Improving the capacity of community-based workers to provide assistance to Iraqi refugees with mental health problems

A major refugee crisis is taking place worldwide with over 65 million individuals displaced as a result of persecution, conflict, generalised violence or human rights violation. Resettled refugees are one of the most vulnerable groups in Australian society, presenting high levels of exposure to traumatic events and consequently high levels of severe psychological distress. While there is a recognised need for professional help, only a small percentage of refugees seek and receive appropriate care for their mental health conditions. One way to improve help-seeking rates among refugees is to provide resettlement workers with training and education, using tailored resources to improve their mental health literacy. The first study of this PhD aimed to define important cultural considerations regarding mental illness and the communication strategies needed to allow first aiders, primarily defined as community workers who assist in the resettlement of refugees, to respond to Iraqi refugees experiencing posttraumatic stress disorder (PTSD) and depression related problems and crises. Using a Delphi method, 16 experts were presented with statements about possible culturally-appropriate first aid actions using questionnaires and were encouraged to suggest additional actions not covered by the questionnaire content. Statements were accepted for inclusion in a guideline if they were endorsed by ≥ 90 % of panellists as ‘Essential’ or ‘Important’. From a total of 65 statements, 38 were endorsed (17 for cultural awareness; 12 for cross-cultural communication, seven for stigma associated with mental health problems, and two for barriers to seeking professional help). By using the Delphi consensus technique (Study One), experts were able to reach consensus on how to provide culturally-appropriate mental health first aid to Iraqi refugees, establishing the suitability of this methodology in developing guidelines for cultural considerations. The evidence developed in the first study informed a tailored, short 7-hour Mental Health Literacy Course on how to assist Iraqi refugees with problems or crises related to depression or PTSD (Study Two). Study Two sought to evaluate a face-to-face Mental Health Literacy Course for educating community-based workers on how to provide initial help to Iraqi refugees with depression and PTSD related problems, using an uncontrolled pre, post and follow-up design. Eighty-six participants completed the pre- and post-training questionnaires. Forty-five (52%) completed all 3-timepoint questionnaires. Fifty-six percent (48/86) of participants were able to correctly recognise posttraumatic stress disorder (PTSD) as the problem depicted in a vignette before the training. This increased to 77% (66/86) following training and was maintained at follow-up with 82% (37/45) correctly recognising the problem (p = 0.032). Recognition of depression also increased from 69% (59/86) pre-training to 83% (71/86) following training and 82% (37/45) at follow-up. There was a significant increase in perceived helpfulness of professional treatments for depression following training (p < 0.001 at post-training, p = 0.010 at follow-up). Significant changes were reported in the confidence of participants when helping an Iraqi refugee with PTSD (p < 0.001 at post-training, p < 0.001 at follow-up) and depression (p < 0.001 at post-training, p = 0.003 at follow-up). A decrease was also found on social distance mean scores associated with PTSD (p = 0.006 at post-training, p < 0.001 at follow-up) and depression (p = 0.007 at follow-up). However, changes to offering help and helping behaviours were not significant following training for either the PTSD or depression vignettes, or for the ‘dangerous/unpredictable’ subscale of the depression vignette. This study provided evidence to support the statement that the 7-hour Mental Health Literacy Course (Study Two) is a recommendable way to better equip staff to respond to mental health crises and offer Mental Health First Aid to Iraqi refugees in a culturally sensitive manner. A primary goal of this PhD study was to develop evidence based resources that can contribute to the community and those working in resettlement organisations. These tools will enable such workers to better understand refugees and their experiences and to confidently provide initial help to those in distress. This project should be viewed as one of several strategies needed to support and ensure refugees are integrated into Australian society in the long term with increased capacity for independence, functionality and productivity