Transcript Mental Illness Concepts and Attitudes in the Somali

Mental Illness Perceptions in the
Somali Community in Melbourne
Dr. Marion Bailes
Masters Candidate
Centre for International Mental Health
University of Melbourne
Supervisors:
A/Prof. Harry Minas
A/Prof. Steven Klimidis
August 2005
The Somali community in Melbourne
 an emerging community
 Australian population 5,000
 Victorian population 3,000
 refugee background
 social and political upheaval
 majority enter through Humanitarian Program and Family Reunion
 culturally distant
 traditional African
 Islamic
Background to the Project
 Addressing
 high mental health needs
 low use of services
 Aims
 Understanding concepts and attitudes
 Examination of influences on help-seeking
 Rationale
 Improve accessibility and relevance of services
Overview of project
Key Informant
Interviews
Observations
Focus Group
Discussions
Audio-tapes
or notes
Notes
Transcriptions
& reconstructions
Journal entries
Qualitative
Analysis
Findings
Individual
Interviews
Vignettes
 ‘Amina’ (depression)
 ‘Ahmed’ (PTSD)
 ‘Ali’ (psychosis)
Qualitative analysis
 Phenomenology/Ethnography
 Looking at themes (deductive/inductive)
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
Somali culture
settlement issues
explanatory models
influences on help-seeking
Somali Culture
Loss
Jinns
Trauma
Islam
Clan
Morality
Relationships
Traditional African
Settlement Issues
 Different culture
 Isolation
 Separation
 Practical problems
 Inter-generational conflict
 Language difficulties
 Financial problems
 Unemployment
 Preoccupation with country of origin
 School problems
 Expectations not fulfilled
 Family reunion difficulties
 Negative host attitudes
 Qualifications not recognised
Explanatory models
Problem
Name
Treatment
Action
Nature
Signs
Cause
Symptoms
Explanatory models:
Nature of mental health problems
 distinction between ‘craziness’ and ‘emotional
problem’
 broad classification with continuum:
emotional problem - ‘not normal’ – crazy (waalli)
‘Not normal’


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
Isku buq (Confused)
Islahadal (Talking to yourself)
Wel wel (Worried)
Buufis (Not normal)
There is a term that has been coined after the civil war. I never
heard before that. This term refers to all mental conditions –
we don’t separate them into conditions where someone is
depressed or anxious or, you know, paranoid – we don’t
separate all these things. We just lump them and we call them
one word. In Somali we call ‘buufis’.
(Individual Interview 13)
Beliefs of causation
 Problems of life
 Settlement issue stress
 Religious / cultural
“When people normally, Muslims or Somalis, cross this order of
not using drugs, drink alcohol or illegal marriage is when they go
overboard and have problems. That’s when the emotional problems
start.”
(Male elders focus group)
Beliefs of causation
 Trauma/Loss
Most Somalians who came here… direct from Somalia or
maybe from refugee camps in Kenya, they have this kind of
experience – dying, dying people, killing maybe some of
immediate family, ….somebody raping girls, somebody killing
innocent people, so it’s a really difficult thing.
(Individual interview 15)
 Jinns
 Evil spirits
‘Amina’ (depression)
 Not mental health problem, common
 ‘Confused’, ‘worried’
 Caused by settlement issues (particularly
loneliness and lack of support)
 Change social situation, help from community
 Intervention from doctor / religious leader
‘Ahmed’ (PTSD)
 Common, mental health problem
 ‘confusion’, ‘becoming mad’
 Caused by traumatic experience, personal
issues, settlement issues
 Keep busy, get on with life
 Talk to family, friends or doctor
‘Ali’ (psychosis)




Mental illness, sickness
‘Waalli’, ‘Mad’
Caused by jinn or evil spirit, or life problem
Treat with Qur’anic recitation or intervention
from doctor
Action to address mental health problem
Individual Action
Self-help
Family/Friend’s action
Direct help
Disclose problem/seek help
Family
Seek professional intervention
Western Professional
Religious Leader
Friends
Elder
Traditional healer
Medication for mental health problems
 Concerns about:
 Side effects
 Addiction
 Inappropriate use
Attitude to counselling
 ‘I told this lady, I told her to go to doctors and she
said “They waste your time, they sit in front of you
and make you talk, talk, talk. I don’t want to talk for a
long time. I just don’t feel like talking to no-one.”’
(Woman, individual interview 7)
Quranic recitation
 May improve emotional health
 Makes jinn leave a person
Religious treatment involves readings from the Holy Book, the
Qur’an… The voice of a jinn may come out…They may say
“Stop reading the Qur’an and I will go away.”
(Religious leaders’ focus group)
Facilitation of help-seeking
 Factors
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Friend/relative
Communication
Empathy/Confidentiality
Knowledge
Positive outcome
Severity
Service availability
Somali worker
Participants (/28)
10
9
8
6
5
5
3
3
Inhibition of help-seeking
 Factors

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Unwilling
Difficult
Shame
Unfamiliar
Fear of Gossip
Practical
Cultural barrier
Need to appear strong
Negative outcome assessment
Participants
22
14
13
12
9
8
7
6
3
Influences on help-seeking
Influences
Influences
Facilitating
Facilitating
Knowledge
Knowledge
Communication
Communication
Inhibiting
Inhibiting
Outcome assessment
Outcome
Assessment
Quality
helper
Quality
ofofhelper
Community
worker
Community
Worker
Unfamiliar
Unfamiliar
Fear
ofGossip
Gossip
Fear of
Friend/relative
Friend/relative
Unwilling
Unwilling
Severity
problem
Severity
of ofProblem
availability
Service Service
Availability
Cultural
Cultural
Barrier Barrier
Difficult
Difficult
Shame
Shame
Need
to appear
strong
Need
to appear
strong
Practical difficulties
Practical
Difficulties
Clinical Implications
Need for awareness of:




religious/social context
different explanatory models
refugee background
contribution of settlement issues
Clinical Implications
 Treatment options
 acceptability
 chance of success
 Confidentiality and Empathy
 Facilitation of Communication
Implications for mental health promotion
 Programs to assist settlement
 Programs to encourage help-seeking




Community mental health promotion
Decrease mental illness stigma
Professional development
Interpreters/ liaison workers/ case workers