Mental Health Issues in Refugees at Nauru Processing Centre

This article discusses the mental health issues faced by refugees at the Nauru Processing Centre and the need for addressing their concerns. It explores the findings from qualitative research and data analysis, highlighting the prevalence of depression, anxiety, and post-traumatic stress disorder among the refugee population. The article also discusses the significance of providing quality mental health services to promote recovery and well-being.

Background
The concentration of refugee literature have been the continuous aspects of psychological
consequences in regards with the trauma, which is experienced prior to the resettlement. (The
Australian Psychological Society Ltd, 2007). The consequences like PTSD (Posttraumatic
Stress Disorder) can be developed from the exposure of an individual to a situational trauma
(The Australian Psychological Society Ltd, 2007). The individuals experiencing trauma may
reflect the psychological effects like sadness, anger, guilt and fear. Serious effects of
psychological effects may lead to anxiety, substance misuse and depression (The Australian
Psychological Society Ltd, 2007). There are numerous alarming syndrome of Trauma,
including impaired functioning of body parts or involuntary imbalance or/and significant
distress. Trauma also includes a series of emotions and thoughts in regards with the events
responsible for trauma, emotional numbing or/and avoidance of the existing situation (The
Australian Psychological Society Ltd, 2007). The post-traumatic effects of PTSD like
depression and anxiety disorders amongst refugees are considered to differ between
populations and studies (Tinghög et al., 2017). The a 29 studies article review for the topic of
mental health in the war victims presented the rate of prevalence ranging between 4.4 percent
to 86 percent for Posttraumatic Stress Disorder, for depression it was reported as 3.2 percent
to 80 percent and for anxiety ranging between 20.3 percent to 88 percent.
In the island of South Pacific, Nauru, the Nauru Regional Processing Centre is located, which
is considered to be the Australian offshore detention facility for immigrants. Immigration
detention facilities is considered to be a mandatory part of the policy depicting the mandatory
detention (Parliament of Australia, 2016). On the other hand, the Nauru Processing Centre
that is known for accommodating children, male and female, majorly comprised of the

asylum seekers from various regions like Pakistan, Sri Lanka, refugees and people from
Bangladesh (Parliament of Australia, 2016).
The 79 percent claims for the access to the asylum of Nauruan Government, which is around
941 out of 1,195 people in the year 2016, October, were refugees
As at 31 October 2016, of the 1,195 people who have had their claims for asylum assessed
by the Nauruan Government, 941(79 per cent) had been found to be refugees. (Parliament of
Australia, 2016).
UNHCR reflects concern regarding the mental and physical health of seekers of asylum of
RPC (UN High Commissioner for Refugees (UNHCR), 2013). There is lack of understanding
of the asylum-seekers for transferring to the region of Nauru or for the purpose of transferring
back to the country, Australia. The families of RPC3 have expressed issues and concerns
regarding the state of mental health, specifically for the children as well as the family with a
62 year aged woman and 72 year man along with mentally ill daughter (UN High
Commissioner for Refugees (UNHCR), 2013). The findings of the report marks the need for
addressing the concerns regarding mental and physical well-being of the asylum-residents.
The response will be aimed at restricting the deterioration, which can be predicted by the
instability, inconsistency and delays in improving the harsh situation (UN High
Commissioner for Refugees (UNHCR), 2013).
Another major concern lies in the lack of evidence and information regarding the status of
mental health of the refugees residing at the Nauru Processing Centre. Therefore, the
assumptions regarding the concern should be utilized as a base for understanding the status of
mental health and for addressing the issues for the purpose of closing gap for the factors of
knowledge.

The research problem
The debate in regards with the solution and conceptualization of the needs of mental health
for the refugees arose due to the research work on the post-migration and post-conflict mental
state of the population (Bjertrup et al., 2018).The claims of UNHCR reflects the shocking
situation of the asylum seekers at Nauru (Fantin, 2018). The demand from one of the senior
official of United Nation depicts the recommendation of reconsidering the processing policy
of offshore project due to the concerns regarding the growing mental health issues (Fantin,
2018). MSF (Medecins Sans Frontieres declared that the state of mental health of the
residents of Nauru is similar to the victims of torture, describing the very first medical data,
which was independently deduced regarding the conditions of mental health at the island
(Metherell, 2018).
Significance of the problem
The research work on the aspects of mental health have majorly focussed on post and pre
migration phases of the population because of the complexities of the researchers for the
purpose of accomplishing access to the camps of refugees form all across the globe (Bjertrup
et al., 2018). The compiled and comprehensive data regarding the mental health of the
refugees, asylum-seekers and the residents of Nauru Island, the data depicted that 30 percent
of the asylum-seekers were found to be attempting suicide, which also included a range of
youngsters and children (Metherell, 2018). The most significant way of enhancing the well-
being and quality of living of the asylum seekers is to incorporate the provision of quality
services regarding mental health for the purpose of enabling the process of recovery from the
state of trauma (The Royal Australian and New Zealand College of Psychiatrists, 2017). The
most marginalized and vulnerable population in the community are considered to be the
refugees and asylum seekers, as they have been the prey of torture, catastrophic events and

