Abstract
BackgroundSouth Australia (SA) has resettled 151,134 refugees in the last ten years (Department of Immigration and Border Protection, Settlement reporting facility, 2014). Northern metropolitan Adelaide, an area which experiences significant social disadvantage, has received a significant number of (predominantly young) refugees. Research indicates that refugee youth are at elevated risk of mental health (MH) and alcohol and other drug (AOD) problems. These factors, along with the low socio-economic status of northern Adelaide, the number of refugee youth residing there, and the added complexity of treating comorbid MH and AOD problems (comorbidity) prompted this research. We investigated the barriers and facilitators to culturally responsive comorbidity care for these youth and whether the MH and AOD services were equipped to provide such support.MethodsThis mixed-methods study employed semi-structured interviews with refugee youth and service providers and an online survey with managers of services. Thirty participants (15 refugee youth, 15 service providers) took part in the semi-structured interviews and 56 (40 complete, 16 partially-complete) in the survey.ResultsThematic analysis of the interview data revealed the most commonly reported barriers related to four broad areas: (1) organisational and structural, (2) access and engagement, (3) treatment and service delivery, and (4) training and resources. Survey data supported the barriers identified in the qualitative findings.ConclusionsThis research highlights significant gaps in the response of MH and AOD services to refugee youth with comorbidity. Based on the findings, ways of overcoming the barriers are discussed, and are of particular relevance to policy makers, organisations and clinicians.
Highlights
South Australia (SA) has resettled 151,134 refugees in the last ten years (Department of Immigration and Border Protection, Settlement reporting facility, 2014)
Participant description Qualitative component Refugee youth Fifteen people aged between 12 and 25 years, 9 female and 6 male, participated. They were from Afghan (60%), African (27% [Congolese, Liberian, Burundian]) and Bhutanese (13%) backgrounds, and had been living in Australia for an average of 4.9 years
Service providers Service providers interviewed were from government (n = 7) and non-government (n = 8) mental health (MH), AOD and refugee support services
Summary
South Australia (SA) has resettled 151,134 refugees in the last ten years (Department of Immigration and Border Protection, Settlement reporting facility, 2014). Research indicates that refugee youth are at elevated risk of mental health (MH) and alcohol and other drug (AOD) problems. These factors, along with the low socio-economic status of northern Adelaide, the number of refugee youth residing there, and the added complexity of treating comorbid MH and AOD problems (comorbidity) prompted this research. Research has consistently reported that individuals with comorbidity experience poorer prognoses, premature mortality, higher rates of suicide, a more severe illness course, greater burden of disability, difficulty obtaining correct diagnoses, greater difficultly accessing effective treatments and greater use of health services than those with only one disorder [4,5,6,7]. The majority of the literature states that integrated and coordinated treatment models addressing both conditions (usually concurrently) are necessary, see, for example, Allsop [1], Donald et al [8], de Crespigny & Talmet [9], and Gordon [10]
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