In Godefa One Man’s Story you are introduced to many of the issues facing people who have
been forced to leave their country because they are at risk of, or have experienced, persecution.
Godefa believes that nurses have a critical role in supporting refugees who are resettled in
Australia.
Critically discuss the key components of the Ottawa Charter for Health Promotion in relation to
the mental health of refugees and what impact you as a nurse can have on improving the mental
health and well-being of refugees and their families.
Mental Health Promotion in Australia
In ‘Godefa One Man’s Story’, there is an introduction to a majority of the issues faced by
people who are forced to desert their country since they are vulnerable to or have undergone
through persecution. Godefa supports the idea that nurses possess a critical obligation in
supporting refugees that have resettled in Australia. The pre-arrival experiences that refugees in
Australia experience have key implications on their long-term mental and physical health. The
refugees flee from persecution in their mother countries. They may have been subjected to
torture and suffered trauma due to conflict and war. Usually, the time the refugees have been in
flight as well as in the countries of 1 st asylum often equate to prolonged insecurity and
displacement, which frequently requires the refugees to spend many years moving in refugee
camps or between places with no or limited access to healthcare and proper nutrition. As a result,
there are unresolved health challenges that only aggravate the mental well-being. After arrival in
Australia, the process for resettlement is often extremely stressfully with crucial negative
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compounding impacts. This has a great consequence on the refugees’ mental wellbeing and
health status.
Mental health issues related to refugees
A majority of the newly arrived refugees Australia in have no friendship and family
networks. Moreover, they experience isolation in the new communities. This brings about
negative mental health impacts and exacerbates the pre-existing mental health concerns (Fazel,
2012; p266). The damaging effect of prolonged separation from their families on the mental
health is a great issue of concern. Often, the mental health issues that are associated with
refugees never manifest immediately. On the contrary, they become apparent later after the
initial settlement. This implies that former refugees may require mental health services in
addition to trauma and torture counseling well after the eligibility for such services (Schweitzer
et al, 2011; p299-300). The difficulties and limitations the refugee entrants face when accessing
mental health assistance is the same as those experienced in the general health services.
A majority of the refugees in Australia are on the bridging visas while waiting for the
protection applications to be processed. Only a few have been under detention. This group also
suffers vital social stressors including unemployment, poverty, isolation from the family, social
dislocation, and the anxieties of a new life in strange communities where there are considerable
cultural and language differences (Watkins, 2012; p126-128). This is compounded by the fact
that the refuges have had a history of witnessing or experiencing severe trauma, persecution, and
torture. This makes refugees very vulnerable to suffering from mental health challenges.
The protracted refugee determination procedure is usually very distressing and difficult
for the refugees. Evidence indicated that this procedure greatly contributes to post-traumatic
stress disorder directly. This is particularly for people who had their claims rejected repeatedly.
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Usually, refugees present with major depression, generalized anxiety disorder, post-traumatic
stress disorder, and adjustment disorders. There are also features of irritability, fluctuating mood,
poor attention and concentration, overwhelming powerlessness and hopelessness feelings, and
recurrent intensive thoughts regarding the determination process (Kirmayer et al, 2011; p959).
Some refugees develop psychotic and dissociative symptoms. Some refugees may become too
obsessed with refugee application process and not be able to focus on anything else outside this
process.
Social, political, economic, and environmental factors that contribute to poor mental health
among refugees
An individual’s capacity to flourish and develop is influenced deeply by the immediate
social surroundings. This also includes the opportunity to positively engage with colleagues,
friends, and family members, as well as earn a life for the families and themselves. The socio-
economic circumstances the refugees find themselves in have a great role. Lost or restricted
opportunities to acquire income or education are particularly pertinent socio-economic factors. A
majority of the refugees undergo through a discrepancy between the social status before and after
migration. This mostly leads to poverty. Many of them have also lost a lot of assets when forced
to fled from the host country. Many also lose significant documents certifying their credentials,
training, and education. This is a huge barrier for employment. Racism and discrimination from
the prospective employers is a very common barrier to employment.
