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)

11. ‘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)

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. That’s 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 it’s 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 Qur’anic recitation or intervention from doctor

17. Action to address mental health problem Individual Action Family/Friend’s 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 don’t want to talk for a long time. I just don’t 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 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)

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

22. 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