention, the Desertification Convention and Human Rights instruments all fail to provide recognition for people externally displaced as a result of environmental conditions. Similarly there is a lack of legal recognition and legal support mechanisms to assist those people internally displaced by environmental conditions. The lack of developed environmental rights in most countries contributes to this problem. Polices and governance frameworks must be put in place which aims to prevent such displacement through programs identifying populations at risk and instigating damage mitigation and relocation programs. In addition there are a number of legal issues which may arise such as; rights of compensation, property and tenure disputes, increases on the water demand and environmental degradation in places of relocation and jurisdictional issues arising in federal countries. This paper will provide an overview of the legal issues at the international and national levels arising as a result of climate displacement from water scarcity.  

A systematic review of naturalistic interventions in refugee populations

Naturalistic interventions with refugee populations examine outcomes following mental health interventions in existing refugee service organisations. The current review aimed to examine outcomes of naturalistic interventions and quality of the naturalistic intervention literature in refugee populations with the view to highlight the strengths and limitations of naturalistic intervention studies. Database search was conducted using the search terms ‘refugee’, ‘asylum seeker’, ‘treatment’, ‘therapy’ and ‘intervention. No date limitations were applied, but searches were limited to articles written in English. Seven studies were identified that assessed the outcome of naturalistic interventions on adult refugees or asylum seekers in a country of resettlement using quantitative outcome measures. Results showed significant variation in the outcomes of naturalistic intervention studies, with a trend towards showing decreased symptomatology at post-intervention. However, conclusions are limited by methodological problems of the studies reviewed, particularly poor documentation of intervention methods and lack of control in the design of naturalistic intervention studies. Further examination of outcomes following naturalistic interventions is needed with studies which focus on increasing the rigour of the outcome assessment process.

The Stitchery collective : fashion in an expanded field

This practice-based presentation explores the role of fashion as an agent for social inclusion and ethical design practice in communities. The Stitchery Collective is an artist-run initiative based in Brisbane, Australia. Operating at the intersection of craft and design, the fashion-based initiative challenges the assumption that fashion is designed, produced and consumed exclusively in the commercial sector. As a not-for-profit cooperative, the stitchery collective is the first and only fashion organisation in Australia to attract funding under the national and state artist-run-initiative scheme. The collective approach extends to the stitchery design practice, facilitated by individual practitioners working within the organisation who devise programs in the context of collaborative and socially engaged design. Working under the banner of a question, Can fashion be more than pretty clothes for pretty people? the stitchery works to extend the cultural field of fashion practice in the 21st century. The premise of dress as a ‘significant creative or cultural expression’ has informed the expanded definition of fashion practice, as adopted by the stitchery. This alternative classification has fostered partnerships with numerous community groups, including those marginalised in the contemporary fashion context such as recent migrants and refugees. Community engagement programs span design, sewing and up-cycling workshops, sustainability lectures, clothing swaps and public education seminars, supported by partnerships with various cultural, government and educational institutions. In 2011, the stitchery travelled to the Venice Biennale’s 3rd International Children’s Carnival, hosting a workshop series and installation to promote design for sustainability. The proven potential for design to connect community members has motivated the stitchery to question the opportunity for fashion practice to, perhaps uncharacteristically, operate under the banner of ‘design for social good’. Acknowledging craft and design as relational fields, this presentation expands fashion as a tool for social innovation and sustainable practice. The stitchery dislocates the consumer status of fashion with small-scale, localised projects; moving beyond fashion as a dictum of social class to an alternative model that is accessible, conscious, flexible, connected and sustainable. As an undefined post-industrial future approaches, the non-commercial status of the stitchery practice might work to present an image of the active post-consumer. How can the stitchery propose a resilient model of design for the future?

