In Australia it is widely accepted that having a home is a right not a luxury. But what constitutes as a home? For some severe mental illness consumers their understanding of home may have developed into an image of white walls, brown clipboards, blue gowns and electric beds- a hospital.
The Mental Health and Drug & Alcohol Office NSW Ministry of Health recognises that this is problematic and in June 2014 begun developing a Pathways to Community Living Initiative to address this issue.
Naz Jacobs looks into the work of SSI, an award winner at 2015’s Mental Health Matters Awards for Culturally and Linguistically Diverse Communities
“The essentials of happiness”, the saying goes, “is someone to love, something to do, and something to look forward to.”
Unfortunately, for refugees and asylum seekers in Australia, these concepts can feel far out of reach. Many have left their families behind, often cannot find immediate employment, and are highly uncertain about their future.
Naz Jacobs, a Journalist and intern with WayAhead, attended the recent ‘Exploring the Mental Health of Muslims’ conference in Sydney’s Bankstown.
“Islamic beliefs and spirituality have a profound impact on suicide prevention in the Muslim community,” says Nooria Mehraby, senior clinician and clinical trainer at STARTTS (NSW Service for the Treatment and Rehabilitations of Torture and Trauma Survivors).
STARTTS and Mission of Hope recently partnered to present the conference ‘Exploring the Mental Health of Muslims’. It aimed to address mental health in Muslim communities and provide religious context for non-Muslim mental health practitioners and those working with migrant groups.
Muslims account for 23%, or 1.6 billion, of the world’s population, which is no small figure. Nevertheless, statistics collected by the World Health Organisation (WHO) in 2011 indicated substantially lower rates of suicide in Muslim-populated countries in comparison to countries in which they are a minority.
While the conference encompassed a range of topics such as domestic violence and self-harm, Mehraby focused on suicide in particular. She explored the reasons why suicide rates are lower in Muslim communities, as well as ways in which mental health practitioners could explore Islamic beliefs with clients as a means to deter them from suicide.
Mehraby says that the main deterrent is the prohibition of suicide in Islam. She quoted the Quranic verse, “Do not commit suicide, as God is merciful to you,” [4:29], and explained that Muslims believe that life is a gift from God and as such are obligated to look after it.
She advised that mental health practitioners may benefit by approaching clients who have expressed suicidal ideation in a way that coincides with their spirituality. Along with the prohibition of the act, there are other elements that may prevent a Muslim individual from following through with their suicidal ideation.
Belief in the afterlife is a significant deterring factor, as Muslims believe that earthly life is temporary and therefore pain, making it easier to accept loss and grief. There is a strong belief that they will also be rewarded for their patience through their struggles.
Many individuals benefit from connecting with their broader Islamic communities and engaging in additional acts of worship. Others find solace in weighing up relative hardship, comparing their personal situation to those less fortunate.
However, despite the low rates, suicide inevitably still occurs amongst Muslims. Along with the grief associated with this, there is also a great sense of shame within communities, as other Muslims may consider the person who has taken their own life to be someone who has turned their back on Islam.
Muslim families who have been bereaved by suicide therefore require extra empathy and support, Mehraby explains. They may face social isolation and disgrace, and harbour immense guilt. Through cross-cultural counselling, they require a non-judgemental environment of respect and psychoeducation.
She says that in almost any mental health setting, Muslims have specialised needs due to their beliefs, and thus benefit from specialised approaches that consider their religious sensitivities.
This idea was discussed throughout the conference as it sought to address the diversity of mental health in Australia’s multicultural climate.
‘Exploring the Mental Health of Muslims’ was attended by Mehna Alacozy, mental health promotion officer At WayAhead, and Naz Jacobs, communications intern. Both are from CALD (Culturally and Linguistically Diverse) communities.
For information about Mental Health in Multicultural Australia, visit www.mihma.org.au.
If you are having thoughts of suicide or know someone who is, contact Lifeline on 13 11 14 or www.lifeline.org.au, or call beyondblue on 1300 22 4636.
Dial 000 for an emergency.
