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