1. Foundation House An integrated model of refugee mental health care Jenny Adams

2. Foundation House Refugee mental health organisation – survivors of torture and trauma 3 sites across Melbourne >130 staff Operating since 1988 ◦ Counsellors – social workers, psychologists ◦ Complementary therapies team - since1990 ◦ Mental health clinic – psychiatrists and psychologists under Medicare ◦ Schools team ◦ Research and policy

3. Client groups Clients – refugees and asylum seekers from 30 different countries ◦ Currently majority from Iran, Afghanistan, Iraq, Sri Lanka, Burma, Bhutan, African countries – Ethiopia, Congo, Sudan

4. Complementary therapy modalities: Herbal and nutritional medicines – fully funded dispensary

5. Massage

6. Yoga groups

7. Structures that support collaboration ◦ Group supervision and debriefing ◦ Weekly team meetings ◦ Regular professional development attended by all staff ◦ In house training and induction for new staff

8. Case study – “Tenzing” Tibetan woman 48yo Referred by counsellor PH 6/12 imprisonment in Tibet for participating in demonstration. Endured beatings, solitary confinement & periods of starvation PC “pains all over body”, headaches, insomnia and nightmares Diagnosed PTSD with depression Frequent crying Constipation Not receptive to counselling but grateful for advocacy Devout Buddhist with strong faith in traditional Tibetan medicine

9. Collaborative care Regular discussion with counsellor – check that treatment goals consistent, compatible. Compare presentation. Travel training by student on placement Liaison with GP to exclude medical diagnoses and check prescribed meds Referred to Tibetan Buddhist centre and arranged meeting with senior monk. Liaised with interpreter to assist her with transport

10. Case study – CT treatment Herbal medicine, dietary and lifestyle advice for sleep and depression (walk son to local park each day) Dietary and lifestyle advice plus herbal medicine and fibre supplement for constipation Massage to reduce anxiety and relieve pain. Massage oil to use at home prn.

11. Case study Regular appointments over 2 years – fortnightly to monthly to 2 nd monthly Sleep improved. Reduced hyperarousal Pain decreased – more manageable but still dominant symptom Fewer headaches (from 2/wk to 1-2/month) Less depressive symptoms Constipation chronic!

12. Thankyou! Client and interpreter Colleagues at Foundation House Judy Singer