Vietnamese in Australia

Vietnamese-Australians live in Australia, a large island continent. The physical contrast between Vietnam and Australia is remarked upon by many Vietnamese in their migration stories. Whereas Vietnam is remembered as an interlinked sensual and social world, Australia is often viewed as a harsh, spacious, empty, dry continent. Australia is located in a regional Asian context, but this location has always been culturally and politically problematic, as it historically attempted to define itself as a "white" European nation in the Southern Hemisphere(Ang, 2000, p. xiii; McNamara & Coughlan, 1997, p. 1). During the Gold Rush period in the late 1800s, when there was widespread opposition to Chinese labor, Australia implemented a "White Australia" policy, although there were historically a significant number of Australians of Asian background. This exclusionary immigration policy was effectively overturned in the 1970s with the acceptance of a large number of refugees from Vietnam, Cambodia, and Laos in 1975. Vietnamese-Australians live predominantly in urban areas with over three quarters living in Sydney and Melbourne, the two largest cities. Within these two cities they are also highly concentrated in ethnically diverse suburbs, most living in areas with more than 1,000 residents born in Vietnam (Viviani, 1996, p. 49). However, Jupp (Jupp et al., 1990; Jupp, 1993) has argued that these areas are also zones of transition, with much movement in and out...

Transnational organised environmental crime

Transnational environmental crime must become a government priority, as organised criminal networks continue to exploit the environment with unprecedented profits. Such earnings come at a substantial social, economic and environmental expense for communities and their livelihoods. Indeed, organised environmental crime is identified by the United Nations as a key factor in the impoverishment, displacement and violent conflicts affecting millions of people — notably in developing societies.2 It is widely recognised that organised environmental crime syndicates, motivated by substantial financial rewards, continue to flourish and expand in disadvantaged societies with porous borders, where corruption is widespread and regulation is poor. The theft of biodiversity and the demise of animal species and habitats have resulted not only in financial loss, but also in an increase in “environmental refugees” — people dislocated and forced to migrate due to loss of livelihoods.

Utilisation of hospital emergency departments among immigrants from refugee source-countries in Queensland

Despite the increasing number of immigrants, there is a limited body of literature describing the use of hospital emergency department (ED) care by immigrants in Australia. This study aims to describe how immigrants from refugee source countries (IRSC) utilise ED care, compared to immigrants from the main English speaking countries (MESC), immigrants from other countries (IOC) and the local population in Queensland. A retrospective analysis of a Queensland state-wide hospital ED dataset (ED Information System) from 1-1-2008 to 31-12-2010 was conducted. Our study showed that immigrants are not a homogenous group. We found that immigrants from IRSC are more likely to use interpreters (8.9%) in the ED compared to IOC. Furthermore, IRSC have a higher rate of ambulance use (odds ratio 1.2, 95% confidence interval (CI) 1.2–1.3), are less likely to be admitted to the hospital from the ED (odds ratio 0.7 (95% CI 0.7–0.8), and have a longer length of stay (LOS; mean differences 33.0, 95% CI 28.8–37.2), in minutes, in the ED compared to the Australian born population. Our findings highlight the need to develop policies and educational interventions to ensure the equitable use of health services among vulnerable immigrant populations.

Longitudinal Evidence on Educational and Occupational Outcomes Amongst South Sudanese Men from Refugee Backgrounds Living in Urban and Regional Southeast Queensland

Australia has continued to benefit from the human, social and economic capital contributed by immigrant resettlement over many years. Humanitarian entrants have also made significant economic, social and civic contributions to the Australian society. Since 2000, approximately 160,000 people have entered Australia under the refugee and humanitarian resettlement program; around 15% have come from South Sudan and one third of these are adult males. In response to the 2003 evaluation of the Integrated Humanitarian Settlement Strategy (IHSS), which recommended to seek further opportunities to settle humanitarian entrants in regional Australia, the Department of Immigration and Citizenship (DIAC) has since encouraged regional settlement to “address the demand for less skilled labour in regional economies and to assist humanitarian entrants to achieve early employment”. There is evidence, however, of the many challenges faced by humanitarian arrivals living in regional areas. This chapter focuses on the educational and occupational outcomes among 117 South Sudanese adult men from refugee backgrounds. In particular, the chapter uses both cross-sectional (at first interview) and longitudinal data (four interviews with each participant at six-month intervals) to compares outcomes between men living in Brisbane and those living in the Toowoomba–Gatton region in Southeast Queensland.

