Mental Health Issues for the NESB Elderly. Emeritus Professor Edmond Chiu A.M. Academic Unit for Psychiatry of Old Age University of Melbourne

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1 Mental Health Issues for the NESB Elderly Emeritus Professor Edmond Chiu A.M. Academic Unit for Psychiatry of Old Age University of Melbourne

2 CALD vs NESB This presentation concentrates on the elderly in Australia who are from Non English Speaking Background. Culturally and Linguistic Diversity is an all inclusive term for all people (English speaking Anglos included) in our multicultural Australia.

3 NESB elderly constitute at least 25% of all elderly people in Australia.

4 History of Recent Migration into Australia Pre-WWII Mostly from UK, a few from Europe. White Australia Policy excluded non- white immigration.

5 Immediate Pre-WWII Early refugees escaping the impending conflicts in Europe and Nazi persecution.

6 Immediate Post-WWII Displaced Persons (D.P. Or refos ) who have survived the War, seeking political and economic stability and safely. Mostly were young, fit, well motivated and resilient survivors.

7 Abolition of the White Australia Policy More from Asia. Non-discriminatory (Followed by Family Re-union, bringing elderly parents.) Skilled migrants assessed on points Post Vietnam war In addition to the Vietnamese, other refugees (Asylum Seekers). To be followed by their elderly.

8 Different Cohorts from different migration eras Around WWII In Australia since late 1930 s Established and likely to be successful Either well integrated or assimulated Speak English with varying degree of fluency strong established ethnic networks created ethnic based welfare systems successful Aussie children and grand children with influence

9 Family Reunion Arrive in Australia in late life Less able to adapt to Australian ways Less able to learn English if not already fluent Deaf, blind and dumb More likely to be isolated

10 Skilled Migrants linguistically fluent well educated and financially established well connected knowledgeable and knows way around the system

11 Central and Basic principle in Care for the Ethnic Elderly Clear and empathic understanding of the elderly person s migration context Migration history when; from where; how travelled; language (include fluency in language of origin); socio-political background associated with time of migration;expectations. Settlement history who sponsored; reception; accommodation; financial, personal and social supports; health issues.

12 Mental Health Issues Protective Factors Risk Factors Health Promoting Strategies

13 Protective Factors Pre-migration well integrated personality with history of Resilience in response to stress, social and personal traumatic events. Supportive and harmonious family. Supportive social/ethnic network. Financial security. Ready access to information sources. Good physical health.

14 Risk Factors Poor physical health, esp. chronic, painful conditions (incl. previous poor nutrition) Past history of mental disorders/symptoms anxiety, depression, adjustment disorder. Inadequate family support. Inadequate social support. Family conflicts. Communication and access difficulties. Inter-generational dissonance (unresolved). Isolation.

15 Promoting Mental Health in NESB elderly Understanding where they re from. Identify their personal RESILIENCE. Enable cohesive supportive and harmonious families. Work positively to resolve inter-generational dissonance/disharmony. Empower ethnic communities to provide community-led services which can also bring the ethnic elderly into the broader community.

16 Promoting Mental Health in NESB elderly Ensure all generic services in health and welfare be empathically culturally sensitive, nonpatronising, free of cringing cultural stereotypes but not creating ethnic and cultural silos. Recognise and understand the nature of Stigma and how you may work with it. When opportunity avails, spend time with ethnic communities in Melbourne or visit their countries of origin as an enlighten tourist.

17 End of Life Issues Understanding of each person and family s deeply held beliefs (even if you disagree) and perspectives in:- o Suicide o Euthanasia o End of life interventions o Rituals

18 RESILIENCE Always remind yourself that the NESB elderly is tougher and more resilient than you think. They have survived all these years to be now in Australia. Acknowledge and utilise this resilience for their better mental health!