from YAPRap December 2002
by Diana Milosevic, NSW Refugee Health Service
Each year around 5,000 humanitarian entrants from overseas settle in NSW. Approximately one third of all humanitarian arrivals to NSW are aged 12 to 25 years. In the five-year period from mid-1996 to mid-2001, over 5,000 young people in this age group settled in NSW (reference 1 below). Over half of these originated from countries of the Former Yugoslavia (31%) or from Iraq (23%). In terms of language spoken, the top three were Arabic, Farsi/Dari, and Serbian. Approximately 70 per cent settled in the greater west of Sydney (Western and South Western Sydney), with 37 per cent settling in just two LGAs, Fairfield and Liverpool. After coming to Australia refugee students generally spend six months to one year at English Languages Centres (ELC) before transferring to a mainstream school. ELC are specialist school settings catering for language needs of newly arrived migrants to NSW.
Adolescence is a time of transition from childhood to adulthood, when young people begin to develop an adult identity involving the formation of their own values and beliefs. This transition itself has been associated with increased vulnerability to a number of mental disorders and behaviour difficulties.
For refugee young people, it is a particularly complex process being affected by the overlay of the refugee experience, cultural adjustment and the practical demands of settlement.
The pre-migration experience of refugee youth may have included:
- Torture, including sexual and psychological violation
- Prolonged periods of persecution
- Forcible removal from their homes and land
- Prolonged periods as a displaced person or in a refugee camp
- Separation from family members, often through death or disappearance.
Mental health
The refugee experience also has significant implications for mental health, with evidence that indicates that children often experience a psychological reaction to trauma not dissimilar to the one found in adults. In addition young people may be affected by their parent's exposure to pre-migration trauma, with studies indicating the inter-generational transmission of trauma effects.
Refugee adolescents may exhibit:
- Withdrawal, lack of interest and lethargy
- Aggression and poor temper-control
- Irritability
- Poor concentration
- Repetitive thoughts about traumatic events
- Poor appetite, over-eating, breathing difficulties, pains and dizziness
- Regression
- Nightmares and disturbed sleep
- Nervousness and anxiety
- Difficulty in making relationships with other youth and adults
- Clinging, school refusal
- Hyperactivity and hyperalertness
- Impulsive behaviour.
An early intervention approach with refugee young people is particularly important, not only because of their vulnerability and their limited access to protective factors, but also because physical and mental health problems may negatively affect refugee young people's capacity to deal with the challenges of the settlement process.
Protective factors and mental health
A sound body of evidence suggests that family and community support and economic and social resources such as education, adequate income, employment and secure housing, play a powerful protective role in relation to mental health. Refugee families have limited financial and material resources available to them in the early settlement period. Despite their already limited economic means, some families face the additional pressure of sending money to family members still in refugee camps or other difficult circumstances overseas. As a consequence, refugee young people may be expected to make a greater economic contribution to the family, which means that they may not be able to devote enough time to study. This in turn leads to conflict at home and they are forced to move out. A significant number of young refugees arrive in Australia without immediate family and arrive alone or with guardians to whom they are only distantly related. Those care arrangements may break down soon after arrival. Homelessness amongst refugee youth has been reported as a result of inter-generational conflict. Unaccompanied minors or young people arriving in Australia without parents or guardians are also seen to be an extremely vulnerable group of refugee youth.
Burdens of responsibility unmatched to age commonly affect refugee youth. This occurs particularly when roles within families change through more rapid adaptation by younger persons, or through the death or absence of a parent, placing additional stresses and responsibilities on the young person. Inter-generational conflict affects refugee young people in particular. The acculturation process heightens inter-generational conflict with differences between their cultural heritage and Western culture, further complicated by the traumatised nature of many of these families. This dissonance may be greater for young women than their male counterparts.
Recommendations related to service delivery issues
Refugee young people can have particular difficulty in accessing services, including health services, as a result of their age, refugee and resettlement experiences, and cultural differences between themselves and providers. Parental beliefs may also exclude them from attending certain services.
In addition, refugee young people often demonstrate low levels of health literacy, including limited knowledge of healthy lifestyle issues and about health services and how to access them (ref 3).
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The special needs of refugee young people should be considered when planning and implementing strategies for youth in general, and for refugee communities in general.
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In particular, there should be coordination at State level with other refugee youth initiatives, such as the current Department of Immigration, Multicultural & Indigenous Affairs (DIMIA) led focus on refugee youth (refs 5,6). This latter process is developing various strategies, including a web portal providing information on relevant services for youth.
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As with other youth, education, training and employment are vital to successful maturation and well being. The added difficulties of refugee young people in these spheres highlight the need for ongoing targeted programs to assist them (ref 5).
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The use of positive role models ie. successful or notable refugee young people themselves, should be promoted (ref 2).
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Case management may be an appropriate model, as many youth, including refugee youth, prefer contact with one trusted individual (ref 2).
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Intensive English Centres (IECs) in high schools are good access points for recently arrived youth. Curriculum development to improve health literacy, self-awareness and knowledge of health services should be promoted (ref 3).
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The use of peer education approaches
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Health services, including specialised refugee services, mainstream youth services and other sites accessed by young people should collect data on migration status to help identify numbers of refugee young people attending. This will allow comparison of service use with other population groups (refs 2,6).
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Specific attention needs to be paid to young people who are holders of Temporary Protection Visas (TPVs) (ref 5) and those who are asylum seekers in the community (ref 6). These two groups endure various restrictions on access to services that, along with the added stress of uncertainty regarding their migration status, are likely to impact adversely on their health. There is a need to assess the impact of such policies on these vulnerable young people.
References:
- DIMIA Settlement Database
- Refugee Resettlement Advisory Committee paper
- Enhancing Refugee Young People's Access to Health Services. Victorian Foundation for Survivors of Torture. June 2000.
- NSW Refugee Health Service/STARTTS community consultations - internal report
- NICOMS Refugee Issues Working Group - meeting on refugee youth, Nov 2001
- WEALTH OF ALL NATIONS: Identification of Strategies to Assist Refugee Young People in Transition to Independence. Report to the National Youth Affairs Research Scheme. Louise Coventry, David Mackenzie & Carmel Guerra.
Notes
Opinions: are the author's and not necessarily YAPA's.
Be careful!
YAPA and the author took reasonable care to ensure that this information was correct at the time of publishing (above). The author/s may have no health qualifications (unless stated), and information provided is general - it is not specific advice. Do not rely on it - check with other publications and authorities and if necessary get qualified professional advice for your situation.
