Mark Brough

Mental health of newly arrived Burmese refugees in Australia: contributions of pre-migration and post-migration experience.

Objective: This study documents the mental health status of people from Burmese refugee backgrounds recently arrived in Australia, then examines the contributions of gender, pre-migration and post-migration factors in predicting mental health. Method: Structured interviews, including a demographic questionnaire, the Harvard Trauma Questionnaire, the Post-migration Living Difficulties Checklist and Hopkins Symptom Checklist assessed pre-migration trauma, post-migration living difficulties, depression, anxiety, somatization and traumatization symptoms in a sample of 70 adults across five Burmese ethnic groups. Results: Substantial proportions of participants reported psychological distress in symptomatic ranges including: post-traumatic stress disorder (9%), anxiety (20%) and depression (36%), as well as significant symptoms of somatization (37%). Participants reported multiple and severe pre-migration traumas. Post-migration living difficulties of greatest concern included communication problems and worry about family not in Australia. Gender did not predict mental health. Level of exposure to traumatic events and post-migration living difficulties each made unique and relatively equal contributions to traumatization symptoms. Post-migration living difficulties made unique contributions to depression, anxiety and somatization symptoms. Conclusions: While exposure to traumatic events impacted on participants’ mental well-being, post-migration living difficulties had greater salience in predicting mental health outcomes of people from Burmese refugee backgrounds. Reported rates of post-traumatic stress disorder symptoms were consistent with a large review of adults across seven western countries. High levels of somatization point to a nuanced expression of distress. Findings have implications for service provision in terms of implementing appropriate interventions to effectively meet the needs of this newly arrived group in Australia.

Social capital meets identity Aboriginality in an urban setting

This article reports on a qualitative study of social capital within an urban Aboriginal and Torres Strait Islander context. Using data generated from 100 Aboriginal and Torres Strait Islander participants in focus group discussions and in-depth interviews collected by Aboriginal community development workers, this article describes two worlds of social capital available to Aboriginal and Torres Strait Islander people. The primary source of bonding social capital comes from family and wider Aboriginal and Torres Strait Islander community connections. In the context of an oppressive history and experiences of ongoing racism and discrimination, a second world of bridging social capital remains elusive to many Indigenous Australians. Our findings suggest that to understand the tensions between the two social capitals requires an engagement with the complexities of identity. We argue that it is vital to explore the texture of social capital, rather than just measure its volume.

Everyday resilience: Narratives of single refugee women with children

This article offers a critical exploration of the concept of resilience, which is largely conceptualized in the literature as an extraordinary atypical personal ability to revert or ‘bounce back’ to a point of equilibrium despite significant adversity. While resilience has been explored in a range of contexts, there is little recognition of resilience as a social process arising from mundane practices of everyday life and situated in person-environment interactions. Based on an ethnographic study among single refugee women with children in Brisbane, Australia, the women’s stories on navigating everyday tensions and opportunities revealed how resilience was a process operating inter-subjectively in the social spaces connecting them to their environment. Far beyond the simplistic binaries of resilience versus non-resilient, we concern ourselves here with the everyday processual, person-environment nature of the concept. We argue that more attention should be paid to day-to-day pathways through which resilience outcomes are achieved, and that this has important implications for refugee mental health practice frameworks.

‘It had to be my choice’ Indigenous smoking cessation and negotiations of risk, resistance and resilience

While Australia is considered a world leader in tobacco control, smoking rates within the Aboriginal and Torres Strait Islander population have not declined at the same rate. This failure highlights an obvious shortcoming of mainstream anti-smoking efforts to effectively understand and engage with the socio-cultural context of Indigenous smoking and smoking cessation experiences. The purpose of this article is to explore the narrative accounts of 20 Indigenous ex-smokers within an urban community and determine the motivators and enablers for successful smoking cessation. Our findings indicated that health risk narratives and the associated social stigma produced through anti-smoking campaigns formed part of a broader apparatus of oppression among Indigenous people, often inspiring resistance and resentment rather than compliance. Instead, a significant life event and supportive relationships were the most useful predictors of successful smoking cessation acting as both a motivator and enabler to behavioural change. Indigenous smoking cessation narratives most commonly involved changing and reordering a persons life and identity and autonomy over this process was the critical building block to reclaiming control over nicotine addiction. Most promisingly, at an individual level, we found the important role that individual health professionals played in encouraging and supporting Indigenous smoking cessation through positive rather than punitive interactions. More broadly, our findings highlighted the central importance of resilience, empowerment and trust within health promotion practice.

