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Hazara Mental Health Consultation Report

Commissioned by the Mental Health Commission of and implemented by for the Treatment NSW NSW Serviceand Rehabilitation of Torture and Trauma Survivors (STARTTS).

Nsw Service for the Treatmentand Rehabilitation of Tortureand Trauma Survivors

Hazara Mental Health Consultation Report

Executive Summary 05

The Consultation 10

Background 07

Recommendations 21

References 23

Emerging Themes 14

Commissioned by the Mental Health Commission of NSW and implemented by the NSW Service for theTreatment and Rehabilitation or Torture and Trauma Survivors (STARTTS)

Hazara Mental Health Consultation Report04

Foreword

I would like to acknowledge the work of STARTTS staff who were involved in the consultations and report writing -

Arif Nabizadah for project coordination; Hassan Rezayee, Rohullah Rahimi, Asthma Nawrozi, Soray Kassimi and

Mohamed Dukuly for group facilitation; Ansuya Naguran and Jasmina Bajraktarevic-Hayward for data analysis and

writing and Hamed Turay for project support and supervision. Thank you also to the Hazara organisations involved

with the project – Kateb Hazara Association and Human Care Welfare; and to the Hazara Peer Support Leader

group. Last but not least, I would like to extend my thanks to the Mental Health Commission of NSW for supporting

our work and mental health promotion in the Hazara community. I am hopeful we will continue to develop further

opportunities for collaboration in the near future.

Jorge Aroche

STARTTS has a long-standing relationship with the Hazara community commencing in early 2000s. It is a

relationship that was built not just on the basis of services provided, but also many years of STARTTS and Hazara

community working side by side on various projects. This is an example of one such collaborative project. While

mental health can often be a difficult topic to discuss with refugee communities, the relationship between STARTTS

and the Hazara community based on trust, reciprocity and mutual respect, has enabled us to enter into

conversations that have led to this report.

STARTTS

CEO

The themes that emerged during the consultations included:

The report captures the key themes and recommendations that emerged from five mental health consultations held

with members of the Hazara community between April and June 2018. The consultations were held with the

purpose of informing and planning a culturally effective mental health literacy campaign for the Hazara community. A

total of 85 Hazara men and women participated in the consultation process. 11 of the 85 participants were asylum

seekers, while the others were permanent residents ranging from new arrivals to residents who had been living in

Australia for as long as 15 years. The age range of the participants was 18-70. 58 were men and 27 were women.

This report was commissioned by the Mental Health Commission of NSW and implemented by the NSW Service for

the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS). The consultations that informed the

report were conducted within the context of a long-standing STARTTS relationship with the community,

implementation of a current Mental Health Literacy and Suicide Prevention project run by STARTTS and funded by

WentWest, and engagement of a number of Hazaragi speaking community development and clinical staff. The

WentWest funded project has resulted in the creation of a group of Hazara community peer leaders trained in

Accidental Counselling and Suicide Prevention. This group provided support and guidance for this project.

Executive Summary


Impact of family separation on mental health

and wellbeing

Community strengths

while participants acknowledged the challenges their

community faced, many highlighted community

strengths. These included: Hazara community

comprising of fast learners with diverse skills and

experiences; individual, family and community

resilience; adaptability; respect for cultures other than

their own; high levels of social capital demonstrated

through existence of active Hazara groups and

organisations running projects and activities for their

community members.

This was the most commonly cited source of distress.

Due to the residency status of some community

members (asylum seekers and Temporary Protection

Visa holders) and mode of arrival by others, family

reunion is impossible or extremely difficult. The

consultation participants reported concern for family

members who are still living in situations of violence and

human rights abuses; and the impact long term

uncertainty has on their increasing levels of distress.

Impact of uncertainty related to immigration and

employment

Another very commonly cited concern of the Hazara

community was the uncertainty that characterises the

asylum seeker experience. Included in this experience

are issues pertaining to family separation, visas,

immigration, challenges associated with learning English

and unemployment.

Social isolation and loneliness

Despite the existence of support services and Hazara

community activities, the participants highlighted

feelings of isolation and loneliness. Some of those

feelings were reported to stem from being in a new

environment, not speaking English and not having

financial resources to support an active social life .

Impact of overseas conflict on mental health

As stated above, many Hazara community members

have families overseas in Afghanistan and Pakistan.

Hazaras are frequent targets of attacks by Taliban and

Da’esh. Consultation participants reported feelings of

sadness and hopelessness associated with this

challenge.

In addition to the consultations, STARTTS trialled a simple mental health campaign developed by the Hazaragi speaking staff and the Peer Leader group. 40 t-shirts were printed double-sided with relevant mental health promotion messages. The messages were designed to reflect Qur’anic sayings, instil hope and encourage people to seek assistance from the identified, visible and trained Peer Support Leaders. All messages were printed in English and Hazaragi. The t-shirts were worn by the Peer Support Leaders during a large community Eid event and during the consultations with Community Leaders. The t-shirts gained significant attention and sparked mental health-related conversations.

Finally, the report recommends channels for further mental health promotion including: ongoing small group conversations using bi-cultural facilitators; development of audio-visual materials such as video role plays or video vignettes with people experiencing mental health issues; expansion of the t-shirt campaign to a wider audience coupled with an increasing number of community members trained in Accidental Counselling; use of other promotional materials such as banners, stress balls or pens; provision of support to Hazara community organisations to implement grassroots community owned mental health promotion initiatives; and ongoing collaboration between STARTTS and the .Mental Health Commission of NSW

Hazara Mental Health Consultation Report 06

Participants reported worrying about their children

losing Hazara culture and facing parenting challenges

due to different approaches to parenting and discipline

in Australia. They were also concerned about specific

settlement challenges facing older community

members.

Consultation participants reported various behaviours

they associated with distress such as emotional

outbursts, withdrawal, difficulties with sleep, anxiety,

tiredness, loss of appetite and use of drugs and

alcohol to self-medicate.

Support required by community members

All participants felt that the consultation was a valuable

exercise as it enabled discussions about mental health

in a safe and supportive environment with bi-cultural

facilitators. Other support activities recommended

included referrals to professional help, social activities,

provision of mental health information in Hazaragi and

use of social media for mental health promotion.

