on individuals or the family will be negative and place them at risk.
Psychosocial interventions Using a framework informed by the World Health Orga- nization Mental Health Emergencies, mental health interventions in emergency care should acknowledge that social interventions can have secondary mental health effects, and that mental health interventions can have social effects – as the term ‘psychosocial’ suggests. World Health Organization (2003) guidelines describe ‘social interventions’ as actions that primarily aim to have posi- tive social effects, and ‘mental health interventions’ as interventions that primarily aim to have positive mental health effects. Preparation by nurses in settings where asylum seekers are likely to present should involve: (i) development of a system of coordination with a specific focal person responsible for linking the nurse to the person seeking help; (ii) design of detailed plans to prepare for adequate social and mental health responses; and (iii) education and training of relevant personnel in indicated social and psychological interventions. This should include assessment and planning for the local context (i.e. cultural beliefs, setting, history and nature of mental health problems, family perceptions of distress and illness, ways of coping, resources within com- munity network, etc.). It should also include quantitative assessment of disability and/or daily functioning, as well as qualitative and psychosocial dimensions. If initial assessments uncover a broad range of needs that are unlikely to be met, nursing assessment reports should specify urgency of needs, local community resources, and potential external resources.
Collaborative interventions need to involve consulta- tion with and engagement between the TPV holder, her/his family and friendship network, migration lawyer and/or agent, mental health workers, nongovernment organizations, and trusted community supporters. This is because a multitude of individuals and agencies who demonstrate innovative ways of operating in a synchro- nized fashion will prevent wastage of valuable resources and help bring health benefit to the asylum seeker and her/his family. At the same time, networking and information gather- ing by the emergency nurse are fundamental to the deliv- ery of clinically relevant, integrated emergency services. This will help emergency nurses learn from TPV holders – about the way in which their cultural beliefs guide and inform their communication of health problems. Described as the ‘explanatory model of health care’ (Kleinman & Seeman 2000), this will involve exploration of the way symptoms are presented, the way stressors are perceived and when, how, and why help is sought and evaluated. This process links the mental health experi- ences of asylum seekers to mental health professional interpretation of these and is consistent with Australia’s National Mental Health Plan 2003–2008 (Australian Health Ministers 2003).
Managing the acute phase of self-harm or suicide attempt Data gathering of symptoms of distress must be in part- nership with significant others and, in what is described here as the ‘acute emergency phase’ characterized by (for example) self-harm, soft tissue injury, and self-poisoning, the crude morbidity rate is elevated and the risk of death or harm to others is extreme. This period can be followed by a ‘reconsolidation phase’ when the acute crisis has passed and fundamental needs are again at a level com- parable to that prior to the emergency. Some valuable early mental health interventions for nurses to employ may include the establishment and maintaining contact with the interpreter and the emer- gency mental health worker to manage the urgent psychi- atric crises (i.e. dangerousness to self or others, severe depression, agitation). If an individual has any pre- existing mental illness, the sudden discontinuation of medication should be avoided. Acute interventions may be best managed without medication by following the principles of ‘mental health first aid’. This process involves preserving life where a person may be a danger to themselves and/or others, preventing major or permanent damage to a person’s emotional health and well-being, and preventing deteri- oration and promote recovery. The clinical skills that are necessary to apply these principles include listening with- out interruption, speaking in a measured way without providing too much information for interpreter to trans- late, conveying compassion, assessing physical and safety needs, ensuring basic physical and spiritual needs are met, not forcing – rather gently encouraging talking, pro- viding or mobilizing company from significant trusted others (especially a volunteer community supporter, a community health worker), encouraging but not forcing social support, and protecting from further harm. Speaking in a calm voice identifying what the nurse can do can help asylum seekers better understand the role of the nurse. It may be useful to use words such as, ‘I am not here to hurt you. I am here to understand you, to listen to your story and see what I can do, with others, to help you’. It may also be useful for nurses to self-question how they are presenting themselves at this time by asking: ‘Am I in immediate danger?’ ‘Is the person in any imme- diate danger?’ ‘Is anyone else in immediate danger – especially children or other vulnerable people?’ ‘Am I able to safely remove a third person from danger?’ ‘Am I able to safely communicate with this person in her/his preferred language?’ Some valuable early social interventions may include establishing and distributing a flow of written and verbal information to asylum seekers (using an interpreter) on the application or visa appeal process, efforts to establish physical safety of self and family (if in a family situation), and efforts being made by each organization/individual to help and support asylum seekers. Information should be as simple as possible and in a language most familiar to the individual and the family (understandable to a local 12-year-old child, for example) and empathic
(showing understanding of the situation of the family member). SUMMARY The provision of adequate resources in the form of the delivery of clinically relevant integrated emergency men- tal health support services is fundamental to prevent risk to applicants for refugee status. Continuity and integra- tion of mental health care is best achieved by bridging discrete elements in the asylum seeker journey of prepar- ing for visa appeals and rejections. This is in the context of different episodes in time, interventions by different providers, and fluctuations in mental distress. A whole-of-service, regional and interdisciplinary approach is required that brings together a range of sec- tors and individuals working within them the impact upon the mental health of asylum seekers. By using a team approach that integrates non-intrusive emotional support and personal safety, nurses can help build resilience and promote positive mental health for asylum seekers at risk of self-harm.
on individuals or the family will be negative and place them at risk.