A longitudinal study of mental health in refugees from Burma: The impact of therapeutic interventions

Objective: The present study seeks to examine the impact of therapeutic interventions for people from refugee backgrounds within a naturalistic setting. Methods: Sixty-two refugees from Burma were assessed soon after arriving in Australia. All participants received standard interventions provided by a resettlement organisation which included therapeutic interventions, assessment, social assistance, and referrals where appropriate. At the completion of service provision a follow-up assessment was conducted. Results: Over the course of the intervention, participants experienced a significant decrease in symptoms of post-traumatic stress disorder, anxiety, depression and somatisation. Pre-intervention symptoms predicted symptoms post-intervention for post-traumatic stress, anxiety and somatisation. Post-migration living difficulties, the number of traumas experienced, and the number of contacts with the service agency were unrelated to all mental health outcomes. Conclusions: In the first Australian study of its kind, reductions in mental health symptoms post-intervention were significantly linked to pre-intervention symptomatology and the number of therapy sessions predicted post-intervention symptoms of post-traumatic stress. Future studies need to include larger samples and control groups to verify findings.

Aboriginal and Torres Strait Islander health research and the conduct of longitudinal studies: issues for debate

The National Health and Medical Research Council, Research Agenda Working Group (RAWG), and the literature on Indigenous health have identified the need to fill gaps in descriptive data on Aboriginal and Torres Strait Islander health and noted both the lack of research with urban populations and the need for longitudinal studies. This paper presents some of the broad ethical and methodological challenges associated with longitudinal research in Indigenous health and focuses particularly on national studies and studies in urban areas. Our goal is to advance debate in the public health arena about the application of ethical guidelines and the conduct of longitudinal studies in Aboriginal and Torres Strait Islander communities. We encourage others to offer their experiences in this field.

Beyond the accolades: a postcolonial critique of the foundations of the Ottawa Charter

Introduction: The Ottawa Charter is undeniably of pivotal importance in the history of ideas associated with the establishment of health promotion. There is much to applaud in a charter which responds to the need to take action on the social and economic determinants of health and which seeks to empower communities to be at the centre of this. Such accolades tend to position the Ottawa Charter as ‘beyond critique’; a taken-for-granted ‘given’ in the history of health promotion. In contrast, we argue it is imperative to critically reflect on its ‘manufacture’ and assess the possibility that certain voices have been privileged, and others marginalized. Methods: This paper re-examines the 1986 Ottawa Conference including its background papers from a postcolonial standpoint. We use critical discourse analysis as a tool to identify the enactment of power within the production of the Ottawa health promotion discourse. This exercise draws attention to both the power to ensure the dominant presence of privileged voices at the conference as well as the discursive strategies deployed to ‘naturalize’ the social order of inequality. Results: Our analysis shows that the discourse informing the development of the Ottawa Charter strongly reflected Western/colonizer centric worldviews, and actively silenced the possibility of countervailing Indigenous and developing country voices. Conclusion: The Ottawa Charter espouses principles of participation, empowerment and social justice. We question then whether the genesis of the Ottawa Charter lives up to its own principles of practice. We conclude that reflexive practice is crucial to health promotion, which ought to include a preparedness for health promotion to more critically acknowledge its own history. (Global Health Promotion, 2013; 20(2): 22–29)

Healthy imaginations: A social history of the epidemiology of aboriginal and Torres strait islander health

It is difficult to imagine Aboriginal and Torres Strait Islander health without the powerful descriptors of epidemiology. The statistical imagery of numerical tables, pie charts, and bar graphs have become a key element in the public presentation of Indigenous public health issues. Such quantitative measurements of health draw on the authority of neutral, objective science and are thus rarely questioned in terms of their social meaning. This paper traces the history of this imagery through the 20th century, providing a social account of epidemiological description. Historical notions such as social Darwinism, assimilation, and dangerous other are all seen to be woven into the epidemiological text The enormous rise in the epidemiological description of Indigenous health problems in recent years needs to be analyzed as a social phenomenon and, in particular, as an aspect of emerging forms of governmentality. Finally, it is argued that such analyses are needed in order to promote an anthropology of epidemiology and to avoid limiting medical anthropology to applications within epidemiology.

Review of Australian Health Related Social Work Research 1990–2009

Abstract Social workers form a critical component of the Australian health workforce. While their roles as practitioners are very strategic within the health system, less clear is their contribution to health research. This paper reviews the published record of social work research in Australian health from 1990–2009 in order to discern the patterns of the social work contribution to new knowledge in health. The results of this review indicate a tendency to focus on discursive commentary rather than empirical research as well as a less-than-expected focus on client studies. Given the rise of evidence-based practice, there are potentially serious implications for social work in terms of how it positions itself as a contributor to new knowledge within the health field.

Making Sense of Mental Illness as a Full Human Experience: Perspective of Illness and Recovery Held by People With a Mental Illness Living in the Community

There is substantial current interest in building evidence about recovery from mental illness in order to inform comprehensive practice in health and social paradigms. This article presents accounts related to recovery and illness expressed by eight people through a Participatory Action Research project. The research facilitated entry to their subjective experiences of living in the community as an artist with a mental illness. Specific concern was raised of recovery as a clinical term with its requirement to meet distinct conventions of recovery formulated by health workers. This article emphasizes that individualized values of mental illness and recovery are interconnected to dynamic and complex perceptions drawn from experiencing life and experiencing things in their life.