Participants reported seeking help from counsellors,

community leaders, friends, family or religious

organisations. The only mental health service

mentioned as a source of support was STARTTS.

Recognition of sadness, pressure and

hopelessness

Perceptions of counselling

Existing help seeking patterns

Participants reported having a limited understanding of

counselling. However, there were some participants who

accessed counselling in the past and were able to

elaborate the positive impact of this on their mental

health.

Perceptions of mental health

However, others spoke about the ways they overcame

loneliness and isolation and acknowledged services and

organisations that supported this.

The participants equated good mental health with feeling happy and relaxed. While many spoke about stigma associated with mental health issues, the majority reported understanding of mental health challenges (eg. Post-Traumatic Stress and Depression) associated with external stressors (trauma, family separation, immigration issues).

Intergenerational challenges

Channels for mental health promotion The participants suggested use of social gatherings, events, regular small group discussions and information sessions conducted in Hazaragi. Importance of bi-cultural facilitators was highlighted. The participants felt that the community was open to mental health promotion.

Along with other Shia minorities in Afghanistan, Hazaras have faced long-term persecution and human rights abuses. Hazaras traditionally lived in Hazarajat in the central mountains of Afghanistan. Before the 19th century the proportion of Hazaras in the overall population of Afghanistan was higher than today. The intense persecution began with massacres by King Abdul Rahman in late 1800s. There are also records of Hazaras having been sold as slaves in the 19th century. Since then their numbers have gradually decreased. During the 19th and 20th centuries, they were marginalised and discriminated against to such an extent that majority were employed in unskilled labour and hard and dangerous work, which further segregated them through socioeconomic disadvantage. Hazarajat was deliberately kept underdeveloped with no roads, schools or clinics. (Ibrahimi, 2017; Marie, 2013; Bacon, 1951; Monsutti, 2005; Poladi, 1989)

The 1979 Soviet invasion of Afghanistan temporarily changed the fate of the Hazara. While they were opposed to the Soviet occupation, the conflict at that time allowed them to organise politically and gain political and financial support from the Shia community in Iran. This was lost when Afghanistan descended into civil war in 1989 and the country fell under the Taliban in 1996. The Taliban targeted the Shi'a Hazara as infidels and subjected them to gross human rights abuses, causing them to flee to other countries as refugees. When Hamid Karzai came to power in 2002, persecution of the Hazaras decreased in urban areas and they were able to regroup politically and gain a significant number of parliamentary seats in the 2005 elections. From 2007, the Taliban built itself back up from their base in Pakistan and expanded back into Afghanistan. Once again, the Hazara were targeted for persecution. This has continued in recent years with Hazaras targeted by both the Taliban and the Afghan branch of Da'esh (ISIS) who have claimed responsibility for a number of large scale bombings of Hazara events or sites (Adlparvar, N. 2014; Maley, 2018).

Hazaras have come to Australia in large numbers on boats from Indonesia since 2000, regarding the journey as a safer option than staying in Afghanistan or Pakistan waiting for UNHCR resettlement. After the overthrow of the Taliban in 2001, a number of Hazaras were forced to return from Nauru to Afghanistan. Most fled immediately to

Although Hazaras have been given full rights under the 2004 Afghan constitution, they still face discrimination in many areas of the country. They are vulnerable to attack and death on Afghanistan's road network, particularly on the roads to and from Hazarajat that are targeted by criminals, insurgent forces and the Taliban and more recently by ISIS affiliated organisations. Many Hazaras fled to the Balochistan province of Pakistan, mostly in and around the city of Quetta, with a sizeable number also in Iran. Hazaras have also fled to western countries such as Canada, Europe, the US and Australia. (Maley, 2018; Human Rights Watch, 2018; UNAMA, 2018; Refugee Council of Australia, 2018)

Hazara community members speak a number of languages including Hazaragi, Dari, Farsi, Arabic and Urdu. However, the primary language spoken by the Hazara community in Australia is Hazaragi. According to the 2016 Census, there were close to 5000 Hazaragi speakers in NSW with the majority settled in Cumberland Local Government Area (69%). Over 55% arrived between 2006 and 2011. There were also close to 10,000 Dari speakers; the majority live in Cumberland LGA (41%) followed by Blacktown LGA (22%). It is essential to consider settlement patterns of the speakers of both languages as many Hazaras would say they speak Dari. Overall, it is clear that Cumberland LGA hosts the highest number of Hazaras in NSW. (Multicultural NSW, 2018).

It is also essential to consider high level of disadvantage in this community. For example, at the time of the 2016 Census, only 8% of Hazaragi speakers had tertiary qualifications compared to 32.3 % of the total population of NSW. Close to 80% of Hazaragi speakers had no qualifications compared to 39.1% of the total population of NSW. The unemployment rate of Hazaragi speakers was 17.6% compared to 6.3% of the total NSW population. Finally, 36.9% reported difficulties in speaking English compared to 4.5% of the total NSW population. Many Hazaras are illiterate in their first language. This is due to the history of persecution as outlined below, deliberate denial of education particularly for women, and suppression of the Hazaragi language. (“The Afghanistan-born Community | Department of Social Services, Australian Government,” n.d.)


Background

Many Hazaras have arrived to Australia via unauthorised means, usually by boats. They have applied for refugee status post-arrival and while they are awaiting the decision on their application, they remain on Bridging Visas. There are different classes of Bridging Visas, but in general this leads to significant challenges: no means of family reunion; limited or no access to financial assistance (due to recent policy changes); limited access to free outpatient medical services; limited or no access to government-funded casework support and employment services. In the past, rules related to particular Bridging Visas included no access to work rights and free education beyond compulsory

schooling age. This has changed in more recent times. Practically, this can result in poverty, homelessness, unemployment or employment in the so called “gig economy” with minimal protection or workers' rights, drug and alcohol abuse as methods of coping with distress. It also means long term family separation and extended anxiety over forced return. (Australian Human Rights Commission, 2019)

Pakistan and some returned to their villages in Afghanistan. Some of them have since been killed by the Taliban who, though no longer in government, nevertheless have substantial power in Afghanistan. Hazaras from Afghanistan still form one of the major groups of boat arrivals in Australia seeking asylum. Many Hazara have relatives remaining in Afghanistan and Pakistan who still suffer constant harassment and persecution. Worry over the safety of relatives is a constant source of stress and anxiety, as well as guilt and shame over leaving them behind and being separated from them. (Maley, 2018; UNAMA, 2018; Refugee Council of Australia, 2018; Ibrahimi & Maley, 2018) Anecdotes from Hazara Australians suggest that rates of depression amongst the Hazara community are high and substance abuse is common, especially amongst those on bridging visas.

