Don’t rely on our resilience. We want equitable mental health care!

In recent years, mental health and wellbeing has been catapulted into public consciousness and the policy spotlight at all levels of government. Reports such as the Productivity Commission’s Mental Health Inquiry Report and the findings of the Royal Commission into Victoria’s Mental Health System have renewed political interest in how our mental health systems can be reformed to meet the needs of our growing, heterogenous population, and to address the social determinants of mental health.

We know that sexism and racism intersect to place migrant and refugee women at greater risk of mental ill-health. People who frequently experience racism are almost five times more likely than those who do not experience racism to have poor mental health. Two to three times more women than men experience depression and anxiety, and women make up over 60% of reported self-harm and attempted suicide. Meanwhile, migration-related stressors and inequalities, including visa precarity, concentration into low-paid jobs and lack of recognition of overseas qualifications, compound health inequities and shape mental health outcomes.

This month, MCWH launched our Building Bridges report, based on a 12-month participatory action research project funded by the Victorian Government. We spoke to 99 migrant women in their preferred language, to better understand their experiences of seeking mental health support, and their recommendations for change. Migrant and refugee communities are often excluded from health research because research is mainly conducted in English. By engaging our team of bilingual health educators, we reached women in 10 different languages, centring a cohort whose voices are rarely heard in this space.

Migrant and refugee women shared significant findings with us. They described how they are pro-active in implementing caring strategies and seeking mental health support. Many of them sought help first and foremost from family, friends and social and religious networks – who together formed meaningful and powerful sources of support. The research from Building Bridges has led us to develop new, bilingual health education modules around the theme of ‘Let’s Talk Mental Health’, which enables migrant and refugee women to provide informal support to their peers and strengthens community care mechanisms.

Our participants also described the great efforts they put into seeking formal support. Mental healthcare in Australia can be difficult to access – wait times are long, costs are high, health information and services are often monolingual (delivered in English only), visa restrictions limit choices, and services do not always address the migration experience. While these challenges formed very real barriers to accessing services, they did not stop our participants from pursuing a range of strategies to improve their health and wellbeing. Some sought online counselling services from their countries of origin, finding the overseas-based services to be more accessible in terms of language, timeliness and costs. Another participant returned to her GP five times to insist that she have access to treatment for depression, refusing to accept her GP’s dismissal of her symptoms.

Migrant and refugee communities are often stereotyped as avoiding mental health treatments due to stigma and bias. We found that the bias very much lies within the healthcare system, not within its patients. Many participants shared how their symptoms were ignored, minimised or dismissed by health professionals, who used discourses of ‘resilience’ to downplay trauma and deny formal health care. Such labelling focuses on the glorification of having to survive injustices and inequalities, rather than providing effective solutions to systemic issues faced by communities.

Migrant and refugee women have the strengths-based solutions to address barriers in the mental health system. Now, more than ever, we need to centre their call to build inclusive, equitable healthcare and migration systems which promote the wellbeing, leadership, and social and civic connectedness of the whole community. MCWH continues to meet this call through our Building Bridges and Let’s Talk Mental Health Project, as well as our PACE Leadership program. By centring migrant and refugee women’s leadership, we can build a mental health system that is responsive to their diverse needs and lived experience.

First published in edition #126 of The WRAP on 31 October 2023.