trauma prior to the fight and displacement (The Royal Australian and New Zealand College
of Psychiatrists, 2017).
The methodology
Prior to the initiation of the qualitative research, the participants for the explanatory quality
research were selected by the help of epidemiological survey. The epidemiological survey
comprises of a questionnaire for the purpose of detecting the depression rates, post-traumatic
stress disorder and anxiety issues. The questionnaire will undergo the process of pre-testing
for acquiring the validity and approval for screening, which will be based upon the Refugee
Health Screener-15 (RHS-15) (Hollifield et al., 2013). As per Hollifield et al. (2013), the data
from RHS-15 has applicability for short duration in the administration, so that it can achieve
effectiveness in epidemiological survey for the purpose of identifying the anxiety rates of
refugees, PTDS and depression rates in the Nauru Regional Processing Centre. The
qualitative research studies of the paper includes the identified outcomes of the sufferings of
refugees from the epidemiological survey. Phenomenology is the best tool of qualitative
research, which best addresses the aims of this research. This tool is designed for the purpose
of describing the details of lived experiences of the individuals in the particular phenomenon
(Creswell, 2013). It aims at describing the description of a specific phenomenon and the
direct investigation result in the form of constant experiences from the population, who have
experienced these specific situations. In accordance with the phenomenological method, the
researchers aims at developing the understanding of the importance of the events with the
human association. The phenomenological research approach aims at describing and for
starting with a perspective independent of perception or hypotheses (Husserl, 1970). It
comprises procedures such as conversations, interviews and focus group meetings.
The method of phenomenology reflects the sub types, however, the kind utilized in the
research process will be in the form of descriptive phenomenology. The form of descriptive

phenomenology depicts the nature of description of the experiences of the respondents
(Matua & Van Der Wal, 2015). The procedure of descriptive phenomenology requires
researcher to develop an understanding regarding the existent phenomenon in minds of
respondents. Thus, the participants/respondents of the research process were asked for
reflecting upon the experiences of specific phenomenon for the purpose of describing the
phenomenon without the presence of interpretation. The reflection is crucial for discovering
the meaning by the respondents in accordance to the approach of phenomenology (Giorgi,
2012). Even if the method of descriptive phenomenology is based on description of a specific
phenomenon, the procedure focusses on a minimum degree of interpretation (Husserl 1970 as
cited in Giorgi, 2012). Nevertheless, the minimum range of interpretation is enabled by
researchers and should be deduced from the existent data like theory. Moreover, the
appropriateness of the descriptive phenomenology can be reflected for the ability of deducing
interpretations, clarifications and data strengthening (Wilson, 2015). Biasness of the
researcher against the views of the refugees and their experiences should not be practiced for
the sake of the integrity in collected data for the study.
Sampling
The method of sampling utilized for the study is non-probability purposive sampling because
the research study is focussed on involving the sufferings of refugees regarding mental health
illness rather than including all the refugees. The method of non-probability sampling is
selected in the situation of non-systematic process which does not ensure equal chances for
the individual subjects of target group (Mohamed & Ahmed, 2017). The purposive sampling
method will be utilized for refugees who are suffering from the state of mental illness by
conducting in-depth interviews.
Moreover, snowball sampling method will be utilized along with purposive sampling for the
purpose of recruiting refugees in the discussion of focus group in the total refugees who are
suffering the state of mental disorder. The method of snowball sampling is considered to be
suitable in the conflicting situations due to the initiation through the trustworthy networks of
society which are core aspects of the method, which can be contribute to the interviewees for
overcoming the mistrust and fear, resulting in ensured access (Kirchherr & Charles, 2018).
The sample size in the studies of qualitative studies, the usual method is using saturation for
the base of structuring principles at the time of data collection (Mason, 2010). The
assumption of saturation is utilized due to the standard for detaching analysis or data
collection method (Saunders et al., 2017). Thus, the precise knowledge about the sample size