Those who are found not to be refugees by the first decision maker (Department of Immigration and Border Protection – DIBP) and following the appeal to the Administrative Appeals Tribunal are often referred to as “double


Hazaras have been frequently retraumatised during precarious journeys by boat and in detention upon arriving in Australia. Examples include being called by number instead of by name and being stripped of personal belongings such as small keepsakes from family members. According to the current Immigration policies, those who have arrived in Australia by unauthorised means and are found to be refugees can only be granted Temporary Visas. This includes the Temporary Protection Visa (TPV) and Safe Haven Enterprise Visas (SHEV). The main differences between the TPVs and the SHEVs are:

A TPV gives a refugee protection for three years and a SHEV for five years

TPV and SHEV holders can work, get Medicare, and get some social support payments through Centrelink. However, they cannot sponsor family members to come and live with them in Australia, and they cannot leave and return to Australia without permission. Even if they live in Australia all their lives, they cannot get the same services and supports that others can – for example, they cannot get government-funded financial assistance for further education. To obtain a SHEV, a person (or his or her family member) must intend to work and study in a regional area. While SHEV offers some favourable conditions, many people are anxious about moving out of Sydney to a place where they have no social networks or service systems they can access. (“Asylum seekers,” n.d.) (https://www.refugeecouncil.org.au/asylum/)

A person with a TPV cannot apply for any kind of permanent visa and a person with a SHEV can apply for a permanent migration visa (but not a permanent protection visa).

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All the above groups are highly vulnerable and have expressed frequent suicide ideations and significant levels of distress possibly resulting in more serious mental health issues. (Australian Human Rights Commission, 2019)

STARTTS has a long history of engaging with the Hazara community, commencing during their early settlement years in the 2000s. Hazaras access all STARTTS services including individual counselling, groupwork, youth groups, camps and the Families in Cultural Transition (FICT) Program. STARTTS has also provided ongoing support for Hazara community organisations implementing projects supporting their own community. Some of those organisations include Kateb Hazara Association (the largest Hazara organisation in NSW) and Human Care Welfare (organisation providing English classes and social support for Hazara asylum seekers). STARTTS currently employs 4 Hazara staff including two clinicians and two community development/project officers. In recent years, STARTTS has been implementing a Hazara mental health literacy and suicide prevention project funded by WentWest. It consists of psychosocial support groups and peer leader training in Accidental Counsellor and suicide prevention skills. The Mental Health Commission project was a natural extension of STARTTS' work with this community.

negative pathway”. Their only options are appeal to the Federal Circuit Court which cannot review the merits of the case but can only assess whether an error of law was made. The final option is a direct appeal to the Minister. People who are on the double negative pathway have no access to financial support, free legal assistance (some is provided pro-bono but this is limited and in high demand) or government funded services. (https://www.refugeecouncil.org.au/asylum/).


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health and wellbeing.

The consultations began with the identification of community strengths and assets. Participants were then asked about the key concerns of the community, and in which ways the community is able to provide support in addressing those concerns. Participants were also asked how they would recognise if someone in their community was feeling sad, pressured or hopeless, and what advice or support they would offer that person. Also discussed was who the community could ordinarily trust or turn to for support. Lastly, participants were asked how they would like to receive new information about staying healthy and happy.

The Mental Health Commission of NSW provided suggestions for consultation questions. These were adapted after the first consultation to suit the particular groups consulted, for example the question “How do you know if someone in your family is not feeling very good?” was replaced by “How do you know if your friend or flatmate is not feeling very good” for the group of participants who were largely single men living in share accommodation. The words “mental health” were only used with the Peer Support Leaders who had an existing knowledge and understanding of mental health issues and services. For all other groups words such as “distress”, “unhappiness”, “worry”, “concern” and “wellbeing” were used. For example for the English Class and Citizenship Class, the Consultation’s title was “Health and Wellbeing Consultation” rather than “Mental Health Consultation”. This was due to stigma and shame associated with the words “mental health”, different cultural constructs and understanding of the concepts of mental

Four of the consultations were conducted in the evening and the women’s consultation was conducted during the day while their children were at school. Evening was identified as the most appropriate time as many people either worked, studied or looked for work during the day. Each consultation was held over 3-4 hours to give sufficient time for dialogue and discussion. Four consultations with existing groups were facilitated largely by Hazaragi facilitators trained and supported by STARTTS staff. One facilitator with the Women’s group was not a Hazaragi speaker but she was a Muslim woman who worked extensively with Hazara community and clients. It was recognised that it was important for the discussion to occur and flow freely through the use of Hazaragi speakers. This also enabled creation of trust and more time for content. Were the discussion held in English and translated, the richness of discussion would have been affected and the consultations would have taken much longer. The community leader consultation was led by a non-Hazaragi speaker and co-facilitated by 6 Hazaragi facilitators (Peer Support Leaders) who ran the small group discussion. The non-Hazaragi speaker was a Muslim Social Worker with extensive mental health and adult education experience and an excellent relationship with the Hazara community. All answers were recorded in Hazaragi using both the butcher’s paper and audio-recorder. These were later translated and transcribed by the Project Officer. Food was provided for all consultations because culturally it is essential to provide hospitality to those one considers guests. The participants were the guests of the project.

Four consultations were conducted with existing groups due to the three month timeframe available to undertake this process. This has also enabled STARTTS to engage with the groups at the time and place of their usual meetings (thus enhancing attendance). A fifth consultation was conducted with a group of community leaders who were specifically invited to attend. This consultation occurred at a location owned by a Hazara organisation to enhance attendance. The community leaders were invited directly by the Bi-cultural Project Officer who had their contact details and a long-term, well-established relationship and standing in the community.

