Dr. Ahmed Munib, Dr. Ahmed Munib, Senior Psychiatry Registrar,Senior Psychiatry Registrar,

The Geelong Hospital, Victoria,The Geelong Hospital, Victoria,

and Research Fellow (Honourary), and Research Fellow (Honourary),

Barwon Psychiatric Research Unit, Faculty of Medicine,Barwon Psychiatric Research Unit, Faculty of Medicine,

The University of Melbourne.The University of Melbourne.

When a New Life is a Hard Life: When a New Life is a Hard Life:

The Impact of Resettlement on the Mental Health of South-Asian The Impact of Resettlement on the Mental Health of South-Asian

Migrants in Melbourne Migrants in Melbourne

Resettlement:“to establish a permanent home in a different location”

Ref: New Oxford American Dictionary-2nd

Edition

Immigration: “the act of coming to live permanently in a foreign country”

2

Ref: Australian Bureau of Statistics Census Data

20013

4

Pre-study observationsPre-study observations

5

Economic uncertaintyEconomic uncertainty

Lower quality of lifeLower quality of life

Lack of higher educational opportunitiesLack of higher educational opportunities

Limited career advancementLimited career advancement

Political and social instabilityPolitical and social instability

Family members/relatives settled overseas Family members/relatives settled overseas

Factors in the home country contributing to migration from Factors in the home country contributing to migration from the South Asia regionthe South Asia region

6

Post-migration scenarioPost-migration scenario

Inadequate social support mechanismsInadequate social support mechanisms

Social isolation and cultural alienation Social isolation and cultural alienation

Predisposition of anxiety/depressionPredisposition of anxiety/depression

Concealment of mental illness due to stigmaConcealment of mental illness due to stigma

Impaired coping and adjustmentImpaired coping and adjustment

Aggravation of psychiatric problemsAggravation of psychiatric problems

Unsuccessful resettlementUnsuccessful resettlement

Return to home countryReturn to home country

Inadequate/delayed therapeutic interventionInadequate/delayed therapeutic intervention

Rehabilitation failureRehabilitation failure

Social disabilitySocial disability

7

Factors affecting migrant emotional well-beingFactors affecting migrant emotional well-being

Inadequate psychological preparation prior to immigrationInadequate psychological preparation prior to immigration

Cultural and linguistic barriersCultural and linguistic barriers

Unfulfilled expectations regarding professional opportunitiesUnfulfilled expectations regarding professional opportunities

Denial of psychological difficulties/adjustment stress Denial of psychological difficulties/adjustment stress

Concealment of mental illness due to social stigmaConcealment of mental illness due to social stigma

Reluctance to utilize psychiatric services in the host country (Australia)Reluctance to utilize psychiatric services in the host country (Australia)

Preference to seeking psychiatric services in the country of originPreference to seeking psychiatric services in the country of origin

8

Post-migration factors affecting settlement outcomePost-migration factors affecting settlement outcome

Reception by the host communityReception by the host community

Host societies’ attitudes towards immigrantsHost societies’ attitudes towards immigrants

Perceived discriminationPerceived discrimination

Language competencyLanguage competency

Recognition of professional skills and qualificationsRecognition of professional skills and qualifications

Economic stability (job opportunities)Economic stability (job opportunities)

Presence of co-ethnic communitiesPresence of co-ethnic communities

Social networkingSocial networking

Adjustment with individualistic social expectationsAdjustment with individualistic social expectations

9

Research project and study outcomesResearch project and study outcomes

10

Study title:Study title:The Effects of Immigration and Resettlement on the Mental Health of South-Asian The Effects of Immigration and Resettlement on the Mental Health of South-Asian

Communities in Melbourne Communities in Melbourne. .

Supervisors: Assoc. Prof. Harry Minas and Assoc. Prof. Steven Klimidis. Supervisors: Assoc. Prof. Harry Minas and Assoc. Prof. Steven Klimidis.

