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.

Managing older workers during a period of tight labour supply

This article reports on a recent survey of employer attitudes and policies towards older workers in Australia at a time of sustained economic growth and ongoing concerns about labour shortages. Findings from a survey of 590 employers with more than 50 employees in the State of Queensland point to an unusually strong orientation towards the recruitment of older workers among respondents, although the retraining of older workers is not prioritised by the majority. The issue of workforce ageing is viewed as being of medium-term importance by the majority of respondents, although for a substantial number the issue is of immediate concern. Both sector and organisation size are predictive of the application of a broad range of policies targeting older workers, with public-sector and larger organisations more likely to be active. Concerns about workforce ageing and labour supply are predictive of employer behaviours regarding older workers, suggesting that sustained policy making may be emerging in response to population ageing over and above more immediate concerns about labour shortages and that this broad thrust of organisational policy making may be immune to the point in the economic cycle. This study found no evidence that the flexible firm will not countenance an ageing workforce.

Making sense of mental illness as a full human experience : Perspective of illness and recovery held by people with a mental illness living in the community.

Recovery is a highly contextualized concept amid divergent interpretations and unique experiences. There is substantial current interest in building evidence about recovery from mental illness in order to inform best practice founded in the ways people find to live productive and meaningful lives. This paper presents some accounts related to recovery and illness expressed by eight people through a Participatory Action Research project. The research facilitated entry to the subjective experiences of living in the community as an artist with a mental illness. The people in the research shared an integrated understanding of illness, recovery and identity. Their understanding provided insight into mental illness as an inseparable aspect of who they were. Further, specific issue was raised of recovery as a clinical term with a requirement to meet distinct conventions of recovery. This paper emphasizes that being ill and being well, for the person with a mental illness, is a dynamic and complex development not easily explained or transformed into uniform process or outcomes. Attempts to establish an integral or consensual approach to recovery has, to date, disregarded mental illness as a full human experience. This paper argues that broader frameworks for thinking and responding to the dynamic processes of mental illness and recovery are needed and require acknowledgment of competing and contradictory ideas.

Discrimination experienced by HIV/AIDS infected persons and its associations with mental health in an Indian sample

Purpose The purpose of this study was to investigate the nature and prevalence of discrimination against people living with HIV/AIDS in West Bengal, India, and how discrimination is associated with depression, suicidal ideation and suicidal attempts. Method Semi-structured interviews and the Beck Depression Inventory were administered to 105 HIV infected persons recruited by incidental sampling, at an Integrated Counseling and Testing Center (ICTC) and through Networks of People Living with HIV/AIDS, in the West Bengal area. Results Findings showed that 40.8% of the sample has experienced discrimination at least in one social setting – such as family (29.1%), health centers (18.4%), community (17.5%) and workplace (6.8%). About two-fifths (40.8%) reported experiencing discrimination in multiple social settings. Demographic factors associated with discrimination were gender, age, occupation, education, and current residence. More than half of the sample was suffering from severe depression while 8.7% had attempted suicide. Discrimination in most areas was significantly associated with suicidal ideation and suicidal attempts. Conclusions Prevalence of discrimination associated with HIV/AIDS is high in our sample from West Bengal. While discrimination was not associated with depressive symptomatology, discrimination was associated with suicidal ideation and attempts. These findings suggest that there is an urgent need for interventions to reduce discrimination of HIV/AIDS in the West Bengal region.

Reasons for substance use among people with mental disorders

Background: Comorbidity of mental disorders and substance use continues to be a major problem. To inform the development of more effective interventions for these co-existing disorders, this paper aimed to determine if there are clear variations in the reasons for tobacco, alcohol or cannabis use across people with different mental disorders. Methods: Data from five randomized controlled trials on co-existing disorders that measured reasons for tobacco, alcohol or cannabis use using the Drug Use Motives Questionnaire, Reasons for Smoking Questionnaire or via free response are reported and combined. Two studies involved participants with depression, two involved participants with a psychotic disorder and one involved participants with a range of mental disorders. A series of logistic regressions were conducted to examine differences in reasons for tobacco, alcohol or cannabis use and to compare these reasons between people with psychotic disorders or depression. Results: Participants had a mean age of 38 (SD=12) and just over half (60%) were male. Forty-six percent of participants had a psychotic disorder and 54% experienced depression. Data from 976 participants across the five studies were included in the analyses. Tobacco and alcohol were primarily used to cope, while cannabis was primarily used for pleasure. People with psychotic disorders were more likely than people with depression to use tobacco for coping, pleasure and illness motives. People with depression, in contrast, were more likely to use alcohol for these reasons and social reasons. Conclusions: It may be important to tailor interventions for co-existing mental disorders and substance use by substance type and type of mental disorder. For example, interventions might be improved by including alternative coping strategies to tobacco and/or alcohol use, by addressing the social role of alcohol and by helping people with mental disorders using cannabis to gain pleasure from their lives in other ways.