From April to June 2018, five consultations were held with a total of 85 Hazara men and women. 11 of the 85 participants were asylum seekers, while the others were permanent residents ranging from new arrivals to residents who had been living in Australia for as long as 15 years. The age range of the participants was 18-70. 58 were men and 27 were women. This is a wide cross-section of the community and represents community diversity in terms of age and gender. However, there may be a need for further consultations with women and young people as traditionally they tend to keep quiet in mixed groups.


The Consultations

While the project was highly successful in terms of engaging the participants, the fact that Ramadan and Eid

occurred throughout half of the consultation period had an impact on participation. Had STARTTS not had a pre-

existing relationship, access to an existing group and the leadership of an experienced and well respected Hazaragi

speaking Project Officer, it is unlikely that this number of participants would have been reached. Another challenge

was that various participants sought assistance with their visas and follow-up on delays with their Citizenship

applications. The Project Officer followed up on all queries and made appropriate referrals. This was essential to

maintain trust and respect with the community and relationship with STARTTS. Additionally, the participants

contributed to the project and were expecting assistance in return. This expectation of reciprocity is congruent with

high levels of Social capital between STARTTS and the community. Individual assistance was also considered an

ethical and moral obligation or an element of Duty of Care by the Project Officer and STARTTS.

In addition to the Consultations, the Project Officer and the Peer Support Leaders decided to have 40 t-shirts

printed double-sided with relevant messages as the start of a Mental Health Campaign. The messages were

selected by STARTTS clinical staff of Afghan background and the Peer Support Leaders. They were designed to

reflect Qur’anic sayings, instil hope and encourage people to seek assistance from the identified, visible and trained

Peer Support Leaders. The three major messages were – Hope, Sharing and Healing. It was decided not to place

any organisational logos on the t-shirts as that would have been perceived as an attempt to promote an organisation

and there would have been less engagement with the actual messages.


All messages were printed in English and Hazaragi. The messages were:

There’s always light after dark

The t-shirts were worn by the Peer Support Leaders who all received Accidental Counselling Training from STARTTS and some had specific Suicide Prevention Training. They wore the t-shirts during a large community Eid event and during the consultations with Community Leaders. The t-shirts gained significant attention and the community members approached the Peer Support Leaders wanting to know why they were wearing the t-shirts and what they were for. This gave the Peer Support Leaders an opportunity to start conversations about mental health and wellbeing and encourage community members to seek them out if they felt distressed. Some community members wanted t-shirts for themselves to show solidarity with the project and spread the message further. The t-shirts were specifically discussed during the women’s consultations. All participants stated that they liked the t-shirts and the favourite saying was “Life is a gift of God”. Peer Leaders, on the other hand, liked “You are not alone” because that was congruent with their aim of supporting vulnerable community members.

You’re not alone Life is a gift of God

1. English classes – 26th April 2018 - all asylum seekers, 11 participants. The class is run by Human Care Welfare (HCW), a Hazara volunteer community organisation. All classes are run at STARTTS Auburn Office in the evenings by volunteer teachers. HCW started these classes around 2012 when many asylum seekers arrived and required assistance with learning English. While English learning is an important aspect of those classes, they are also designed to provide a meaningful activity and create social support networks. STARTTS has assisted HCW since its inception. Most participants shared their personal experiences of stress and distress without using the words “mental health.” This consultation was facilitated by the Project Officer. One participant from this group expressed an interest in participating in mental health promotion video vignettes. The majority have asked for a group where they can share their stories and feelings to continue. There was a high level of commitment to the consultation as the participants felt their distress was not seen or heard by the wider community. They have indicated this by saying to the Project officer “you are our voice who can let people know about our pain”.

2. Citizenship classes - 10th May 2018 14 participants with the majority being permanent residents waiting for their citizenship. They have all experienced delays in processing of their Citizenship Applications. They started attending the class to prepare for the Citizenship test and the majority are still waiting to be invited to sit the test. The class is also an avenue to build social connections and provide support to isolated community members. It is run by a Hazaragi speaking Counsellor from STARTTS. This consultation was co-facilitated by the Counsellor involved and the Project Officer. Presence of the Counsellor encouraged trust and rapport building thus leading to a more open discussion. As above, the majority of the participants

requested individual assistance with pursuing their citizenship applications.

3. Peer leaders – 15th May 2018 - 13 participants (10 male and 3 young female). All participants have received Accidental Counsellor training in the past and were able to identify distressed people in their community. The consultation was held at STARTTS during the time the group usually meets. The purpose of this group is to provide mutual support for people assisting vulnerable community members and to act as a leader on mental health issues in the Hazara community. The group members are all well-educated and well known in the community. Two of the Leaders are actors and are willing and available to be involved in the development of potential mental health promotion video-vignettes.

4. Hazara community leaders - 23rd June 2018 - 23rd June 2018 - 29 participants including 5 females and facilitators. This group consisted of recognised community leaders and activists with some having arrived in Australia as long as 15 years ago and others


Below is the list of the consultations:

having lived in Australia for a few months. The consultation was held at Kateb Hazara Association Community Centre. This is the largest Hazara organisation in NSW and the location is well known and accessible to community members. Using the Kateb Hazara Community Centre also indicated the organisation’s support for the project.

4-5 vulnerable and disengaged community members each. This enabled a sense of community building and positive action arising from the consultation.

The consultation started with an introduction about the project, the aims and objectives of the consultation and group rules. The participants then divided into 3 small groups facilitated by 2 Hazaragi-speaking Peer Support Leaders each and using the World Café approach (“World Cafe Method,” 2015) .Each group had two questions with 10 minutes for each question then they moved to the next table. There were 6 questions in total and this part of the consultation took approximately 80 min (some participants needed more time with specific questions). After the small group discussion, butchers papers were put on the wall with names of the suburbs where Hazara people live, particularly those struggling with immigration issues and without family support. Participants who wanted to placed their names on suburb/s where they will approach and support at least

consultation; presentation of certificates of completion of a wellness/stretching STARTTS program; Eid celebration lunch; evaluation of the wellness/stretching STARTTS program. The facilitators were both female and one was of Hazara background. Although it was hard to gather insights from this group (limited participation), it was possible to observe that they have a high stigma around mental health and that mental health issues are still a taboo for them although most of them have been involved previously in STARTTS programs and have been in Australia for over one year. However, it clearly appeared that STARTTS plays a key role in connecting the community together and helping people settling in as most solutions that came up from the discussions were related to STARTTS programs.