Many years ago, David Peters lived and breathed the homeless life. Now as an Arafmi employee, he is attempting to change the lives of today’s homeless population, through ongoing research and running social programs. Speaking one-on-one with David, Harry Easton discovers the links between mental health and homelessness.
Driving into the central NSW town of Cobar one is struck by two things. Firstly the lack of water, sitting on the edge of desert Cobar Shire is incredibly dry – the water for the mines is pumped all the way from orange and dry red earth shows everywhere. Secondly the trees. Lining the road they form an oddly rhythmical look with their perfectly trimmed leaves and branches. One could be excused for thinking that an enthusiastic topiarist had been trimming the vegetation, but these neat lines are in fact the work of wild goats, whose farming also forms the backbone of Cobar’s agricultural industry. [Read more…]
For over 80 years, WayAhead – Mental Health Association NSW (WayAhead) has been a key figure in running annual campaigns to engage the Australian community with issues of mental health. [Read more…]
The concept of ‘social isolation’ adds a new layer of meaning to our understanding of wellbeing. It encourages us to recognise the complexity to a person’s mental health, as it can be influenced by a variety of internal and external factors. [Read more…]
Harry Easton, in conversation with Brett Collins (pictured), explores the implications that the NSW prison system is having on mental health.
The health issues of prisoners within NSW jails are rarely placed in the national spotlight. There is a prevailing thought that those who have been convicted for a crime deserve to “do the time” behind bars.
Yet the isolated environment of jail can be a trigger point for mental illnesses to develop. There is also strong evidence of mental illness sufferers making up a large majority of the personnel in NSW correction services.
Brett Collins spent 10 years in jail during the 1970’s. He is now Co-ordinator of Justice Action, a community-based advocacy group that focuses on criminal justice and health systems, assisting those who suffer abuse form the system.
He says that a 2007 Australian Bureau of Statistics report on female prisoners found that 78% of men and 90% of women in the 12 months before sentencing had come to the attention of mental health authorities.
“Its a very significant statistic . Most people inside prison are likely to have a whole range of other social disabilities and mental illness as part of a spectrum of problems they have.”
In January 2015 a report by the Inspector of Custodial Services, Dr John Paget, titled Full House: The growth of the inmate population in NSW highlighted a range of issues NSW jails are facing due to increasing imprisonment rates across the state.
Mr Collins highlights a specific line in the Inspector’s report that he believes emphasises the unsustainable environment that prisoners can experience.
“The foreword has a statement on the second page, where it states prisoners are held without a ‘modicum of dignity and humanity.’ Those words constitute the definition of torture.”
Mr Collins said there were a variety of factors that led to prisoners suffering from mental health problems.
“You’ve got isolation, loss of connection between people. It’s no surprise at all people end up with mental health issues. People are frightened when they are in jail; they feel as though they are likely to be preyed on. You end up with a tension for people trying to avoid interactions and avoid antagonising others.”
Deputy Director of the Sydney Institute of Criminology, Dr Garner Clancey, said the prison environment could compound underlying psychiatric issues that individuals may have.
“A prisoner suffering from a mood disorder might find that symptoms are exacerbated by entering prison, especially if it is their first time. Anxiety associated with entering the prison system, possible disruption to previous medication regimes, difficulties adjusting to routines… all have the potential to exacerbate any pre-existing psychiatric illness.”
The confined spaces of the prison cells can also heighten stress and anxiety. Prisoners are placed in these conditions for extended periods of time, as the Inspector’s report found that NSW jails had the lowest number of out-of-cell hours in the country.
Its findings show that for 16 hours a day, prisoners have no access to fresh air, programs, recreation activities, or contact with their families.1
Mr Collins says these restrictions are unacceptable.
“You have people who are normally working or moving around, who have social interactions with people, locked in an area that is the size of a bathroom. They are in there with someone else they don’t know. If you put two animals together in a cage you end up with tension between them. You throw 2 human beings who are under immense pressure and there are questions of dominance and respect… and these are the sort of tensions that make people fearful and concerned.”
Mr Collins also identifies disempowerment as a major psychological issue for prisoners.
