Dear  ,

Welcome to the April 2024 edition of the Asylum Seeker and Refugee Mental Health Network Committee Newsletter.

Chair update

Recent Committee Meetings

Following the November 2023 meeting, the Committee agreed on increasing the regularity of meetings in the New Year as a first step to reinvigorating the Network's aims and workplan.

So far in 2024, the Committee have met on two occasions (12 February in Melbourne, and 15 April via videoconference) and a lot of conversation has been generated around the general direction of the Network, value offering, and priority-identification in the short and long term.

Priority Areas Identified by the Network Committee

Amongst the various activities included in the Network's workplan, the Committee have identified the following as priority areas for 2024: 

1. Citizenship test exemptions.
2. Release of detainees into the community and discrimination from the public.
3. Trainee education and information about how care is accessed and how clinicians go about advocating and organising that care.

If there is a particular issue or opportunity that you'd like to see on the Committee's agenda, please email us.

End of an Era - 10 Years on the Network Committee comes to an end

I will be concluding as the Committee's Chairperson at the end of May 2024.

I set up the inaugural working group in 2014, and since then the working group has transitioned into a network in 2018 as a result of growing community needs.

Having chaired the Network Committee since its inception, I would like to take this opportunity to express my gratitude for those who have been a part of the Committee during this time. It's been a real pleasure to follow through on all of the work and projects that we've successfully completed in the last decade.

I look forward to seeing the work of the new committee throughout the year.

Positions now open on the Committee

In May 2024, most committee members' terms will lapse in alignment with the AGM. It is vital for the continued success of the Network that the Committee is comprised of passionate and skilled representatives, who are willing to drive jurisdictional and national/bi-national change for the vulnerable communities that we support.

Several positions are currently open for nominations (closing COB Monday 6 May 2024). If you're interested in this opportunity, we strongly encourage you to apply. Applications can be submitted via the nomination link below. 

Other initiatives

Committee Representation on the Racism Awareness Steering Group

The Committee has agreed to have representation on the College's Racism Awareness Steering Group (RASG). Dr Trushna Murgahayah, our trainee representative, has been appointed into this RASG representative role. 

The purpose of the Steering Group is to provide the Board with guidance on how the College can address systemic racism and mental health in Australia and Aotearoa New Zealand, in line with the priorities outlined in the Public Statement: combatting racism in psychiatry. We're looking forward to seeing the impact that our contribution on this forum can make.

Mentoring For Trainees and Early Career Psychiatrists

The Members listed below are available to informally mentor trainees and early career psychiatrists in the area of asylum seeker and refugee mental health, in particular to develop reporting writing skills. Members can be contacted via memberhelp@ranzcp.org.

• Dr Kym Jenkins (VIC)
• Dr Sue Lutton (WA)
• Prof Louise Newman (VIC)
• Dr Beth O’Connor (NZ)

2024 Webinars and Podcasts

The Committee are keen to host some podcasts and webinars this year for our members. Should you have any suggestions or comments about what you'd like to see us presenting on, please let us know.

Member highlight

We're on a mission to increase the connectivity amongst the Network and as part of the Network Newsletter, we'd like to take the opportunity to showcase some of our amazing members.

When asked questions about her experience, these were her responses. 

1. As a trainee, why are you interested in being a part of the ASRMH Network?
    

   I have always been passionate about working with refugees and asylum seekers since I started my career in psychiatry because it was an underfunded and under resourced area. It was important for me to understand the various struggles refugees and asylum seekers experience, and the solutions that can be provided to overcome some of these adversities. I feel privileged enough to be able to receive medical care, education and justice when needed, however I could not accept that these resources were not made available to every individual. I felt it was not just a moral obligation but a desire to ensure that in some ways, refugees and asylum seekers receive equal care and treatment.

   The concept of detention camps are appalling and the conditions that individuals are living in are inhumane, and should not exist in this day and age; albeit the challenges governmental organisations face.

