For many years, Cabramatta was known as the heroin capital of Australia. Crime on the streets was rife, so was racism, and people were scared. I have many memories of wanting to play in the park but not being allowed to because there were needles on the ground.
There are lots of those stories in the media, and elsewhere, but there is also an untold story. One about the community’s mental health.
A Little History…
Before Australia opened its borders, there were only about 700 Vietnamese people living in Australia, mostly tertiary educated students or wives of the Australian Defence Force from their time during the Vietnam War (Department of Immigration and Citizenship, 2014).
But by early 1980s, the Vietnamese community had multiplied exponentially. Currently, there are about 190,000 Vietnamese immigrants (Census of Population and Housing, 2016) now living in Australia. In particular, Cabramatta is home to the largest concentration of Hoa Vietnamese immigrants in southwest Sydney. Hoa Vietnamese people are a minority group in Vietnam with Chinese ancestry, with which I personally identify. Since the fall of their government to the Communist regime in the 1970s, about two million Vietnamese fled their homeland by boat in search for freedom.
One of their destinations was Australia.
Cabramatta Mental Health Issues
According to the Australian Social Trends 2014 Report (ABS, 2014), a total of more than 20,000 residents were born in Vietnam and are now living in Cabramatta and surrounds. It is the third-most populated local government area of Sydney and the fourth-most disadvantaged.
Since leaving Vietnam, some Vietnamese people have been through war, violence, isolation, racism, stress and difficulty adapting to their new country. Looking back on its history, it is unsurprising that existing mental health studies of Vietnamese refugees have found to have high levels of depression, anxiety and post-traumatic stress disorder (Hinton et al, 1993). The Fairfield City Health Framework 2012 reported that Fairfield City residents have high incidences of suicide, mood disorders and other mental health issues.
But interestingly, this is not reflected in their access to mental health services where it was reported in the 2009-2010 Social Health Atlas that Fairfield City residents accessed psychiatrists at a much lower rate than elsewhere in Sydney.
Dr David Rouen, from the Bankstown Anxiety Clinic, treats two major cultural communities: the Vietnamese and the Arabic. In his experience, considering the long history of trauma and displacement, the Vietnamese community is very underrepresented in the clinic. He believes that psychological treatment does not fit well with their cultural understanding as it is traditionally not acceptable to seek out treatment for things such as anxiety disorders.
Because of this, patients often misdiagnose themselves. Dr Rouen explained that sometimes when a patient is having a panic attack, they will call the ambulance, believing that they are having a heart attack. Once the hospital confirms that their heart is fine, then that is the end of that. They cannot see that their symptoms could be anything other than a physical illness.
“Sometimes the only way we get into contact with the Vietnamese community is when their doctor or GP has to convince them to go but by the time that they do, we find that it is a much more severe psychological illness,” explained Dr Rouen.
It is hard for a community to see an invisible mental health issue when they often have more pressing matters at hand such as work or family responsibilities and teaching their children not to play with things they find on the ground. Dr Rouen also often wondered if the underrepresentation of patients could be attributed to their work ethic and strong sense of self-diligence as the Vietnamese community prioritise their work and family responsibilities over engaging with their mental health.
I asked my mother recently, what she thought mental illness was, or whether she knew anyone with depression or anxiety. I struggled to describe the conditions to her and she struggled to understand me.
There is relatively little research into Vietnamese communities utilising mental health services in Australia, contributing to a greater cultural divide and miscommunication. I found a study into the research of the characteristics of Vietnamese patients attending an anxiety clinic in Australia and it found that Vietnamese people did not differentiate between concepts of ‘stress’, ‘anxiety’, and ‘depression’, believing that they were synonymous with each other (Wagner et al, 2006).
Like my mother who came to Australia from Vietnam, many Vietnamese people have very traditional beliefs about mental health – that it is a shameful and humiliating thing that must be kept hidden within the family for fear of ‘losing face’.
