Mental Illness Perceptions in the Somali Community in Melbourne

1
Mental Illness Perceptions in the Somali
Community in Melbourne

• Dr. Marion Bailes
• Masters Candidate
• Centre for International Mental Health
• University of Melbourne
• Supervisors
• A/Prof. Harry Minas
• A/Prof. Steven Klimidis
• August 2005

2
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

3
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

4
Overview of project
5
Vignettes

• Amina (depression)
• Ahmed (PTSD)
• Ali (psychosis)

6
Qualitative analysis

• Phenomenology/Ethnography
• Looking at themes (deductive/inductive)
• Somali culture
• settlement issues
• explanatory models
• influences on help-seeking

7
Somali Culture
Loss
Jinns
Trauma
Islam
Clan
Morality
Relationships
Traditional African
8
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

9
Explanatory models
Problem
Name
Treatment
Action
Nature
Signs
Cause
Symptoms
10
Explanatory models Nature of mental health
problems

• distinction between craziness and emotional
  problem
• broad classification with continuum
• emotional problem - not normal crazy (waalli)

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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 dont
  separate them into conditions where someone is
  depressed or anxious or, you know, paranoid we
  dont separate all these things. We just lump
  them and we call them one word. In Somali we call
  buufis.
• (Individual Interview 13)

12
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. Thats when the
  emotional problems start.
• (Male elders focus group)

13
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 its a really difficult
  thing.
• (Individual interview 15)
• Jinns
• Evil spirits

14
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

15
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

16
Ali (psychosis)

• Mental illness, sickness
• Waalli, Mad
• Caused by jinn or evil spirit, or life problem
• Treat with Quranic recitation or intervention
  from doctor

17
Action to address mental health problem
Individual Action
Family/Friends action
Self-help
Direct help
Disclose problem/seek help
Seek professional intervention
Family
Western Professional
Religious Leader
Friends
Elder
Traditional healer
18
Medication for mental health problems

• Concerns about
• Side effects
• Addiction
• Inappropriate use

19
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
  dont want to talk for a long time. I just dont
  feel like talking to no-one.
• (Woman, individual interview 7)

20
Quranic recitation

• May improve emotional health
• Makes jinn leave a person
• Religious treatment involves readings from the
  Holy Book, the Quran The voice of a jinn may
  come outThey may say Stop reading the Quran
  and I will go away.
• (Religious leaders focus group)

21
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

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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

23
Influences on help-seeking
Influences
Facilitating
Inhibiting
Knowledge
Outcome Assessment
Unfamiliar
Fear of Gossip
Cultural Barrier
Quality of helper
Communication
Friend/relative
Shame
Unwilling
Community Worker
Need to appear strong
Severity of Problem
Service Availability
Practical Difficulties
Difficult
24
Clinical Implications

• Need for awareness of
• religious/social context
• different explanatory models
• refugee background
• contribution of settlement issues

25
Clinical Implications

• Treatment options
• acceptability
• chance of success
• Confidentiality and Empathy
• Facilitation of Communication

26
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