5. Hazara Women - 25th June 2018: - 18 women participated in the women’s consultation. Most of them were over 50 years of age, have been in Australia from 1 year to 6 years and have taken part in previous STARTTS programs. This meant that the group was not truly representative of the Hazara women in Sydney: young women were not represented nor were ladies who have arrived more recently and are not yet known to STARTTS. However, the short-term nature of this project meant that in-depth work required for wider engagement was not possible particularly as Ramadan occurred during the funding period.

The consultation was one part of the meeting’s program for the women’s group: welcome and introduction;

I know people who are here and they are the head of the family but their families are in another country [Afghanistan, Pakistan, Iran, Indonesia].

People can handle the problem however people who have wife and kids, their issue and problems are much more than us (people who are here with no family and single males)

I have been waiting for 4 years to get my citizenship and that caused me to not being able to see my family and to help them.

The most commonly cited challenge to community members is the issue of family separation. Participants reported that early in their settlement journey, they may feel happy and hopeful. However, this changes in the long term and is particularly impacted by family separation. Consultation participants were very articulate highlighting the impact of this challenge on mental health:

4.2.1. Family Separation

4.2. Community challenges that contribute to feelings of sadness, pressure and hopelessness

“Hazara people in Afghanistan have been humiliated and tortured and for years lived under oppressed and tyranny, therefore that helped us to help each other and also when we came to Australia we felt safe and feeling of being valued and living in peace and harmony.”

Respondents reported that despite limited literacy, the Hazara community is one which comprises fast learners with diverse skill sets and experience which make them contributing members of any society. The Hazara community also holds a high level of respect for other cultures, and as such can adapt easily within a multicultural setting.

The Hazara community also offers its members a range of cultural, sporting, religious and social events that encourage social interactions that help community members to feel less isolated and lonely. Events and activities include volleyball, soccer and cricket teams and tournaments, English Classes, music classes, Hazaragi community language classes, community gatherings where food is shared and cultural performances presented, celebrations of specific religious and cultural events such as Eid (Eid al-Adha and Eid al-Fitr, (“Eid-ul-Fitr and Eid-ul-Adha – What is the Difference?,” n.d.), Muharram (Islamic New Year

and commemoration of the assassination of the grand-son of the Prophet Mohammad, (“Muharram,” n.d.) , and Nowruz (Persian New Year), prayers for the family members who were deceased in Australia or overseas, and commemoration of any tragic events that occur in Afghanistan and Pakistan.

4.1. Community Strengths

The transcripts of all groups went through Qualitative Data Analysis by the STARTTS Community Development Evaluation Officer. The presentation of findings follows a common presentation of the results of such analysis and includes direct quotes from the participants. This is congruent with the participatory research methodology where it is important for participant voices to be heard directly. There are numerous sources outlining the importance

of faith for mental health and use of faith in the process of counselling (Mehraby, N. 2003 & 2002). The Hazara community spoke about the importance of faith for resilience and religious events being a crucial way of bringing the community together for social support.

- (Participants, Community Leader Consultation)

“Hazara community are easy to adopt to the new culture and society, we have more respect and values to women compared to many other Afghan communities. We don’t stop our girls and women to work or study however there are a very small number of people who still have restricted mentality towards their daughter and wife.”

Hazara businesses were mentioned as a source of community strength and an avenue that provides connections. Participants also noted that the community harbours low levels of crime.

Emerging Themes


There are some support available in Australian to assist them however his family and 4-5 kids are in Indonesia, they have no support from that country and/or UNHCR, the issue we have in share accommodation as a single person with all its issue and when our wife and kids living in another country with much more issue and difficulties that put extra pressure on us and badly effect our mental health and wellbeing.

The long-term family separation leaves Hazara community in a prolonged state of uncertainty and increasing distress:

- (Participants, Citizenship Group Consultation)

Other issue I see is that our people lacking proper planning when they try to move out the country (Afghanistan) I believe should plan well to able to deal with situation like financial and how many years that will take them to settle get their family to where they have gone - those pressure will cause them to become mentally ill, depressed, isolated, moody and all those make them feel that everyone own them and pick on everyone and everything

- (Participant, Peer leader Consultation)

4.2.2. Uncertainty: Visas, immigration and unemploymentAnother very commonly cited concern of the Hazara community was the uncertainty that characterises the asylum seeker experience. Included in this experience are, as stated above, issues pertaining to family separation and additionally visas, immigration, challenges associated with learning English and unemployment.

Participants reported that the ongoing killings of Hazara in Pakistan and Afghanistan towards which governments are unresponsive also significantly

I know few people that have work right because of the visa a lot of people struggling to find job, few people that have been rejected few time now they have lost the work right, everywhere they go they can’t get job, they constantly thinking of where I can get money, how can I keep my job, even if I find a job I have to work on ABN or wages and I can’t find cash in hand job to get money to survive. … Its legally you are non-existed, you are not allowed to work, you are not allowed to study you are not allowed to… I don’t know, basically you are not exist.