   I had come across the work that various ASRMH members had been doing in detention camps when I joined RANZCP as a psychiatry registrar. I was inspired by the work the ASRMH Network was undergoing such as working on policy issues, promoting education and training to psychiatrists/trainees, advocating for high quality services for refugees and asylum seekers, as well as promoting the highest clinical and ethical standards in the delivery of mental health services. This was a driving factor for me to be part of a network committee that shared similar values and acknowledged the need for refugees and asylum seekers to obtain the highest level of care regardless of their background.
    

2. What’s your experience and background in AS&R psychiatry?
    

   I am currently working with the Central Adelaide Local Health Network in South Australia. I am a final year psychiatry registrar doing an advanced certificate training in consultation liaison psychiatry. I had previously worked with Rohingya Refugees together with UNHCR while working in Malaysia before moving to Australia. This further sparked my interest as the challenges that often arose were unexpected and differed from the patients I would normally see in my clinical practise.

   My perspective changed when I worked with young Rohingya children who were not given the opportunity to receive basic education because there was no funding allocated. To complicate matters further, delivering psychiatric care was challenging because most of their families were opposed to it due to perceived stigma and cultural differences.

   Some of the issues that arose included limitation of biological and psychological treatment options, resulting from the lack of medical insurance and government funding. The lack of advocacy for refugees and asylum seekers was disappointing and I felt it was crucial for me to work harder and be part of a network committee that could make a difference. I struggled to comprehend that in an era where we are meant to have basic necessities, people were still struggling to be granted citizenship of the country they were born in, and not have access to education or medical care.

   I have been privileged to meet so many diverse patients and learn from them which inadvertently helped me in my day to day clinical practise with regards to having a broader understanding of culture and the legal challenges faced by refugees and asylum seekers.

   I am also interested in the long term impact of complex post traumatic stress disorder and intergenerational trauma in refugees and asylum seekers because it is not an area where there has been a lot of research undertaken. Perhaps, if there were more research and longitudinal studies done in this area, we could further reinforce the importance of abolishing detention camps.

   Apart from the above, I also have an interest in working with Aboriginal mental health patients. I have been fortunate enough to work with these groups of marginalised populations in very remote parts of South Australia, and have gained a completely different perspective on mental health issues that arise in rural Aboriginal communities and the intergenerational trauma they have been exposed to.
    

3. What are the challenges you experience, and what do you feel are the greatest challenges for trainees in this area of practice?
   
   Some of the challenges that I have experienced is the concept of refugees and asylum seekers not always getting psychiatry/medical services and treatment while in detention camps due to the legal implications involved. Perhaps even more so in psychiatry when patients who are mentally incompetent are unable to consent to treatment, but there are no formal orders in place to facilitate ongoing treatment/management.

   As trainees working in metropolitan areas, we do not often get the opportunity to work with refugees and asylum seekers. Hence, we are not familiar in dealing with some of the complex issues that arise with refugees and asylum seekers, or develop the required report writing skills. There is a lack of familiarity with regards to the different medical insurances available and to what extent we are able to provide medical treatment within these policies.

   Apart from that, as trainees, there are limited models of care and guidelines that are available to assist us with delivering psychiatric care to asylum seekers and refugees.

   I am also concerned that there are no formal, standardised medical insurance policies in place for refugees and asylum seekers in most countries. As such, the level of medical care that is provided varies across countries and in some instances, refugees and asylum seekers are completely deprived of psychiatric care when it is in fact an utmost priority. I would like to understand better the concept of health policies and medical insurance that are available for refugees and asylum seekers worldwide.

   My wish for the future is that world leaders are able to come together to identify core challenges, abolish the concept of detention camps, and provide optimum mental health care services for refugees and asylum seekers worldwide. As part of my future career goal, I am interested in collaborating with health care policy leaders to work towards implementing a standardised model of care from a psychiatric perspective without compromising treatment options for refugee and asylum seekers worldwide.

   “A refugee is someone who survived and who can create the future” - Amela Koluder

   If refugees and asylum seekers are given equal opportunities and the highest level of mental health care services right from the beginning, there is no question that they will be able to have a better life for themselves, but also contribute towards a better future for all of us.