(Department of Psychiatry/Centre for International Mental Health)(Department of Psychiatry/Centre for International Mental Health)

Adult Bangladeshi and Indian Australian permanent residents/citizens located in Adult Bangladeshi and Indian Australian permanent residents/citizens located in

metropolitan Melbourne. metropolitan Melbourne.

Recruitment: ‘Bangladesh Samity’ and ‘Federation of Indian Associations of Victoria.’Recruitment: ‘Bangladesh Samity’ and ‘Federation of Indian Associations of Victoria.’

Qualitative phenomenological approachQualitative phenomenological approach

One-on-one in-depth interviews; number of participants-38One-on-one in-depth interviews; number of participants-38

Narrative data analyzed with NVivo qualitative software for identification and extraction of Narrative data analyzed with NVivo qualitative software for identification and extraction of

themes/subthemes.themes/subthemes.

Outlines of PhD research project: Outlines of PhD research project: [Department of Psychiatry-University of Melbourne][Department of Psychiatry-University of Melbourne]

11

Profile of interview participantsProfile of interview participants

Religious identityReligious identity Country of originCountry of origin GenderGender TotalTotal

HinduHindu MuslimMuslim ChristianChristian IndiaIndia BangladeshBangladesh MM FF3838

99 2727 22 1010 2828 3030 88

12

Post-migration themesPost-migration themes

Social isolation (alienation, lack of social support)Social isolation (alienation, lack of social support)

Perceived discrimination Perceived discrimination

LonelinessLoneliness

Stigma (regarding mental illness, racial life events, ethnicity)Stigma (regarding mental illness, racial life events, ethnicity)

Adaptation concerns (blame, thoughts about repatriation)Adaptation concerns (blame, thoughts about repatriation)

Adjustment stress (language difficulties, cultural incongruity)Adjustment stress (language difficulties, cultural incongruity)

Racism (verbal/physical abuse, harassment, religious vilification)Racism (verbal/physical abuse, harassment, religious vilification)

Psychological distress (anxiety, agitation, antipathy, dysphoria)Psychological distress (anxiety, agitation, antipathy, dysphoria)

13

Deductions from research data Deductions from research data

[Resettlement difficulties][Resettlement difficulties]

Regret and self-reproach regarding decision to migrateRegret and self-reproach regarding decision to migrate

Feelings of resentment towards Australian societyFeelings of resentment towards Australian society

Anxiety, apprehension and uncertainty about the futureAnxiety, apprehension and uncertainty about the future

Feelings of social isolation and cultural alienationFeelings of social isolation and cultural alienation

Reinforcement of preconceived stereotypes about perceived Reinforcement of preconceived stereotypes about perceived

discriminationdiscrimination

Dysfunction in inter-personal relationshipsDysfunction in inter-personal relationships

Adverse impact on psychological well-beingAdverse impact on psychological well-being

14

Voices of the study participantsVoices of the study participants

15

Non-recognition of professional skillsNon-recognition of professional skills(impact on the individual)(impact on the individual)

“ I tried getting a job for three years and a half. I tried one after another, one after

another…but when I saw that it was hard for me getting job in my qualification…that

time I was so much mentally depressed that I was almost very sick. I lost my appetite,

psychologically I was very sick and I was extremely…anxious to get a job and I was

very unhappy truly speaking and it was hard for me to think all the time that I am

unemployed…no job, nothing. I was very seriously affected…because of lack of job…

depression was very high…I suffered very much.”

-Bangladeshi

malemale

16

Non-recognition of professional skillsNon-recognition of professional skills

“...we think we have everything and walk over to Australia and we can’t find a job or

something…general kind of people, some are frustrated because they couldn’t find

the placement equal to what they were doing...some people find it very frustrating

because they believe that they got the highest degree...and they come here and nobody

will accept it.” -Indian male

17

Racial discrimination (impact on the individual)Racial discrimination (impact on the individual)

“…certainly racism in general in Australia has affected me a lot…just from growing up…

the inevitable racism which migrants face…besides superficial racism at school or in the

workplace…subtle discrimination is much harder to pinpoint because you never know if

people are reacting to you for a certain way…but certainly in terms of overt racism that has

always been in the form of racial abuse or racial slurs or things like that. I would say that…

that the discrimination I have faced has been based on literally the colour of my skin above

anything else.”

