Torture and trauma experiences can vary greatly. They can include effects of imprisonment, physical and psychological problems from torture, rape and life as a child soldier, as well as the stress of life in refugee camps. However, “[a]ccessing treatment is exceptionally difficult because the concept of counselling is unfamiliar to most Africans, and cultural norms may discourage the disclosure of such problems.”244
Above and beyond issues of physical access, such as not knowing how or where to find services, or even knowing that such services exist, African Australians can experience tremendous barriers in simply admitting the need for such services.
Even from a Western perspective where, in general, mental health issues are understood and the value of counselling is broadly accepted, admitting the need for and using these services can be problematic. Western culture still considers the need for such services shameful, even in the wake of stress or a traumatic event. These sentiments can be compounded further when a person comes from a culture that is not necessarily familiar with the concept of addressing mental health issues through counselling services.
22.3The culture effect
Refugees are a diverse group, representing many countries, languages, cultures and religions. The ability of a refugee to cope with and come to terms with past and current trauma is largely dictated by their culture, experience and personality.245 Depression is culturally construed; what might be considered out of the norm and lead to depression in one culture may be considered normal in another and dealt with as part of everyday life.246 This raises a crucial question: if a refugee is depressed according to Western measures but does not feel depressed, how does the mental health community best serve them?247
In African cultures, a person’s emotional state is not necessarily seen as connected to their mental state. As a result, it is felt that traumatic events do not have the same level of mental health impacts as they would on a person from a Western culture.248
Despite these views, cultural differences should not become a barrier to effective mental health treatment for those who require them.249
22.4Mental health issues
It is not necessarily the stress of previous trauma that a refugee may identify as the most significant factor affecting their mental health. Instead, it might be their migrant status, the stress of having to settle into and acclimatise to life in Australia, unemployment or under-employment or the potential loss of status within their family or community.250
Other factors affecting the mental health and well-being of refugees include: the loss of family and cultural support; economic pressures; low socio-economic status or a drop in socio-economic status following migration (status inconsistency); culture shock or culture conflict; language problems; prejudice and discrimination; isolation; traumatic experiences or prolonged stress before or during immigration; value differences concerning gender and intergenerational relations; and language and cultural barriers to mental health service, including stigma about mental illness and lack of knowledge about services.251
Social isolation often leaves refugees at a loss for how to respond to stressful situations in the absence of their normal coping mechanisms. In the oral tradition of African countries, there is constant discussion about everything, which occupies and stimulates the mind. Social networks serve as a sounding board for such discussion. However, upon arrival in Australia, that social network is suddenly gone. In its absence the “mind turns to monologue.”252
Mental health issues are exacerbated by a person’s social and geographical isolation.253. Perceived social support from one’s own community plays a significant role in positive mental health outcomes.254 Interventions that help to restore social order, improve social support networks and focus on appreciation of traditional systems might have a greater impact on improved mental health than an individual, Western and 'medicalised' approach to mental health.255.
The risk of substance abuse is heightened when people move to a new and different environment and, at the same time, are dealing with past experiences of torture and trauma. These scenarios have been studied through the lens of the Acculturative Stress model of substance abuse, which analyses the effects of moving to a country with more permissive attitudes towards drinking than the home country.256 When the act of using substances loses its taboo, when social support networks are limited and in the absence of any other coping mechanism, people will increasingly use, and then misuse, alcohol.257
The particular risk factors leading to substance misuse in refugee communities are highly amenable to prevention, yet those services that do exist for this group generally target treatment.258 This should be rectified, starting with programs that promote the importance, and encourage the appeal, of dealing with mental health issues.
23Impact on communities, families and social support networks
“One of the most significant causes of distress reported by African refugees is family disintegration and the loss of traditional social supports and conflict resolution mechanisms.”259 Regardless of the cause of their stress, the loss of their support network compounds the challenges facing refugees and impacts on their ability to adjust and thrive in their new community.
In the African context, extended family and community networks become part of their identity as a people.260 However, refugees often face a situation where these vital networks have been destroyed, in a process that often began with war and displacement in their home countries. This was exacerbated during their time in refuge, with extended families, communities, friendship circles or social networks not always placed together.
The stress of adjusting to life in Australia, and moving from a collectivist society to one with a stronger focus on the individual and the nuclear family, can increase incidences of domestic violence and substance abuse, which can have equally devastating effects on family cohesion.261 “Pressures associated with resettlement, new family dynamics and extended family commitments can also place strains on intergenerational relationships.”262
It is important to note that African refugees in Australia come from different countries, tribes and languages, as well as having different educational and socio-economic backgrounds.263 Even when a community of people from the same country is gathered together, there is no guarantee that they will know each other or share a cultural or linguistic background. They may also be from communities that would not associate in their home country. Indeed, they might even be members of groups that were antagonistic, or possibly enemies, in a conflict back in that country.