Foreign-trained professionals often have challenges having their skills accredited. They
have to undergo through costly recertification and time-consuming processes. The challenges
involved in learning the new language create barriers to employment. There may also be limited
quality and accessibility to ESL programs (English as a second language. As a result of this,
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sustained unemployment and underemployment periods are common among the refugees. There
is usually a tendency for the refugees to blame themselves when they cannot acquire a job that
matches what they had in their country of origin. Often this leads to feelings of humiliation,
helplessness, inferiority, despair, anger, and nostalgia that negatively impacts on their mental
health.
The political system in Australia does not have solid strategies for preventing refugees’
isolation and offering social support. Many of the refugees separate from their family and
friends during the migration process. They also experience the absence of similar ethno-cultural
communities as was in the host country. Considering that there are inadequate language skills,
forming friendships becomes difficult. Racism and unfriendly reception from Australians can
create barriers that hinder support networks. The seniors and women have a heightened isolation
risk since they are most likely unemployed and have to spend more time at home compared to
men (work) and children (school). These factors are great contributors to the refugees’ mental
health problems.
The wider geopolitical and socio-cultural environment in which the refugees find
themselves in Australia affects the community’s, household’s, and individual’s mental health
status. This also includes the level of access to the basic services and commodities (rule of law,
essential health services, and water); practices and attitudes; and exposure to the predominating
cultural beliefs. There is also a challenge of economic and social policies that are created at the
national level. For instance, the global financial crisis has crucial mental health impacts such as
increasing harmful alcohol use and suicide rates. Gender or social conflict or inequity and
discrimination are some of the adverse structural mental well-being determinants.
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It is worth noting that these factors interact with each other in dynamic ways. Therefore,
they can either be against or for the refugees’ mental health state. Addressing the issues that
refugees face in Australia should, therefore, involve identifying and addressing the multifaceted
factors.
Primary healthcare strategies, principles, and philosophy of the Ottawa Charter for Health
promotion in relation to refugees’ mental health
The Ottawa Charter for Health Promotion encompasses of five principal health
promotion strategies; creating supportive environments; building healthy public policy;
strengthening community action; developing personal skills; and reorienting services towards
prevention, promotion, and early intervention (Potvin and Jones, 2011 244-245). Promoting
mental health encompasses of enhancing the capacity of the communities and individuals so that
they can have control in their lives as well as better their mental health. When promoting mental
health, there is use of strategies that promote supportive environments as well as individual
resilience. This is usually accomplished while demonstrating respect for equity, culture,
interconnections, social justice, and personal dignity.
Mental health promotion and the Ottawa Charter for Health Promotion share common
elements. There is a keen focus on enhancing the refugees’ well-being as opposed to illness.
Second, the population is addressed as a whole, with an inclusion of people that are experiencing
risk conditions in their everyday life context (Correa-Velez et al, 2010; p1403). Another
commonality is that both are oriented towards acting on the health determinants including
housing and income. There is also a focus on broadening the focus so that there is inclusion of
protective factors as opposed to simply focusing on the risk conditions and factors. The two
approaches also encompass of a wide array of strategies including education, communication,
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organizational change, policy development, local activities, and community development. The
population’s competencies are also reinforced and acknowledged. Finally, the social and health
fields in addition to medical services are encompassed. This is usually founded on the fact that
the social arena has a great contribution to the health status of refugees in Australia (Vasey and
Manderson, 2012; p50). In this regard, promoting the health status of the refugees should
encompass addressing the social factors that influence the health.
The Ottawa Charter on Health Promotion advocates for strengthening community action.
This process has at its heart communities’ empowerment, their control and ownership of their
personal destinies and endeavors. Community development focuses on the existing material and
human resources in a community with the intention of enhancing social and self-help support, as
well as developing flexible systems that can promote health matters’ direction and public
participation. If mental health has to be promoted among the refugees in Australia, it is
important to have this responsibility shared among community groups, individuals, governments,
health service institutions, and health professionals. All relevant stakeholders have to work
together towards a healthcare system that addresses all the needs of refugees. The reorientation
of health services should also be accompanied by a stronger attention to research and changes in
professional training and education. This should lead to attitude change as well as a
transformation in health services’ organization, that concentrates on the complete needs of
refugees as whole persons.
The charter emphasizes that the principal resources and conditions for health are equity,
social justice, sustainable resources, a stable ecosystem, income, food, education, shelter, and
peace. Therefore, improving the mental health of refugees should have a secure foundation in the
mentioned basic prerequisites. Three major components for health promotion are advocate,
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enable, and mediate. More significantly, health promotion should go past health care. Policy-
makers from all sectors as well as all levels should be included. They should be aware of the
impacts their decisions have and acknowledge the huge role they have in promoting health.