- Bangladeshi male- Bangladeshi male

18

Racial discrimination Racial discrimination (impact on the family)(impact on the family)

“…“…because of our colour they treat us differently...which makes me really upset and because of our colour they treat us differently...which makes me really upset and

sometimes my son...he’s in year 11 now...last year he used to say that I wish that I had sometimes my son...he’s in year 11 now...last year he used to say that I wish that I had

white skin...I don’t want...like to be a brown boy in the class.”white skin...I don’t want...like to be a brown boy in the class.”

-Bangladeshi female-Bangladeshi female

19

Racism and religious vilificationRacism and religious vilification(impact on the individual and family)(impact on the individual and family)

““Recently...my Mom, she wears what is called the hijab. She stopped at a petrol station and

she was getting some petrol for her car and someone was driving past on the street, decided to

stop and park next to her and started to abuse her. She was really scared, she really didn’t

know what to do, where to go, she pretty much came home. I think she might have been

crying for a while... I probably felt just as much as Mum.”

- -

Bangladeshi maleBangladeshi male

20

Role of the family in copingRole of the family in coping

“I don’t think South-Asian families are designed for external intervention…I just…I

think an Anglo family…because of their culture and their acceptance of…psychiatric

or therapeutic intervention, I think they would be much more comfortable in seeking

outside help, but I think there is a great deal of pride associated with the integrity of

the family unit…in South-Asian communities…and to seek some kind of outside

assistance, I think would be a huge admission of failure…on part of both the family

units. So I think ultimately differences would have to be straightened out by the

family.”

- Bangladeshi - Bangladeshi

malemale

21

Psychological distressPsychological distress

“...I feel I’m like out of my own culture, I don’t belong here, I don’t belong with my

friends...I feel really depressed...I’m having some medication for depression because it

gets really bad and as I told before, now I feel my family very much. I feel this here

the life is so mechanical, you have to follow the same routine day after day…and I feel

like I’m just working like a machine.”

-Bangladeshi

female

22

Cultural incongruityCultural incongruity

“...Australians’ way of life is entirely different from our way, especially from the

subcontinent and their sense of humour is different and how they speak is different, how

they behave, how they react to the...suppose if I say one thing…Australian don’t

understand that. He may think in a different way.”

-Indian male-Indian male

23

Psychological impact of Psychological impact of cultural incongruitycultural incongruity

“Somebody’s son committed suicide because he tried to have an Australian girlfriend who being very

sincere to her...one fine morning she says, ‘get lost, don’t come back to me’...and this is a normal thing

here...and it was too much for him, he committed suicide.”

-Bangladeshi male-Bangladeshi male

24

Research findingsResearch findings

25

Profile of themes and sub-themes

Themes/subthemes Minimum Maximum Mean Standard deviation f (%)

Alienation 0 11 1.68 2.36 26 (68.4)

Emotional disconnection

0 10 1.55 1.83 29 (76.3)

Cultural uprooting 0 9 1.42 1.75 26 (84.2)

Racism: ethnicity 0 6 1.79 1.44 32 (84.2)

Racism: religious identity

0 8 0.68 1.82 7 (18.4)

Racism: professional arena

0 4 1.13 1.17 24 (63.2)

Stigma: mental illness 0 2 0.11 0.39 3 (7.9)

Antagonism towards host society

0 8 1.05 1.74 15 (39.5)

Resentment 0 12 3.21 3.04 29 (76.3)

Uncertainty about migration

0 7 1.37 1.57 23 (60.5)

Thoughts about repatriation

0 5 1.29 1.29 26 (68.4)

Non-recognition of professional skills

0 8 1.76 2.08 24 (63.2)

Unfulfilled expectations

0 10 2.84 2.50 29 (76.3)