In this community difficulties we face like citizenship and this program that is held to help us. Language is another issue whereas when we are to sit for the citizenship we won’t be able to have an interpreter to use. Therefore, it is important for us to know the language and this is one of the biggest issues we face. - (Participants, Citizenship Group Consultation)

4.2.3. Overseas conflict

- (Participant, Peer Leader Consultation)

I myself I have been waiting for my citizenship, I have 4 kids living in Quetta of Pakistan and the security situation is extremely bad, Kabul is the same, just yesterday 4 suicide bombers went only to small Shia district, my kids attend English course there. We are getting sick, depressed, crossing the red light, I know you [Arif] and Hassan for 7 years and coming to English class for 4 years and waiting for my citizenship, I can’t bring my family. My body is here but not my mind, yes that I’m living here safe but my thoughts are with my kids and family. Every day I call them to know if they are alive. They are not safe even for one second. I know people have become psycho from these situations- (Participants, Citizenship Group Consultation)

Culturally men are the one to bring money home and look after the whole family- people who work here have 10 people behind him to send money, they work seven days a week, they do the hard and heavy work like in the construction side, so these people don’t have the time motive and energy and ability to look after themselves, and that one of the reason these people are not for themselves, they are here for the whole family. They don’t get time for themselves, and these are always don’t have secure job so they are constantly thinking of that they might lose their job and also a lot of them don’t get paid by their employer because of their vulnerability. I know a lot of people for one month, two months and at the end they don’t get paid.

For those who have jobs, there are significant pressures to support their families overseas. This can lead to lack of self-care and burnout. This is compounded by the nature of the “gig-economy”, sham contracting and lack of knowledge of industrial legislation in Australia.



The problem is that it is becoming an ongoing and continuing issue, we sleep every night with seeing the sad news and photos and we wake up with the sad news and photos by checking the Facebook and other social media

- (Participant, Community Leaders Consultation)

One consultation participant reported that due to being lonely, he would spend extended periods on social media which he found to be further isolating, as social media tended to encourage high expectations for his social life that could not be met under his circumstances.

Language is definitely important but also the way people here interact with each other. When two people come across one another the least that they will do is smile at each other and say hello. Whereas, with us it is not really like that. Please do forgive me for saying this. When we see someone we know when they get close they are embarrassed or they put their head down. However, good thing about people here [non-Hazaras] is that when they get close they smile and then say hi and go pass each other.

Some participants shared that they have dealt with their loneliness by meeting new people through attending events and classes.

When I first came here my biggest problem was loneliness, I was quite upset and lonely. But the way I solved it was attending English classes and classes like this where I can pass the time, meet good friends and surrounded by good friends. I’m not going to sit around at home and wallow and cry that I’m away from home, I’m away from my country. That’s how I solved by attending events like this where I would be distracted.

A lot of people that I’m know or I meet with, they are generally very unhappy, they are sad, isolated and their kids are not going the way they want to… a lot of generational gap and the kids are stuck between two culture, their kids have double live and that create a lot of family issue that cause of problem for parents and that lead to a lot depression.

We can't say anything to our kids to discipline them or to say things for their best… there was an information session by DOCS (Department of Community Services) and Police, and they told us that if we beat our children police and DOCS will take the kids away.

contribute to feelings of sadness and hopelessness.

4.2.4. Social isolation and lonelinessFeelings of isolation and loneliness in a new environment also contribute to depression. Limited financial resources were also cited as a major contributor to sadness and hopelessness.

- (Participant, Citizenship Group Consultation)


There are so many people that feel lonely, we have to find them away to sort of touch [connect] them to a group or program, when you touch them with a program then they get a sense of belonging, therefore they will share more, there are a lot of people who have issue they keep away because they don’t have a sense of belonging so if we create more program and invite them and they will share and participate and they no longer will be loneliness.

I feel being lonely is a big issue. When I first come for 3-4 years I didn’t know the community, I was feeling lonely and whenever I had that feeling I was going on social media, social media itself will bring depression because you unknowingly compare your life with others and celebrities, social media creating high

expectation. So we need to create social program and social networking to make people use less social media and socialise with people face to face.


- (Participant, Women’s community consultation)

4.2.5. Inter-generational challenges: Parenting and elder careSeveral parents reported that concerns pertaining to their children contributed to feelings of sadness and hopelessness. These concerns include access to proper education, financial resources for meeting basic needs, uncertainty of their children’s future, and fear of their children losing their cultural and religious values. Further, parenting styles differ in Afghan and Australian cultures. Parents reported being unsure of how to discipline their children, and feeling fearful that if they discipline their children in the way they are used to that their children will be taken away from them.



The people that we know that are sad, upset or tired, the reason is that they become isolated to an extent. And they become moody to an extent. They start having problems with their friends. They become sleepless. Other signs of these kind of people is for example, they eat less. These are signs that this person is suffering and is mentally and psychologically tired. These are the signs I see.

Two other sign that I notice is that they lacking decision making and send that they forget things quickly (short memory). I personally forget things so quickly, I come to English class to learn but I forget what all I learned, I go to market to buy things and I forget what I have went for, whatever happened in the past I have forgotten them most.

In participants’ own words:

4.4. How community members could be supported

· People talking to themselves


· Loss of appetite· Forgetfulness

Participants reported that they could recognise feeling of sadness, pressure and hopelessness in community members through the following behaviours (exact words used by the participants):

· Quieter/more withdrawn

As soon as we step from the door, we are completely different person… I share my own experience. Inside my parent home I’m this Afghan girl that follows everything my parents saying but as soon as I walk out of the door, I am Australian girl who tries to fit in with other Australians. So are forced to follow both cultures, you don’t have a choice at all.

Elder people have more problems than younger one because they [young people] can speak the language. They [older people] don’t know the culture and hard for them to adapt. So I think the solution and responsibility is on the Hazara community organisations to work for those who are not feeling well. We should invite uni students to come and work with the community.

- (Participants, Community Leader Consultation)

Participants also raised the concern that elders in the community require additional support as their English language abilities are often limited, and generally have a more difficult time adapting to a new culture. It was suggested that younger members of the community work with older community members to help them adjust to their new environment.

- (Participant, Community Leader’s Consultation)

4.3. How to recognise feelings of sadness, pressure or hopelessness in community members

· Emotional outbursts

· Frequent arguments with family members

· Sleeplessness

Two quotes below illustrate the importance of provision of social support by participants’ own community and the negative experiences they faced in this regard.

· Promotion of mental health on social media (Hazara community are high users of Facebook. Young people also use Instagram and Snapchat)

· Listening

Participants identified that community members struggling with feelings of sadness and hopelessness can be supported through:· Provision of relevant information in Hazaragi· Encouragement to participate in social and sporting

events as outlined in the section 4.1 (eg. soccer, volleyball, martial arts, cricket, music, etc.)

