Understanding mental distress in young people from a migrant background in Australia through photo-interviewing

Abstract

Young people from a culturally and linguistically diverse (CALD) background in Australia are reluctant to engage with formal support services when they experience mental health problems, and are under-represented amongst the users of such services. These discrepancies in service engagement may be the result of differences in how they identify and explain mental distress experiences in comparison with the prevailing perspectives within the Australian health system. Kleinman described this conceptually as a conflict between “the cultural construction of clinical realities”.

I had the following aims for this research project: to discover how young people from a CALD migrant background identified and described their experiences of mental distress, to identify the explanatory models and belief systems they utilised to understand these experiences, and to explore how their responses to these experiences – including any interactions with formal mental health services – were influenced by these understandings. Knowledge of these explanatory models and belief systems can inform the enhancement of existing mental health services, as well as provide fresh opportunities for the development of new services and programs with greater appeal and perceived relevance for this population.

Fifteen participants between 18-25 years of age from a CALD migrant background and residing in Melbourne, Australia engaged with ‘photo-interviewing’ to express personal mental distress narratives. They each created up to 20 photographs that represented their mental health and distress experiences, and discussed the meaning of these photographs within the setting of an open qualitative interview. This method encouraged rich descriptions, reflective interpretation, and a storied expression of their lived experiences. The interview transcripts were analysed for themes that were relevant to how they identified, explained, and responded to these mental distress experiences.

A variety of colloquial and psychological terms were used interchangeably to identify mental distress, as well as temporally situated accounts that did not utilise signifying terminology. Mental distress was explained as the result of disruptions to self-identity, social identity, and established social connections. ‘Self-identity’ referred to idealised concepts of the self that participants had either lost, aspired to attain, or sought to escape; whilst ‘social identity’ referred to their value and status amongst peers, family, and the broader community. These notions of identity were influenced by archetypal social roles and values embedded within their cultural background, and were subject to challenges from their interactions with Australian society. Separation from trusted social connections due to their migration journey resulted in disruptions to their informal support networks and their established social identities. The participants favoured self-directed actions and receiving informal social support over the engagement of formal support services. These actions were directed towards the restoration of a spoiled identity and a sense of social belonging.

These findings suggest that young people from a CALD migrant background would benefit from multidisciplinary support interventions that address concerns related to disrupted identities, promote post-migration social inclusion, and build upon the capacity of informal social supports to facilitate their engagement with formal mental health services.