“If you have depression outside of jail, then you can visit your family, you have a chance to talk to someone. In prison you can’t do that, you don’t have access to social support or peer mentors.”
The implications for prisoners are potentially fatal. Dr Clancey believes prisoners can become prone to self-harm and even suicide.
Earlier this year, an inquest was held into the suicide of an inmate at the Alexander Maconochie Centre in Canberra. The coroner heard that the inmate, who was on anti-psychotic medication, had to be moved out of the Centre’s mental health unit due to high demand for beds. The 30-year-old man died took his own life shortly after being transferred.
Dr Clancey says the NSW Justice Health and Forensic Mental Health Network (JH&FMHN) provides a range of health services to prisoners, but stressed that the demand was intensifying.
“The growing numbers of prisoners and the increasing prevalence of mental illness in the prisoner population
place ever growing demand on these services. More prisoners in cramped environments locked in cells for long periods will only result in greater psychological distress.”
The number of trained clinical staff has also become a cause for concern within the NSW prison system.
In a short statement, a JH&FMHN spokesperson said that a clinician examines every inmate as soon as practicable after being received into a correctional centre.
“Generally, the clinician is a suitably qualified, skilled, and experienced registered nurse. Inmates who are identified as having health conditions are referred on to specialist nurses and medical practitioners as required.”
However the Inspector’s report determined “that JH&FMHN has some difficulty in filling certain health positions, thus exacerbating waiting list times. There is a community-wide shortage of mental health nurses… on occasion a position is filled with an applicant who does not fulfil all the requirements.”2
Prisoners themselves are also wary of seeking clinician assistance and in some cases don’t want to be formally diagnosed as having mental illnesses. Mr Collins says prisoners do not trust doctors and are fearful of the system.
“As soon as they get diagnosed, they feel as though they are being targeted as conditions for people who are in mental health pods are worse than that of the major part of the jail. They lose social interactions with other prisoners. In the major part of the jail you have a chance to get a job, support, education but in the mental health pod you get none of those things.”
Even when prisoners apply for an appointment with nurses and doctors, there is a high rate of cancellations. The Inspector’s report found that 50% of appointments didn’t occur to lack of officers available to transport prisoners to the specialist.
Mr Collins also highlighted that prisoners themselves face losing key benefits if they visit the specialists.
“They don’t want to go to appointments, as they will lose their cell where they already have some stability, a place to themselves.”
The Inspector’s recommendations for change in the correction service system include increases in out-of-cells
hours, easier access to medication and prioritising staff roles. Mr Collins believes these are good starting points and highlights the possible use of electronic bracelets in the future.
“Instead of being sentenced, you can be monitored in an area for over an extended period. So you have the same control without the expenses and the destruction of locking people up. They use them now for people charged with sex offences, but they haven’t really been expanded into the general community.
“A lot of prisoners have come to us [Justice Action] and they think the monitoring system of the electronic bracelet has prevented them from doing illegal things.
“Then the money that is normally used to lock prisoners up can be spent on offering the positive services those inmates with mental health issues need.”
Dr Clancey believes that a community-based prevention strategy and a review of the isolating prison environment could decrease the number of prisoners with mental illnesses.
“Improving the availability of mental health services in the community will help to ensure mental illness is diagnosed earlier and more readily, rather than such diagnoses becoming evident for the first time in prison.
“Serious consideration needs to be given to the prison experience. Prisoners in NSW can spend very long periods of the day in their cells. Unstimulating and isolating experiences such as these will have negative impacts on prisoner well-being.”
Mr Collins agrees that early prevention is vital.
“If the health issues had been dealt with in the community, before the offence had occurred, then there would neither be an offence nor a victim. The economic cost would also be avoided…as well as the social cost, the cost to the victim. Clearly there is a need for proper community mental health care and social support.”
Harry Easton – Journalism Undergraduate UTS
1. Full House: The growth of the inmate population in NSW, State of New South Wales through Inspector of Custodial Services, Department of Justice, April 2015, p.11
2. Full House: The growth of the inmate population in NSW, State of New South Wales through Inspector of Custodial Services, Department of Justice, April 2015. p.50