Meeting the needs of refugee children: helping resolve the complex mental health needs of refugee children living in New Zealand is the aim of a new intersectoral service in Auckland.

ON TRACC, Auckland's Transcultural Care Centre, offers an intersectoral approach to severe behavioural and mental health issues for children and young people from refugee backgrounds living in the central city.

Established as a pilot programme Last November, it provides specialised interventions involving the school, family and mental health services for refugee children who have been identified as having high and complex needs. Delivered in partnership with refugee communities, it involves three major services: The Ministry of Education Special Education, the Auckland District Health Board Child and Adolescent Mental Health Service (Kari Centre), and the Department of Child, Youth and Family Services. The ON TRACC team, based at the Greenlane Clinical Centre, consists of psychologists, a psychiatrist, social workers, cultural advisers and a behavioural support worker. Some of the team are from refugee backgrounds. It is the first time such a transcultural and intersectoral service has been tried in New Zealand.

According to clinical team Leader and psychologist Peter Shaw, until the service was established, New Zealand had not provided specialised refugee mental, health services targeting children and their families. "New Zealand has a fine record for accepting and resettling refugees. However, compared to some other resettlement countries, our record for providing post-arrival support is poor," he said. "Both Australia and Canada have been running some great mental health programmes for young refugee people for a number of years. We are looking at overseas models and we are developing our own assessment and intervention systems, appropriate to the New Zealand situation."

Around 40,000 people of refugee backgrounds live in New Zealand. Since the early 1980s, New Zealand has settled an annual quota of 750 refugees, one-third of them under the age of 18. In addition, around 1000 asylum seekers arrive each year, with about a third to a half eventually remaining in the country. Another 4-500 people resettle each year under the family reunification programme. Over 60 percent of refugee families settle in Auckland, with smaller groups in Christchurch, Wellington, Napier and Hamilton.

ON TRACC is working to capacity, having had 24 referrals since the service began and with 12 young people and their families presently being seen. Children can present with a combination of behavioural problems, mental health concerns such as anxiety, depression, post traumatic stress disorder symptoms, and sometimes care and protection issues. Interventions can include assistance with the process of acculturation, managing stress, anger, loss and grief, and trauma counselling. The ON TRACC service also aims to support young people's participation in the school setting, helping to reduce learning barriers, strengthen family units and raise awareness with teachers and schools of the complex issues surrounding refugee children and families.

Registered nurse and Auckland Regional Public Health Service refugee health co-ordinator, Annette Mortensen, believes the stresses of coping in a new environment are often at the root of many refugee mental health problems.

Coping with the stigma of mental health

"Most refugees arrive in this country hugely traumatised by the experiences they have been through in their home countries or from their years living in refugee camps. Suddenly they are in a new environment where they don't understand the culture, language and the services they are entitled to. They struggle with housing and budgeting, send money to family members left behind in the camps and are desperate to find employment. For many families and communities, having someone with a mental. health problem is a huge stigma.

"Families arrive here with such high hopes for their children and for the utopia they now believe they are Living in. New Zealand seems such a benign country, but unfortunately, for many refugee people, the reality can be very difficult and different from what they imagined. Just getting through each day is a struggle." Some refugees were highly educated but their skills were not always recognised in New Zealand, said Mortensen, who is also a member of the ON TRACC board. Others have had no education, especially those born in refugee camps. "Some women have been sexually assaulted by camp guards, a terrible stigma they do not wish to talk about in New Zealand. Other women have Lost their husbands in wars and arrive in New Zealand with no family support. Trying to parent successfully coping with such multiple stresses becomes very difficult."

Most families in the initial stages were focused on the more immediate problems of resettlement, which required practical intervention, not counselling, she said. Services also needed to work within the refugees' own cultural dynamics. "People want to do what's best for their children but they don't always know what might be available to help."

The struggle to find employment

The resettlement process for each family was unique, as each family had its own story to tell, said Shaw. For many families, family unification and employment were top of the List. "Around 85 percent of Somali adolescents and adults are unemployed. In traditional societies men are expected to support the family. Many will try for a number of years to find work. As a last resort, some will move to Melbourne or Sydney where the chances of finding a job are perceived to be that much greater.

"Our services are developing as we go along. Often we end up helping the whole family, arranging appointments with Work and Income New Zealand so they get the benefits they are entitled to, and doing our best to reduce the stresses families are under, You need to deal with the immediate problems, like paying the bills, first, before moving to more complex issues." Mortensen is aware that many families are having to cope with both physical and mental health problems. She sees similar patterns among refugee communities as those experienced in other poor New Zealand communities--weight gain, poor oral health and high rates of heart disease and diabetes, Work is currently underway with primary health organisations in areas where refugees live to ensure they meet the complex needs of those communities.