· Financial support· Prayer· Referrals to professionals (such as STARTTS).

Please note, STARTTS was the only mental health service identified and mentioned by the participants.

Respondents added that young people feel conflicted between maintaining their Afghan identity while assimilating into Australian culture.

· Tiredness

· Not looking after themselves/unclean

· Feeling anxious

· Lack of motivation to work or do anything

· Feeling worried· Feelings of guilt and worthlessness

· Negative mood

· Difficulties with decision making and planning· Aggression and agitation

· Use of drugs and alcohol



The best way is to refer them to counselling.


The most important issue here is that, when we come from overseas the severe issues we go through like not knowing anyone or the language the only thing you need is someone to at least just speak with you. It feels like you are stuck in a desert and don’t know where which way to take. And so if our community especially our Hazara community looks into and if possible to check on these people. They don’t want a lot of money or anything for that matter. The only thing they do need is someone to speak to and someone that can guide them. Because they are new here in a new environment they would like information on for example how to manage their expenses.


So, if our friends here from especially from the Hazara community to check on them to save them from their loneliness and guide them in this matter as well would be great. We know this because we have faced these issues and we have witnessed that the other communities do regular checks and encourage them. However, with our community unfortunately when you even go and speak to them forcefully in reply they say if I have time I will help otherwise nothing. Other communities would come and check and ask what problems are you facing? Just to allow us to come and speak would be beneficial.

First we need find the source and cause of the problem and issues that made people to have depression, anxiety and mental and then refer them to counsellors and psychologist.

There was some level of understanding that in Australia there are professionals who can assist with mental health issues:

The importance of faith for mental health and suicide prevention was highlighted by some participants:Faith helps very much, from my personal experience and the scientist finding it proved that religious people have more calm and stable state of mind then those who don’t have religious faith and believes no matter what religious believe and faith they have.


Participants reported that they would ordinarily turn to counsellors, community activists/leaders, friends, family or religious organisations for support. Other participants felt they would turn to STARTTS and perceived the organisation through the experience of their engagement with STARTTS community development work.

4.5. Who the community can turn to for support

Something that is good in the community and that helps us is one the existence of STARTTS. I have been studying here for 3 years now and they have been a great help to better improve our English language. From the first day to now I am able to read and write now a little. That is one of the good things I have received from it. STARTTS is one of the examples as I don’t have any other connections.

Religious believers and faith will stop people from suicide because its haram (forbidden).

Some participants spoke about work being their coping strategy:When I’m at work, my mind is busy and I don’t think about anything but when I’m home all the problems and issue that I have and had to come to my mind and I start to get depressed, sad, pressured and moody.

For us STARTTS a lot of times they organise excursions and take us places which have been extremely beneficial for our mental health. Because we have been away from our families for many years and that has had a positive impact on us.




- (Participant, English Class Consultation)

Because when people lose themselves they need someone support and for them God is the only and best support

Some participants reported that they had “nowhere to turn”. A number of participants highlighted the systemic nature of issues they face and the larger political context:When there is an issue or problem for any member of a society or nation, the solution is in hand of the government of that society or nation because they have resources, we are part of these society an frankly to say.. that current government is the source of all these issue, they don’t give us citizenship, they don’t let us bring our children, even though we are not citizen but we work and serve for these society



4.7. Perceptions/knowledge of mental health

The way the parents approach to the children in this situation, instead of understanding they approach very negatively by beating them [children] or getting angry at them that you are not allowed to feel that way. That’s why kids are staying away from their parents and not being friendly with them

On the other hand, the participants were aware that their life circumstances could cause stress and distress and they perceived this to be different from “mental illness”. Mental health challenges such as Post-Traumatic Stress or Depression were considered

and country … don’t know where else we can go to seek help or complain.

Participant responses reflected a limited understanding of counselling. Some participants perceived teachers and doctors to be counsellors. Some participants recognised that counselling can improve mental health without medication.

I heard that teachers and doctors are counsellor because they are psychoanalyst and can when they

can find the issue with us they can give you the cure, I mean practical cure like breathing, exercising etc. rather than giving us prescription, they will tell you what to do practical to overcome with the depression and mental health.

4.6. Perceptions/knowledge of counselling


It was reported that young people in particular feel unsupported with regards to receiving mental health care. Participants expressed that many young people feel as though they are not allowed to feel sad. This causes a rift between parents and children.

- (Participant, Community Leader Consultation)

I went to the counsellor and told them that I can’t sleep, I forget things. The counsellor told me to exercise and when u can’t sleep listen to music, it will distract your thought and sometime it will and sometime it won’t.

The importance of counsellors supporting their clients with the family reunion process and collaborating with the lawyers was highlighted:

There is not a specific definition of the mental health [in our community]. In our society, according to our culture, we always try to hide our problems

When I come first from Indonesia I had depression and I was attending counselling session 2-3 time a month and not helped me with my depression it also helped me getting my family here quicker because the counsellor, my lawyer and the Embassy of Australia worked together and were in touch with each other and they were aware of my depression and that help me getting my family here.


This was attributed to limited awareness of, and stigma attached to, issues around mental health.

- (Participant, Community Leader Consultation)

Participants also raised that some community members are hesitant to talk to doctors or counsellors from their own community because they do not trust that these professionals will honour their commitment to confidentiality. A particular concern was raised by some participants that their information may be given to the Immigration Department thus jeopardising their asylum applications. Others worried about Hazara community members hearing about their difficulties and judging them.

I cannot trust a GP and counsellor from my community. It is easier for me to trust an Indian or Chinese GP ‘cause they may not reveal my problems with my relatives and family

The source of stigma related to mental health issues among multicultural communities is well documented. The same applies to the Hazara community. Sources of stigma are multiple including fear of behaviours that are commonly associated with mental illness (eg. delusions and hallucinations, paranoia, lack of self-control), beliefs about the aetiology of mental illness (eg. family weakness/genetics, “evil eye”, and curse), perceived impact of being considered “crazy” (eg. social isolation and loss of community status).