Role of nurses in improving and supporting refugees’ mental health
When nurses engage in interventions aimed at improving and supporting the mental
health for refugees, their ultimate goal should be reducing inequities, decreasing risk factors, and
increasing protective and resilience factors. Nurses should have a keen interest on strengthening
the ability of the mentally-handicapped refugees, families, and communities to cope with the
everyday life occurrences (Savic et al, 2013; p 390). This should encompass of increasing
community or individual resilience; increasing the coping skills; improving the feelings of
satisfaction and quality of life; enhancing self-esteem; enhancing a sense of belonging and well-
being; strengthening the sense of identity and social supports; and strengthening the balance
between psychological, spiritual, emotional, social, and physical health.
Nurses should involve mental health promotion strategies that minimize the factors that
place the refugees at risk of diminished mental health. According to Happel et al (2011; p 707)
this can be achieved through eliminating or reducing distress and stress; depression; anxiety;
sense of helplessness; social exclusion, violence, and abuse; problematic substance abuse; and
suicidal attempts’ history or suicidal ideation.
Nurses also have the role of reducing inequities as well as the subsequent impacts on
mental health. These inequities are often based on poverty, age, gender, mental or physical
disability, employment status, race, geographic location, sexual orientation, and cultural or ethnic
background. Nurses can reduce inequities through implementing equity and diversity policies.
Nurses can also offer regular equity and diversity training as well as evaluation of the results.
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Transitional programs can also be created for identified refugee groups. This involves tailoring
programs so that they are made more responsive and inclusive to marginalized populations.
Nurses also have a great responsibility in promoting anti-stigma campaigns or initiatives that can
greatly address the system barriers that the refugees face, including discrimination and racism
(Stone, 2012; p8).
References
Correa-Velez, I., Gifford, S. M., & Barnett, A. G. 2010. Longing to belong: social inclusion and
wellbeing among youth with refugee backgrounds in the first three years in Melbourne,
Australia. Social science & medicine, 71(8), 1399-1408.
Fazel, M., Reed, R. V., Panter-Brick, C., & Stein, A.2012. Mental health of displaced and
refugee children resettled in high-income countries: risk and protective factors. The Lancet,
379(9812), 266-282.
Happell, B., PLATANIA‐PHUNG, C., Gray, R., Hardy, S., Lambert, T., McAllister, M., &
Davies, C. 2011. A role for mental health nursing in the physical health care of consumers with
severe mental illness. Journal of Psychiatric and Mental Health Nursing, 18(8), 706-711.
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Kirmayer, L. J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A. G., Guzder, J., … & Pottie, K.
- Common mental health problems in immigrants and refugees: general approach in primary
care. Canadian Medical Association Journal, 183(12), E959-E967.
Potvin, L., & Jones, C. M. 2011. Twenty-five years after the Ottawa charter: The critical role of
health promotion for public health. Canadian Journal of Public Health/Revue Canadienne de
Sante’e Publique, 244-248.
Savic, M., Chur‐Hansen, A., Mahmood, M. A., & Moore, V. 2013. Separation from family and
its impact on the mental health of Sudanese refugees in Australia: a qualitative study. Australian
and New Zealand journal of public health, 37(4), 383-388.
Schweitzer, R. D., Brough, M., Vromans, L., & Asic-Kobe, M. 2011. Mental health of newly
arrived Burmese refugees in Australia: contributions of pre-migration and post-migration
experience. Australian and New Zealand Journal of Psychiatry, 45(4), 299-307.
Stone, T. 2012. Mental Health and Illness in Australia: Some Contemporary Facts and Figures.
Journal of Nursing Science 29(4), 7-9.
Vasey, K., & Manderson, L. 2012. Regionalizing immigration, health and inequality: Iraqi
refugees in Australia. Administrative Sciences, 2(1), 47-62.
Watkins, P. G., Razee, H., & Richters, J. 2012. ‘I’m Telling You… The Language Barrier is the
Most, the Biggest Challenge’: Barriers to Education among Karen Refugee Women in Australia.
Australian Journal of Education, 56(2), 126-141.