Mental Illness Perceptions in the Somali Community in Melbourne

Dr. Marion BailesMasters Candidate

Centre for International Mental HealthUniversity of Melbourne

Supervisors:A/Prof. Harry Minas

A/Prof. Steven Klimidis

August 2005

The Somali community in Melbourne

an emerging community Australian population 5,000 Victorian population 3,000

refugee background social and political upheaval majority enter through Humanitarian Program and Family Reunion

culturally distant traditional African Islamic

Background to the Project

Addressing high mental health needs low use of services

Aims Understanding concepts and attitudes Examination of influences on help-seeking

Rationale Improve accessibility and relevance of services

Overview of project

Key Informant Interviews

Observations Focus Group Discussions

Individual Interviews

Notes

Audio-tapes or notes

Transcriptions & reconstructions

Qualitative Analysis

Findings

Journal entries

Vignettes

‘Amina’ (depression)

‘Ahmed’ (PTSD)

‘Ali’ (psychosis)

Qualitative analysis

Phenomenology/Ethnography

Looking at themes (deductive/inductive)

Somali culture settlement issues explanatory models influences on help-seeking

Loss

Trauma

RelationshipsTraditional African

Morality

ClanIslam

Jinns

Somali Culture

Settlement Issues

Different culture Isolation Separation Practical problems Inter-generational conflict Language difficulties Financial problems Unemployment Preoccupation with country of origin School problems Expectations not fulfilled Family reunion difficulties Negative host attitudes Qualifications not recognised

Explanatory models

Explanatory Model

CAUSE SIGNS

SYMPTOMS

TREATMENTNAME

ACTION

NATURE

Name

Nature

CauseSymptoms

Signs

Action

Treatment

Problem

Explanatory models:

Nature of mental health problems distinction between ‘craziness’ and ‘emotional

problem’

broad classification with continuum: emotional problem - ‘not normal’ – crazy (waalli)

‘Not normal’

Isku buq (Confused) Islahadal (Talking to yourself) Wel wel (Worried) Buufis (Not normal)

There is a term that has been coined after the civil war. I never heard before that. This term refers to all mental conditions – we don’t separate them into conditions where someone is depressed or anxious or, you know, paranoid – we don’t separate all these things. We just lump them and we call them one word. In Somali we call ‘buufis’.

(Individual Interview 13)

Beliefs of causation

Problems of life

Settlement issue stress

Religious / cultural

“When people normally, Muslims or Somalis, cross this order of not using drugs, drink alcohol or illegal marriage is when they go overboard and have problems. That’s when the emotional problems start.”

(Male elders focus group)

Beliefs of causation

Trauma/Loss

Most Somalians who came here… direct from Somalia or maybe from refugee camps in Kenya, they have this kind of experience – dying, dying people, killing maybe some of immediate family, ….somebody raping girls, somebody killing innocent people, so it’s a really difficult thing.(Individual interview 15)

Jinns

Evil spirits

‘Amina’ (depression)

Not mental health problem, common ‘Confused’, ‘worried’ Caused by settlement issues (particularly

loneliness and lack of support) Change social situation, help from community Intervention from doctor / religious leader

‘Ahmed’ (PTSD)

Common, mental health problem ‘confusion’, ‘becoming mad’ Caused by traumatic experience, personal

issues, settlement issues Keep busy, get on with life Talk to family, friends or doctor

‘Ali’ (psychosis)

Mental illness, sickness ‘Waalli’, ‘Mad’ Caused by jinn or evil spirit, or life problem Treat with Qur’anic recitation or intervention

from doctor

Action to address mental health problem

Individual Action Family/Friend’s action

Disclose problem/seek help Seek professional intervention

Self-help Direct help

Family

FriendsElder Traditional healer

Religious Leader

Western Professional

Medication for mental health problems

Concerns about:

Side effects Addiction Inappropriate use

Attitude to counselling

‘I told this lady, I told her to go to doctors and she said “They waste your time, they sit in front of you and make you talk, talk, talk. I don’t want to talk for a long time. I just don’t feel like talking to no-one.”’

(Woman, individual interview 7)

Quranic recitation

May improve emotional health

Makes jinn leave a person

Religious treatment involves readings from the Holy Book, the Qur’an… The voice of a jinn may come out…They may say “Stop reading the Qur’an and I will go away.”

(Religious leaders’ focus group)

Facilitation of help-seeking

Factors Participants (/28) Friend/relative 10 Communication 9 Empathy/Confidentiality 8 Knowledge 6 Positive outcome 5 Severity 5 Service availability 3 Somali worker 3

Inhibition of help-seeking

Factors Participants Unwilling 22 Difficult 14 Shame 13 Unfamiliar 12 Fear of Gossip 9 Practical 8 Cultural barrier 7 Need to appear strong 6 Negative outcome assessment 3

Influences on help-seekingInfluences

Facilitating Inhibiting

Fear of Gossip

Need to appear strong

Unfamiliar

Unwilling Shame

Difficult

Cultural Barrier

Outcome assessment

Friend/relative

Quality of helper

Knowledge

Service availability

Communication

Community worker

Severity of problem

Practical difficulties

Facilitating Inhibiting

Knowledge

Communication

Community Worker

Service Availability

Outcome Assessment

Quality of helper

Friend/relative

Severity of Problem

Fear of Gossip

Difficult

Unwilling

Unfamiliar

Cultural Barrier

Shame

Need to appear strong

Practical Difficulties

Influences

Clinical Implications

Need for awareness of:

religious/social context different explanatory models refugee background contribution of settlement issues

Clinical Implications

Treatment options acceptability chance of success

Confidentiality and Empathy

Facilitation of Communication

Implications for mental health promotion

Programs to assist settlement

Programs to encourage help-seeking

Community mental health promotion Decrease mental illness stigma Professional development Interpreters/ liaison workers/ case workers