Participants perceived mental health to be “feeling happy and relaxed” and as having “no issues or problems”. As discussed above, some participants spoke about stigma associated with mental health issues but there was recognition of the impact on their mental health of the various stressors they were facing.



consequences of exposure to trauma and unjust treatment rather than mental illness. Therefore any discussion about mental health should use this as a starting point with a focus on words such as “wellbeing” rather than “mental health”. The participants were open to discussions about the impact of immigration-related challenges, concern for their family overseas and ways to improve their wellbeing.

4.8. Preferred channels for delivering information about staying mentally healthy

I don’t know the local community however I suggest that local community to hold program like tonight’s (mental health consultation) on regular basis, these is one of the ways that we can get information and can raise our issue and pain and to understand our pain.

By having these kind of event, community should do different way of announcements to reach us, if I hear about any event I can share it with my friends and my friends can share it with their friends.


I think we should have more events and celebrations like New Year, Eid and other festivals as excuse to get people to come and we can go and talk to them.

- (Participant, Community leader’s consultation)

Participants reported that they would like to receive new information on mental health at social gatherings and cultural, religious or sporting events. Information sessions, weekly programs, conferences and dialogues facilitated in Hazaragi were also identified as effective ways of receiving mental health information. Face-to-face was the preferred mode of mental health information delivery by many. It also appeared that the community was prepared to discuss mental health issues directly in small groups where they felt safe and supported and preferably with Hazara facilitators.


This report provides insights into the Sydney Hazara community’s experiences of mental health and the community’s mental health literacy. The recommendations below are starting points for how the community’s mental health literacy could be further supported.

Recommendations for Mental Health Commission of NSW

1. Continue the consultations and engage with groups not covered within this consultation series, particularly young people and isolated women.

2. Develop video vignettes with people experiencing mental health issues to encourage the community to talk about mental health and normalise such conversations, and therefore encourage help seeking. Video vignettes are suggested because they would cater for those who are illiterate in their own language and English and who cannot make use of written materials. Additionally, the video vignettes are dynamic and engaging as well as enabling the viewers to empathise with the vignette participants. Examples of the use of video vignettes for mental health promotion and stigma reduction are “I am Still Me” by the South Australia Mental Health Commission (SA Mental Health Commission-Government of South, 2016) and Mental Health First Aid Training vignettes

The vignettes can be used in the following ways:

Ÿ Use of vignettes in social support and therapy groups run by STARTTS staff and during STARTTS Families in Cultural Transition (FICT) groups delivered by Bi-cultural facilitators over 10 x 3 hr sessions. This approach uses vignettes as conversation starters leading to deeper and more involved discussions in a safe space with a bi-cultural facilitator. Services other than STARTTS could use the vignettes particularly if a short conversation guide is produced for each vignette.

6. Print a large banner with mental health messages and display at the Hazara Community Centre on a long-term basis. As above – the banner would reflect the same message as the t-shirt. There would only be a need for one or two banners to display at the Kateb Hazara Community Centre.

The vignettes would need to use themes of hope, healing and sharing, echoing those delivered on the t-shirts. However, they should also provide a diverse representation (eg. gender, age, immigration pathway stage) of people who might be experiencing mental health problems and diverse mental health issues (eg. Depression, Anxiety, Post-Natal Depression, Post-Traumatic Stress Disorder) as well as self-care and self-help strategies.

4. Expand on the T-shirt campaign to convey further mental health messages to a wider audience. Detailed description of the use of t-shirts is provided above. The t-shirts were a conversation starter and enabled community members to either seek help or offer to provide help. The expansion would occur through ongoing Accidental Counsellor Training delivered by STARTTS (no funding required) and provision of t-shirts to those who are trained (funding required). They could then wear the t-shirts at various community social and religious functions. The t-shirts make the invisible network of social support visible and easily accessible. They also normalise mental health issues and help seeking.

Ÿ Distribution of vignettes on social media sites accessed by Hazara community.

Ÿ Use of vignettes in the Accidental Counsellor Training to illustrate challenges people with mental

health issues face and give the learners visual cues.

5. Print mental health messages on other promotional material e.g. stress balls, pens, mobile phone covers etc. This would only be done if there is funding further to video vignettes and t-shirts. These items are a lower priority. However, if used, they would echo the messages delivered on the t-shirts – Hope, Healing, Sharing.

3. Develop video role plays for the community and for training purposes. The role plays would use the same principles as the video vignettes but could be used on community radio or during group meetings and discussions.

Recommendations

8. Seek further funding to implement peer mental health literacy development.

Recommendations for STARTTS

7. Engage and support Hazara organisations to conduct their own Mental Health Literacy campaigns. Also ensure Hazara organisations are funded to deliver social support groups and programs. While this may not be financially viable, it is a useful grassroots approach that allows community to take ownership of the campaign thus generating commitment and engagement.

9. STARTTS and Mental Health Commission of NSW to continue this collaboration and potentially to expand to other refugee communities.

1. Train Hazara religious leaders in Accidental Counselling and as Mental Health Ambassadors. Religious leaders have significant standing, influence and access to community members. Additionally, they are often the first people approached by members of many communities when they are experiencing distress. It is essential that religious leaders promote an anti-stigma stance and are able to support those facing mental health issues including referring them to appropriate services.

1. Deliver workshops on workplace/industrial laws in Australia and ensure the Hazara community have access to appropriate legal assistance in this aspect.

4. Training for mainstream mental health providers about Hazara community issues – delivered by STARTTS. This is already funded through another source.

5. Partner with other relevant agencies to identify and support women who were brought to Australia to marry and are experiencing family and domestic violence.

2. Continue and expand provision of free Immigration Law assistance

3. Advocacy around immigration, citizenship and family reunion issues for individual clients and community in general. This does not address mental health literacy but it addresses the major concerns the community members have raised throughout the consultation.

6. Ensure STARTTS We Can Do This module of the Families in Cultural Transition (FICT) Program is delivered consistently. This is funded through other sources.

2. Further social support groups at STARTTS focused on skill development and coupled with psychoeducation.

Recommendations for other services



References

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