Improving the provision of services to young people from refugee backgrounds with comorbid mental health and substance use problems: addressing the barriers.
BACKGROUND
South Australia (SA) has resettled 151,134 refugees in the last ten years (Department of Immigration and Border Protection, Settlement reporting facility, 2014). Northern metropolitan Adelaide, an area which experiences significant social disadvantage, has received a significant number of (predominantly young) refugees. Research indicates that refugee youth are at elevated risk of mental health (MH) and alcohol and other drug (AOD) problems. These factors, along with the low socio-economic status of northern Adelaide, the number of refugee youth residing there, and the added complexity of treating comorbid MH and AOD problems (comorbidity) prompted this research. We investigated the barriers and facilitators to culturally responsive comorbidity care for these youth and whether the MH and AOD services were equipped to provide such support.


METHODS
This mixed-methods study employed semi-structured interviews with refugee youth and service providers and an online survey with managers of services. Thirty participants (15 refugee youth, 15 service providers) took part in the semi-structured interviews and 56 (40 complete, 16 partially-complete) in the survey.


RESULTS
Thematic analysis of the interview data revealed the most commonly reported barriers related to four broad areas: (1) organisational and structural, (2) access and engagement, (3) treatment and service delivery, and (4) training and resources. Survey data supported the barriers identified in the qualitative findings.


CONCLUSIONS
This research highlights significant gaps in the response of MH and AOD services to refugee youth with comorbidity. Based on the findings, ways of overcoming the barriers are discussed, and are of particular relevance to policy makers, organisations and clinicians.
Discipline of Psychiatry, School of Medicine, University of Adelaide, Level 4, Eleanor Harrald Building, Frome Rd, Adelaide, South Australia, Australia. Miriam.posselt@adelaide.edu.au.
Miriam
M
Posselt
Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Karalyn
K
McDonald
School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia.
Nicholas
N
Procter
School of Nursing, University of Adelaide, Adelaide, South Australia, Australia.
Charlotte
C
de Crespigny
Discipline of Psychiatry, School of Medicine, University of Adelaide, Level 4, Eleanor Harrald Building, Frome Rd, Adelaide, South Australia, Australia.|Ramsay Health Care, Adelaide, Australia.|Northern Adelaide Local Health Network, Adelaide, Australia.
Cherrie
C
Galletly
D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration / Q000592:standards; D000328:Adult; D002648:Child; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology; D008605:Mental Health Services / Q000458:organization & administration / Q000592:standards; D012036:Refugees; D013021:South Australia; D019966:Substance-Related Disorders / Q000150:complications / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology; D055815:Young Adult
Comorbidity; Mental health; Refugee; Service provision; Substance use; Youth