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Introduction
While the health systems in Australia, New Zealand and other developed countries are regarded as some of the finest in the world, there is an ever-present need to ensure flexibility regarding cultural competence and responsiveness and cultural inclusivity across a range of practice settings. Australia, for example, has one of the most diverse populations in the world, with more than 25 per cent of its current population being born overseas (Commonwealth of Australia, 2012). If current rates of immigration to Australia continue to grow, it is estimated that by 2050 approximately one-third of Australia's population will be overseas-born (Cully and Pejozki, 2012).
This chapter examines the mental health needs of people from refugee and immigrant backgrounds, with particular emphasis given to asylum seekers. Mental health issues that may affect these populations are explored, as is engagement between people of refugee and asylum seeker backgrounds and mainstream mental health services. This chapter seeks to deepen and broaden readers’ understanding of the effects of trauma among people of refugee background, and links this to strategies that might be used by mainstream mental health practitioners and services in response.
PERSONAL NARRATIVE
Hanan's story – part one
My name is Hanan. I am a 51-year-old housewife and mother of two from Iraq, where I worked as a teacher for 10 years. My journey began in 1996, when I left Iraq with my family and spent time living in Jordan, Syria, Iran, Malaysia and Indonesia, then Nauru before eventually, in 2004, being granted refugee protection and permanent residence in Australia.
Traumas to my mental health started during the journey to Australia in a leaky fishing boat, upon which 270 people were squashed, including my young sons. During the boat journey I felt uncertain of my survival from one hour to the next and was in a constant state of high stress for several days. This constant fear was compounded by my children becoming ill, the lack of a bathroom (with only one toilet on board) and the smugglers constantly demanding that all passengers move around to balance the boat and stop it from taking on too much water and sinking. When the boat was no longer safe, I was told to wait for another ship to pick us up. We waited for seven days on the boat while it took on water. I suffered a constant fear of death.
Tardive dyskinesia is important in the side-effect profile of antipsychotic medication.
The development of tardive dyskinesia was evaluated in patients treated with double-blind, randomly assigned olanzapine or haloperidol for up to 2.6 years.
Tardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale (AIMS) and Research Diagnostic Criteria for Tardive Dyskinesia (RD-TD); it was defined as meeting RD-TD criteria at two consecutive assessments. The risk of tardive dyskinesia, the relative risk, incidence rate, and incidence rate ratio were estimated.
The relative risk of tardive dyskinesia for the overall follow-up period for haloperidol (n=522) v. olanzapine (n=1192) was 2.66 (95% CI=1.50–4.70). Based on data following the initial six weeks of observation (during which patients underwent medication change and AIMS assessments as frequently as every three days), the one-year risk was 0.52% with olanzapine (n=513) and 7.45% with haloperidol (n=114). The relative risk throughout this follow-up period was 11.37 (95% Cl=2.21–58.60).
Our results indicated a significantly lower risk of tardive dyskinesia with olanzapine than with haloperidol.
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