Cultural incongruity 0 10 2.76 2.29 34 (89.5)

Anxiety 0 12 4.39 2.94 36 (94.7)

Depression 0 12 0.84 1.92 15 (39.5)

Despair 0 10 2.11 2.36 23 (60.5)26

Profile of themes (frequency of discussion salience)

27

Social isolation

28

Loneliness

29

Anticipated discrimination

30

Racism

31

Stigma

32

Adaptation concerns

33

Adjustment stress

34

Psychological distress

35

Psychological buffering

36

Help-seeking

37

Successful strategies for copingSuccessful strategies for coping

Social interaction and networking with co-ethnic communities.Social interaction and networking with co-ethnic communities.

Community-based social support networks (sharing and Community-based social support networks (sharing and

discussion of problems)discussion of problems)

Spiritual/religious pursuits (eg, meditation, prayer)Spiritual/religious pursuits (eg, meditation, prayer)

Community volunteer activities (eg, charity work)Community volunteer activities (eg, charity work)

Acculturation: interaction with local Australian communitiesAcculturation: interaction with local Australian communities

Seeking help: family, friends, chaplain, counsellor, GP, Seeking help: family, friends, chaplain, counsellor, GP,

psychologist, psychiatrist.psychologist, psychiatrist.

38

Long-term goals of the studyLong-term goals of the study

Promote awareness about mental health concerns within the South-Asian Promote awareness about mental health concerns within the South-Asian

community.community.

Increase awareness within the professional mental health system about Increase awareness within the professional mental health system about

mental health issues affecting South-Asian and other migrant communities.mental health issues affecting South-Asian and other migrant communities.

Formulation and implementation of culturally compliant psychiatric services.Formulation and implementation of culturally compliant psychiatric services.

Seeking professional help for psychological stress and/or mental illness is Seeking professional help for psychological stress and/or mental illness is

culturally acceptable, appropriate and necessary.culturally acceptable, appropriate and necessary.

Psychological difficulties and mental illness should not be associated with Psychological difficulties and mental illness should not be associated with

stigma.stigma.

Social networking and positive host community receptivity is an important Social networking and positive host community receptivity is an important

buffer for migrants settling in a new country.buffer for migrants settling in a new country.

39

Practical suggestionsPractical suggestions

Establishing community links and constructive networks to educate migrants Establishing community links and constructive networks to educate migrants

about identifying mental health issues and concerns.about identifying mental health issues and concerns.

Informing migrant communities about the potential health risks and negative Informing migrant communities about the potential health risks and negative

consequences of concealing psychological concerns and not accessing consequences of concealing psychological concerns and not accessing

available services for mental illness.available services for mental illness.

Establishing links with GPs and Carer networks to inform/educate migrant Establishing links with GPs and Carer networks to inform/educate migrant

families about mental illness and dispel culturally ingrained stigma.families about mental illness and dispel culturally ingrained stigma.

Peer support workshops for GPs and mental health clinicians to recognize Peer support workshops for GPs and mental health clinicians to recognize

culturally unique presentations of mental illness by clients from ethnic culturally unique presentations of mental illness by clients from ethnic

backgrounds.backgrounds.

Understanding that migrant families are more likely to internalize Understanding that migrant families are more likely to internalize

psychological concerns, and require empathic rapport for conventional psychological concerns, and require empathic rapport for conventional

therapy to be accepted and received by clients.therapy to be accepted and received by clients.

40

The process of resettlement is psychologically challenging for all concerned.

South-Asian migrants present a greater propensity to experience psychological distress due to multiple psychosocial factors.

Mental illness is not an inevitable consequence of resettlement.

Conclusion

41

Thank YouThank You

For further information:For further information:

Dr.Ahmed MunibDr.Ahmed Munib

Swanston Centre, Swanston Centre,

Geelong Hospital, Vic 3220.Geelong Hospital, Vic 3220.

Tel # (03) 5226 7410Tel # (03) 5226 7410

Email: Email: amunib@unimelb.edu.au

42