1. Mental Health Issues for Refugee Adolescents Monica McEvoy Multicultural Mental Health Nurse Practitioner Candidate Child & Adolescent Mental Health Service

2. Overview Introduction Mental health difficulties experienced by refugee adolescents Risk and protective factors Interventions Case study Diversity in services

3. Mental health difficulties experienced by refugee adolescents Post-traumatic stress disorder Repeated re-living of the trauma Hyperarousal Persistent avoidance of stimuli Complex trauma Developmental impact of exposure and adaptation

4. Mental health difficulties experienced by refugee adolescents (2) Depression, anxiety and grief High levels of depression and anxiety reported Co-morbidity common Additional psychological difficulties Somatic complaints Sleep problems Conduct problems Social withdrawal Attention problems Generalised fear Restlessness and irritability Peer relationships Enduring nature of mental health difficulties

5. Risk and protective factors Risk factors Related to trauma Exposure to war-related trauma Multiple traumatic events Severity of trauma Perception of degree of personal threat Level of personal involvement Unknown fate of missing family members Characteristics of the individual Pre-existing vulnerability Previous conduct problems Previous chronic physical illness

6. Risk and protective factors (2) Risk factors FamilyPoor parental mental health Especially maternal distress Political persecution and imprisonment of father Unaccompanied by family members Post-migration environment Low levels of social support Post-migration stresses Unresolved asylum status Financial hardship Unemployment Frequent moves Language problems Social isolation Racial discrimination

7. Risk and protective factors (3) Protective factors Related to trauma Characteristics of the individual Disposition – good temperament, positive self- esteem, ability to respond to new situations Belief systems – ideological commitment to aims of combatants’ own side and strong Buddhist beliefs FamilyRole of family Cohesion adaptability Post-migration environment High levels of social support

8. Interventions Cognitive behaviour therapy Testimonial psychotherapy Narrative exposure therapy Eye movement desensitisation & reprocessing (EMDR) Pharmacological treatments

9. Diversity in services School Leisure Support to teachers Support to youth focussed services