‘Losing face’ is an interesting concept; it means losing pride or respect and it is seen as a weakness – it is a shameful, dishonourable thing to admit that you need help. Social stigma has a strong hold and Vietnamese families prefer to hide their mentally ill family members until the problem becomes severe and professional help is needed (Chiu, 1994).
Apart from internalised stigma, external factors such as a lack of cultural awareness can also hinder communication (Sozomenou et al, 2000). According to one study, consumers thought that health professionals generally lacked cultural awareness when dealing with a diverse community.
Some of the barriers could be overcome by addressing the lack of knowledge about mental health services within the Vietnamese community. Transcultural Psychiatry (Wagner et al, 2006) suggests that by educating the community on these issues, including doctors and primary carers, would lead to better identification and treatment of mental illness. It is through education and awareness that mental illness can be destigmatised and understood.
In a western society, there is a reliance on the western biomedical model which is based on biological factors to the exclusion of environmental and social factors. This model, while very successful in treating illness in most western countries, could be incompatible or inappropriate for certain cultures. (Sozomenou et al, 2000).
It is also very important to have trained bilingual staff and interpreters who are able to overcome language and cultural barriers as they encourage more access to mental health services for those who share the language (Sozomenou et al, 2000). Jacky Yeung, a Fairfield Community Mental Health nurse, believes that their capacity to accommodate patients with a migrant background by having bilingual workers allows for better communication and engagement. Without this bridge, Mr Yeung says there are wild misconceptions about the mental health industry.
“Unfortunately, what I find with the Vietnamese community is that if there was no hospital or police involvement then we won’t know about what is happening; they tend to hide it within their family and we don’t know about it until something big happens because they think don’t trust mental health services. . . They think that they are being experimented on or that we are conspiring against them,” he said.
On a Sunday afternoon in December, we celebrated International Human Rights Day in Cabramatta. Many Vietnamese people came on stage in true Vietnamese style, took hold of the mic and belted out songs about their suffering and anguish since the fall of their country. While not understanding much of the lyrics, I could hear the emotions flowing through their words and heartbreak through their falsetto. This says to me that the community in Cabramatta is still recovering from their history and they are still dealing with their mental health.
But I also understand now that this community is dealing with its mental health every day but in a variety of different ways. They like community gatherings and they like karaoke.
From my findings, it is clear that mental health services are not very popular, but it is still important to provide access to such services that cater for this community because they experience mental health issues just as any people of any culture would. With continual training for professional staff alongside education and awareness in the community, Cabramatta will know where to seek the help it needs.
By Cindee Duong
- Sozomenou, P. Mitchell, M. H. Fitzgerald, A. E,. Malak, D. Silove. Mental Health in a Culturally Diverse Society. National Mental Health Strategy, Mental Health Consumer Participation in a Culturally Diverse Society 2000, 89-131.
- Australia Bureau of Statistics, 2014, Australian Social Trends 2014 Report, viewed 11 September 2016, < http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features102014>
- Department of Immigration and Citizenship, Community Information Summary: Vietnam-born, Commonwealth of Australia 2014, viewed 17 September 2016, <https://www.dss.gov.au/sites/default/files/documents/02_2014/vietnam.pdf>
- Fairfield City council: Social, Health and Housing, 2012, Fairfield City Mental Health Framework, viewed 30 September 2016, <http://www.fairfieldcity.nsw.gov.au/downloads/file/384/fairfield_city_health_framework>
- R. Wagner, V. Manicavasagar, D. Silove, C. Marnane, V.T. Tran. Characteristics of Vietnamese Patients Attending an Anxiety Clinic in Australia and Perceptions of the Wider Vietnamese Community about Anxiety. Transcultural Psychiatry 1996, 259-271.
- W.L. Hinton, J.D. Chen, C.G. Tran, J Miranda, S. Fraust. DSM-III-R Disorders in Vietnamese Refugees: Prevalence and Correlates. Journal of Nervous and Mental Disease 1993, 1113-1122.