SettleMEN-2: Displaced twice? Impact of the Queensland floods on men from refugee backgrounds living in Brisbane and Toowoomba. Broadsheet No. 1: Exposure to and impact of the floods

Between 2008 and 2010, the SettleMEN study followed a group of 233 recently arrived men from refugee backgrounds living in urban and regional Southeast Queensland with the aim of documenting their health and settlement experiences. The study found that overall, these men bring important resources that may help them to cope better with the challenges of settlement: good levels of subjective health status, mental health and wellbeing; good family and social support; and good levels of engagement in tertiary/trade education in Australia. Over time, however, their levels of wellbeing decreased as they experienced barriers to social participation and inclusion within their host community, including: unemployment and difficulties securing good jobs (even for those with tertiary/trade qualifications obtained in Australia), financial stress, difficulties accessing housing, limited interactions with neighbours, and experiences of racism and discrimination. Importantly, although men living in the Toowoomba acknowledged some of the benefits of regional settlement, they faced greater barriers to participation in the labour market, reported lower job satisfaction, and were more likely to experience social exclusion overall. In 2012 method approach and a peer interviewer model, we were able to conduct a follow 141 (61%) of the original 233 SettleMEN participants to document the impact of the January 2011 Queensland floods on their health and settlement. This broadsheet focuses on participants’ degree of exposure to and impact of the floods, their perceptions of safety and security, and their vulnerability and adaptive capacity to extreme weather events.

Trauma and survival in African humanitarian entrants to Australia

Former refugees have been resettled in Australia since the 1940’s through the Humanitarian Migration Stream. This chapter highlights the impact of forced migration and the refugee experience of trauma on survival. The journey from pre-migration crises, to the process of fleeing one’s country, through to the challenges associated with resettlement, can have a significant impact on the mental health of Humanitarian Entrants to Australia. Differences in culture can have an impact on the meaning constructed from these experiences, and on help-seeking behaviour and preferred methods of intervention. To date, Western mental health services have used an understanding of trauma based on pathology and largely individualist intervention techniques. In this chapter, however, we seek to understand the experience of trauma for former refugees from a salutogenic perspective, and acknowledge community based coping methods and the strengths and resilience of former refugees. Using the construct of posttraumatic growth, adaptive factors of strength, religion, compassion, and new possibilities are identified as relevant to African Humanitarian Entrants in Australia.

Re-orientations : East Asian popular cultures in contemporary Vietnam

Vietnamese-Australians live in Australia, a large island continent. The physical contrast between Vietnam and Australia is remarked upon by many Vietnamese in their migration stories. Whereas Vietnam is remembered as an interlinked sensual and social world, Australia is often viewed as a harsh, spacious, empty, dry continent. Australia is located in a regional Asian context, but this location has always been culturally and politically problematic, as it historically attempted to define itself as a "white" European nation in the Southern Hemisphere (Ang, 2000, p. xiii; McNamara & Coughlan, 1997, p. 1). During the Gold Rush period in the late 1800s, when there was widespread opposition to Chinese labor, Australia implemented a "White Australia" policy, although there were historically a significant number of Australians of Asian background. This exclusionary immigration policy was effectively overturned in the 1970s with the acceptance of a large number of refugees from Vietnam, Cambodia, and Laos in 1975. Vietnamese-Australians live predominantly in urban areas with over three quarters living in Sydney and Melbourne, the two largest cities. Within these two cities they are also highly concentrated in ethnically diverse suburbs, most living in areas with more than 1,000 residents born in Vietnam (Viviani, 1996, p. 49). However, Jupp (Jupp et al., 1990; Jupp, 1993) has argued that these areas are also zones of transition, with much movement in and out.