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    Asylum seekers on Nauru, sitting down for a meal

Paper plates and throwaway cutlery

generating trust with released asylum seekers

Associate Professor at the School of Nursing and Midwifery Nicholas Procter makes a cogent case for a return to practical strategies and simple clear communication in order to help people at high risk of suicide better understand their situation and discuss it with others.

Related pages

7 April 2004: Supporting TPV Holders: Partnering Mental Health and Migration Law - Nicholas Procter calls for the structure of individual mental health support to be built around the processes of seeking asylum and coping with rejections and setbacks during the processes attendant upon applications for refugee status.

28 October 2004: Procter: From 'temporary' to permanent' Protection Visas - Nicholas Procter argues that It's Much More Than a Quick Political Fix. "If TPV holders already disoriented by trauma, sometimes years of detention and then the relentless insecurity of temporary status in Australia, find that once again they are facing mixed messages, it will be disastrous. Trust is a fundamental requirement for mental stability..."

Paper plates and throwaway cutlery: aspects of generating trust during mental health initiatives with asylum seekers released from Immigration Detention Centres

Summary

Working with some of the most marginalised of mental health consumers - asylum seekers released from immigration detention centres and living in rural South Australia - Nicholas Procter makes a cogent case for a return to practical strategies and simple clear communication in order to help people at high risk of suicide better understand their situation and discuss it with others.

by Nicholas Procter
Extract from Synergy -
First published in Synergy No 1 2004, pp 8-9
Republished with permission August 2004

Nicholas G Procter [RN PhD] works as Associate Professor at the School of Nursing and Midwifery at the Division of Health Sciences, at the University of South Australia.

For most of 2003, myself and Dr Mohammad Amirghiasvand, an interpreter and health liaison worker from the Migrant Health Services, Adelaide Central Community Health Service, have been working on ways to develop more informed and compassionate understanding of mental health issues for refugees released on Temporary Protection Visas (TPVs). Achievements in this area have demanded a team approach and have been relevant to mental health service delivery in country South Australia. As part of this process, we have been learning new ways to effectively generate trust between health workers and asylum seekers, which is essential to delivering effective mental health care treatment and services.

For many of the men we have been working with, suicide is a very real option. These are people who fled to save their lives, whose will to live is strong but for whom the prospect of death looms large. Their Temporary Protection Visas will soon expire and so too their hopes of remaining in Australia. If forced to return home, they're convinced they'll be killed. If their lives are to be lost,most would prefer it to be at their wn hands.

Many are taking medication to help them sleep at night and treat their depression. The uncertainty of their lives has wrought an enormous physical and psychological toll. So fragile is their grasp on being, some see no point in the usual accoutrements of life; even their tableware is impermanent - paper tablecloths, paper plates, throwaway cutlery.

The recent onset of TPV review interviews for Permanent Protection Visas in South Australia has revealed new information about the way some asylum seekers experience their current existence, and the impact previous trauma has upon everyday life. The uncertainty of their existence and strongly held belief that it is unsafe to return to their homelands, has had an enormous physical and psychological toll. To make matters worse, there is no way of knowing in advance when interviews to assess claims will take place, or what questions will be asked.

Knowledge of these and other stressors impacting upon TPV holders are important. Prevention of mental health problems, mental illness and suicide for asylum seekers involves:

  • understanding what contributes to the risk and protective factors;

  • identifying the groups and individuals who can potentially benefit from interventions;

  • developing, disseminating and implementing effective interventions that are culturally and linguistically appropriate. [1]

The table below was first formulated three years ago during a project in Adelaide called 'Speaking of Sadness and the Heart of Acceptance: Cultural Healing Uncovered'. Further details of the project are outlined in the book 'Reciprocity in Education' published by Multicultural Mental Health Australia. The contents of the table have been developed and defined situationally as a best practice initiative. Fundamental to the delivery of clinically relevant integrated services is understanding how cultural beliefs guide and inform communication of health problems, the way concerns are talked about, and when, how and why help is sought and evaluated.