The public health challenges of mental health problems and associated difficulties

Mental health is a major global health issue. Neuropsychiatric conditions are the most significant cause of disability worldwide, and account for 14% of the global burden of disease. Depression in particular places a huge burden on society, with the Global Burden of Disease 2000 study listing it as the fourth leading cause of disease burden worldwide and the largest non-fatal disease burden. In Australia, mental disorders are startlingly common and related to significant disability. The 2007 National Survey of Mental Health and Wellbeing revealed that the lifetime prevalence of any mental disorder was 45%, and within the last 12 months 20% of Australians met criteria for a mental disorder. Many of the articles in this issue explore mental health issues in young people. Indeed, mental health issues account for a large proportion of the disease burden in young people. Across the globe, mental health disorders caused the greatest number of years lost to disability(YLDs) amongst young people aged 10 to 24 years (45% of total YLDs). Depression caused the highest number of disability-adjusted life-years (DALYs) across this age group, accounting for 8. 2% of DALYs alone.6 It is clear that mental health is a critical area of focus for researchers, practitioners, and policy makers.

Creative writing in recovery from severe mental illness

There is evidence that creative writing forms an important part of the recovery experience of people affected by severe mental illness. In this paper, we consider theoretical models that explain how creative writing might contribute to recovery, and we discuss the potential for creative writing in psychosocial rehabilitation. We argue that the rehabilitation benefits of creative writing might be optimized through focus on process and technique in writing, rather than content, and that consequently, the involvement of professional writers might be important. We describe a pilot workshop that deployed these principles and was well-received by participants. Finally, we make recommendations regarding the role of creative writing in psychosocial rehabilitation for people recovering from severe mental illness and suggest that the development of an evidence base regarding the effectiveness of creative writing is a priority.

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.

Sex discrimination and non-random sampling in the Australian labour market

Historically a significant gap between male and female wages has existed in the Australian labour market. Indeed this wage differential was institutionalised in the 1912 arbitration decision which determined that the basic female wage would be set at between 54 and 66 per cent of the male wage. More recently however, the 1969 and 1972 Equal Pay Cases determined that male/female wage relativities should be based upon the premise of equal pay for work of equal value. It is important to note that the mere observation that average wages differ between males and females is not sine qua non evidence of sex discrimination. Economists restrict the definition of wage discrimination to cases where two distinct groups receive different average remuneration for reasons unrelated to differences in productivity characteristics. This paper extends previous studies of wage discrimination in Australia (Chapman and Mulvey, 1986; Haig, 1982) by correcting the estimated male/female wage differential for the existence of non-random sampling. Previous Australian estimates of male/female human capital basedwage specifications together with estimates of the corresponding wage differential all suffer from a failure to address this issue. If the sample of females observed to be working does not represent a random sample then the estimates of the male/female wage differential will be both biased and inconsistent.

Sex discrimination and occupational segregation in the Australian labour market

This paper explores the implications of the difference between the occupational distribution for males and females in a joint model determining earnings and occupation. The male/female wage differential is evaluated for a number of broad occupational classifications. This is followed by an evaluation of the role and relative importance of inter-occupational and intra-occupational effects as contributors to the overall male/female wage differential The main conclusion following from the econometric results is that intra-occupational effects dominate Thus, policies which attempt to address the gender wage differential by re-allocation of labour across occupations are unlikely to solve the problem.

Sample selection in a model of female labour supply : an alternative approach

Suggests an alternative and computationally simpler approach of non-random sampling of labour economics and represents an observed outcome of an individual female′s choice of whether or not to participate in the labour market. Concludes that there is an alternative to the Heckman two-step estimator.

Child mental health after parental separation: The impact of resident/non-resident parenting, parent mental health, conflict and socioeconomics

Children of separated parents tend to have poorer mental health than children of intact families. Explanations to date have tended to focus on resident mothers, neglecting the potential importance of non-resident fathers. Using recent data from the Longitudinal Study of Australian Children, and independent teacher-reports of child mental health, this study 1) compares the mental health of children with resident and non-resident fathers and 2) explores predictors of poor mental health among children with a non-resident father. Children with a non-resident father had poorer mental health than those with a resident father, but this difference was explained fully by exposure to parental conflict, and to a lesser extent by socioeconomic status, parenting, and parent mental health. For children with a non-resident father, the strongest predictors of child mental health were mothers' employment and maternal parenting consistency. Policy implications are discussed.