Psychosocial interventions Using a framework informed by the World Health Orga- nization Mental Health Emergencies, mental health interventions in emergency care should acknowledge that social interventions can have secondary mental health effects, and that mental health interventions can have social effects – as the term ‘psychosocial’ suggests. World Health Organization (2003) guidelines describe ‘social interventions’ as actions that primarily aim to have posi- tive social effects, and ‘mental health interventions’ as interventions that primarily aim to have positive mental health effects. Preparation by nurses in settings where asylum seekers are likely to present should involve: (i) development of a system of coordination with a specific focal person responsible for linking the nurse to the person seeking help; (ii) design of detailed plans to prepare for adequate social and mental health responses; and (iii) education and training of relevant personnel in indicated social and psychological interventions. This should include assessment and planning for the local context (i.e. cultural beliefs, setting, history and nature of mental health problems, family perceptions of distress and illness, ways of coping, resources within com- munity network, etc.). It should also include quantitative assessment of disability and/or daily functioning, as well as qualitative and psychosocial dimensions. If initial assessments uncover a broad range of needs that are unlikely to be met, nursing assessment reports should specify urgency of needs, local community resources, and potential external resources.
Collaborative interventions need to involve consulta- tion with and engagement between the TPV holder, her/his family and friendship network, migration lawyer and/or agent, mental health workers, nongovernment organizations, and trusted community supporters. This is because a multitude of individuals and agencies who demonstrate innovative ways of operating in a synchro- nized fashion will prevent wastage of valuable resources and help bring health benefit to the asylum seeker and her/his family. At the same time, networking and information gather- ing by the emergency nurse are fundamental to the deliv- ery of clinically relevant, integrated emergency services. This will help emergency nurses learn from TPV holders – about the way in which their cultural beliefs guide and inform their communication of health problems. Described as the ‘explanatory model of health care’ (Kleinman & Seeman 2000), this will involve exploration of the way symptoms are presented, the way stressors are perceived and when, how, and why help is sought and evaluated. This process links the mental health experi- ences of asylum seekers to mental health professional interpretation of these and is consistent with Australia’s National Mental Health Plan 2003–2008 (Australian Health Ministers 2003).
Managing the acute phase of self-harm or suicide attempt Data gathering of symptoms of distress must be in part- nership with significant others and, in what is described here as the ‘acute emergency phase’ characterized by (for example) self-harm, soft tissue injury, and self-poisoning, the crude morbidity rate is elevated and the risk of death or harm to others is extreme. This period can be followed by a ‘reconsolidation phase’ when the acute crisis has passed and fundamental needs are again at a level com- parable to that prior to the emergency. Some valuable early mental health interventions for nurses to employ may include the establishment and maintaining contact with the interpreter and the emer- gency mental health worker to manage the urgent psychi- atric crises (i.e. dangerousness to self or others, severe depression, agitation). If an individual has any pre- existing mental illness, the sudden discontinuation of medication should be avoided. Acute interventions may be best managed without medication by following the principles of ‘mental health first aid’. This process involves preserving life where a person may be a danger to themselves and/or others, preventing major or permanent damage to a person’s emotional health and well-being, and preventing deteri- oration and promote recovery. The clinical skills that are necessary to apply these principles include listening with- out interruption, speaking in a measured way without providing too much information for interpreter to trans- late, conveying compassion, assessing physical and safety needs, ensuring basic physical and spiritual needs are met, not forcing – rather gently encouraging talking, pro- viding or mobilizing company from significant trusted others (especially a volunteer community supporter, a community health worker), encouraging but not forcing social support, and protecting from further harm. Speaking in a calm voice identifying what the nurse can do can help asylum seekers better understand the role of the nurse. It may be useful to use words such as, ‘I am not here to hurt you. I am here to understand you, to listen to your story and see what I can do, with others, to help you’. It may also be useful for nurses to self-question how they are presenting themselves at this time by asking: ‘Am I in immediate danger?’ ‘Is the person in any imme- diate danger?’ ‘Is anyone else in immediate danger – especially children or other vulnerable people?’ ‘Am I able to safely remove a third person from danger?’ ‘Am I able to safely communicate with this person in her/his preferred language?’ Some valuable early social interventions may include establishing and distributing a flow of written and verbal information to asylum seekers (using an interpreter) on the application or visa appeal process, efforts to establish physical safety of self and family (if in a family situation), and efforts being made by each organization/individual to help and support asylum seekers. Information should be as simple as possible and in a language most familiar to the individual and the family (understandable to a local 12-year-old child, for example) and empathic
(showing understanding of the situation of the family member). SUMMARY The provision of adequate resources in the form of the delivery of clinically relevant integrated emergency men- tal health support services is fundamental to prevent risk to applicants for refugee status. Continuity and integra- tion of mental health care is best achieved by bridging discrete elements in the asylum seeker journey of prepar- ing for visa appeals and rejections. This is in the context of different episodes in time, interventions by different providers, and fluctuations in mental distress. A whole-of-service, regional and interdisciplinary approach is required that brings together a range of sec- tors and individuals working within them the impact upon the mental health of asylum seekers. By using a team approach that integrates non-intrusive emotional support and personal safety, nurses can help build resilience and promote positive mental health for asylum seekers at risk of self-harm.
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