[1] This statement is based upon the National Mental Health Plan 2003-2008. Canberra: Australian Government, 2003.

ASPECTS OF GENERATING TRUST DURING MENTAL HEALTH INITIATIVES WITH ASYLUM SEEKERS ON TEMPORARY PROTECTION VISAS
Issue/problem/concern Goal/objective
  • Asylum seekers (understandably) questioning the motives of the health worker."Why do you want to help us? What is in it for us? What do you think about "Deep down,tell us what do you really think about us." "Do you like us?"
  • People describing themselves as tense, locked-up, unable to talk openly or freely;
  • People asking for repeated explanations and reassurance about how the actions of the health worker will benefit them/members of their community;
  • People fearing that information about their mental health issues will be misused by people within and beyond their cultural group;
  • People showing a reluctance to participate in individual or group discussions fearing that what they say will be used against them when applying to DIMIA for permanent residency status in Australia;
  • People fearing that information about their lives and experiences will bring them or their family persecution in their homeland;
  • People feeling that they are caught up in a dehumanising political and legal process beyond their control;
  • People feeling lost, anxious and in search of accurate information regarding what the "truth" is about their situation and fate.
  • To work towards establishing trust and establishing friendship between the clinical team, participants, and the wider community;
  • To define the nature and scope of this trust and how it helps form partnerships within cultural groups and beyond;
  • To alleviate and overcome feelings of suspicion and generate trust as a two-way reciprocal process;
  • To increase participants 'attendance and participation at group meetings as well as have new people join;
  • To encourage a feeling of belonging and that contributions to the initiative are valued;
  • To educate about how this health initiative is separate from DIMIA procedures;
  • To help people, some of whom are struggling with problems of daily living, to learn from each other about ways of coping and promoting health and wellbeing;
  • To break away from formal meeting structures characteristic of Western-style group functioning;
  • To identify and establish w rth as a human being whose life has meaning and incorporate this into an advocacy role;
  • To help bring about a sense of relief from understanding their situation and discussing it with others.
Strategies Outcomes of Strategies
  • Reassure people that you are not here to hurt them;
  • Value traditional practices and beliefs;
  • Explore why people are suspicious and seek to clarify this using verbal and non-verbal means;
  • Remain accessible, open and flexible;
  • Explain how you see their situation and how you hope to bring benefit;
  • Be clear about what is being offered in the initiative and avoid giving false hope;
  • Make the benefits of the initiative visible in community languages as a way of delivering on their trust;
  • Avoid focusing on detailed individual migration histories;
  • Demonstrate respect and appreciation of the thoughts and opinions held by participants;
  • Help arrange and/or support group outings with the clinical team;
  • Provide appropriate food and refreshments;
  • Provide transport to help people attend meetings;
  • Provide individual support for interpreters and translators;
  • Be consistent when explaining the initiative and how it is designed to help support asylum seekers;
  • Accept invitations to have a meal with people in their own home;
  • Translate English language newspaper reports of the initiative into community languages.
  • People say that they are "more informed" about clinical initiatives, aims and objectives;
  • Interpreters say that community people appear more relaxed and willing to attend meetings, and explain their thoughts and feelings;
  • People say they "feel lighter" after talking about their inner feelings;
  • Community people say they can see how and where the initiative is heading;
  • People bring stories of their inner life struggles to share with others;
  • People requesting to have their experiences spoken about in electronic and print media;
  • People are willing to use local health services and openly express this;
  • People prepare food for community outings;
  • Community people say they are feeling more relaxed, feel accepted, respected and valued by the facilitator;
  • People are willing to disclose deeper experiences;
  • People are willing to become volunteers to assist new arrivals within their own community;
  • People invite their friends to group meetings and, over time, they too begin to speak openly with others;
  • Group meetings continue as a self-directed activity led by community people;
  • People feel that trust is possible and desirable.
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