Somali Conceptions and Expectations Concerning Mental Health: Some guidelines for mental health professionals

New Zealand Journal of Psychology, Jul 2004 by Guerin, Bernard, Guerin, Pauline, Diiriye, Roda Omar, Yates, Susan

The Somali population in New Zealand is a rapidly growing one that should be of interest to mental health professionals due to their experience of resettlement Stressors and the refugee histories of many Somali. Many factors contribute to barriers and difficulties between mental health professionals and Somali clientele. We present here some of the cultural and religious issues influencing Somali conceptions and expectations about mental health services in an attempt to reduce barriers and difficulties. While Somali views are diverse, many view "mental illness" as only encompassing the most severe and possibly untreatable cases. Few Somali see warrelated trauma as a direct cause of their problems but instead cite preoccupation with reunifying their families or other resettlement Stressors as direct causes. We outline some traditional treatments, especially the common use of Koran readings for dealing with both physical and mental health problems. Somatization of problems leads to a heavy reliance on General Practitioners. Complications with specialist referrals and inadequate cultural skills and knowledge of professionals aggravate adequate treatment with this population. Problems with translation and miscommunication are very common. We recommend that health professionals spend more time finding out about clients' family and community relationships, carefully explaining diagnoses and treatments, and listening to, incorporating, and facilitating Somali views on mental health issues and traditional treatments.

Although there have been many cross-cultural approaches to understanding mental health (Aponte, Rivers & Wohl, 1995; Cheung & Snowden, 1990; Cu�llar & Paniagua, 2000; Ekblad, Abazari & Eriksson, 1999; Ferguson & Barnes, 1997; Ho, Au, Bedford & Cooper, 2003; Ho, 1987; Minas, 1991; Monteiro, 1995; Narduzzi, 1994), they have often focussed on westernized groups such as Asian Americans or Hispanics. Literature relating to mental health issues of refugees resettled in western countries is more limited. In particular, little is known about: 1) how the western conceptions of mental health impact on resettlement of refugees from non-western countries and; 2) what the conceptions of mental health are for these groups. The purpose of this paper is to provide mental health professionals with some background to issues in mental health relevant to Somali refugees who have been resettled in New Zealand.

There are now about 4000 Somali in New Zealand, most of whom have arrived as quota refugees or as part of family reunification. Many of those will have mental health needs (Cheung & Snowden, 1990; Elmi, 1999). Brundtland (2000) points out that "it is established that an average of more than 50 per cent of refugees present mental health problems ranging from chronic mental disorders to trauma, distress and great deal of suffering." (p. 1). In the Refugee Voices project (New Zealand Immigration Service, 2003), one-third of the interviewees reported having emotional problems related to experiences prior to moving to New Zealand and related to moving to and settling in New Zealand. The Refugee Voices project also reported that 60% of those had not seen anyone relating to their emotional problems or concerns and that one-third wanted some sort of help relating to the stress they were experiencing. Despite evidence that refugees in general have above-average mental health service needs, there is other evidence that many Somali refugees in New Zealand do not access the services available for many reasons (Yates, Diiriye, Guerin, & Guerin, 2003). These include language barriers, inappropriate use or lack of interpreters, unfamiliarity with the provision of such services, bureaucratic barriers, and transportation issues.

* Somalia comprises a majority nomadic culture with low western education levels and literacy, particularly among older men and women. With the civil war there has been no government for a number of decades and a non-consumer-oriented, non-western economy, meaning that Somali life and culture is very different to that in New Zealand. The majority are Muslims, and have many contacts with the Middle East rather than the rest of Africa. They primarily speak Somali but the language was only put into a written form in 1972 (using English letters) so many of the older people cannot read or write their language, since they always had an oral tradition. Many also speak Arabic and Swahili. The social organization is very kinbased and the communities often close. While this was based on a clan system in Somalia, many have rejected this form of organization because of the trouble it caused the country (for a more detailed review of Somali social organization, see Abdullahi, 2001; Ahmed, 1995; Farah, 2000; Guerin & Guerin, 2002; Kahin, 1997; Lewis, 1994).

Somali are a particularly interesting group to study in relation to the western approaches to mental health service provision because of the many issues that make them different to typical 'westerners'. Briefly, these include differences in religion, skin colour, education and literacy, and culture in general. Nearly all Somali are Muslims, practicing the religion of Islam, requiring women to dress in ways that sets them apart from other New Zealanders. This, combined with their black skin, makes the women particularly visible in New Zealand communities.