will be understood at the time of conducting the research study. In accordance with Hagaman
& Wutich (2016), the size of around 20-40 interviews were required for the data saturation.
The participants for each focus group ranged from 3-21 respondents along with median of ten
respondents. In the focus group meeting, there were around seven (median) respondents
(O.Nyumba, Wilson, Derrick & Mukherjee, 2018).
Recruitment
Data collection
In qualitative research, the method of data collection comprises of-
1. One-to-one basis direct interactions with the individuals
2. Direct interaction in group structure
The data collection procedure of qualitative research are usually time consuming and thus the
data is collected form comparatively smaller sample size, which makes the process of
qualitative research more costly.
The major method of collecting data will reflect face-to-face interviews by recruiting
respondents by the method of focus group discussions and purposive sampling, which will be
carried out through selecting respondents from the sampling method of snowball.
The collection of data from the interviews with respondents will serve as a characteristics for
a range of qualitative studies. In interview method, researcher receives most straightforward
and direct approach for gathering comprehensive and valued data in regards with specific
phenomenon (Barrett & Twycross, 2018). The purpose of face-to-face interviews is to
develop a precise understanding about the experiences and opinions of the mental state of
refugees by the deduced information regarding depression, anxiety and stress disorder. For
gaining a detailed understanding of the experiences of refugees, the episodic interview
procedure will be used which will enable the process of narrative and focussed interviewing
process (Bjertrup et al., 2018). The accumulated narratives regarding the experiences of
sufferings, violence, well-being and distress are linked to various life events of respondents
(Bjertrup et al., 2018). For creating a different and comfortable environment with the
inclusion of privacy, the interviews were conducted in on-site clinic or the shelters or van of
the research team (Bjertrup et al., 2018). The interviews were conducted under qualitative
research with the help of interpreters during the interview in the known language of refugees
(Bjertrup et al., 2018).FGDs were organized and extracted insight for everyday life issues and
concerns, experienced by refugees in the community of various sites, like complex asylum
methods, poor sanitation and poor education or work opportunities (Bjertrup et al., 2018).
With the help of FGDs, it was made possible to extract the disagreements and consensus in
the refugee population that assisted with initial analysis (Bjertrup et al., 2018). In an average,
FGDs continued around 60 mins with the discussion at on-site clinic (Bjertrup et al., 2018).
FGDs and IDIs were audio-recorded with the transcription of English language (Bjertrup et
al., 2018).

Data analysis
The method of data analysis selected will be the method of phenomenological reduction. The
chosen version by the researcher will be Colaizzi’s procedure for the assessment frame of
study. As per Wojnar & Swanson (2007), there are in total 4 important assessment frame of this
study utilizing the method of descriptive phenomenology, like analysing, bracketing,
describing and intuiting (Wojnar & Swanson, 2007, p. 175). In the method of
phenomenological analysis process, in accordance with the Morrow, R., Rodriguez, A. and King,
N (2015). The procedures in Colaizzi’s descriptive phenomenological method:
1. Familiarisation- The researcher of the study familiarises herself/himself with
information by the process of reading through every respondents
2. Extraction of important statements- The identification of every statement in accounts
which holds direct importance to phenomenon in investigation.
3. Formulating meanings- identification of concepts significant to phenomenon which
arises through detailed consideration of important statements. Researcher should be
reflect using bracket for her or his assumption of sticking closely with the
phenomenon as faced.
4. Cluster themes- The clusters of researcher are identified with the concept of themes
which are similar in all accounts. Moreover, the method of bracketing of the pre-
assumptions is significant specifically for avoiding the potential impact of the existing
theory.
5. Constructing a comprehensive description- Researchers presents a comprehensive
description of phenomenon which includes the themes extracted from setp 4.
6. Manufacturing fundamental structure- Researcher summarises the comprehensive
description of the down to short and extracting dense responses which captures the
aspects which are deemed for important structure of phenomenon.
7. Deducing verification of basic structure- Researcher aimed at returning basic structure
responses from the respondent for asking if it is able to capture the experiences. She
or he may return back and mould earlier procedures for the process of analysis in light
of feedback.
The seven step process of Colaizzi 1978 reflects a comprehensive assessment with the
association of steps for staying up close with the data. The end outcome is summarised by
including the description of phenomenon in the study with the method of validation through
respondents which formed the data. The procedure is dependent on the rich accounts of
sufferings which may arrive through the process of face-to-face interviews.
Rigour or trustworthiness
Consistency simply depicts the value and quality of the state of carefulness with the
association of strict details or value of being exhaustive and right (Cypress, 2017). The
theories like validity, generalizability and reliability is linked with the procedure of
qualitative research (Noble & Smith, 2015). The researcher of the study presents the rigor of
the qualitative research which equates to theory of validity and reliability with significant
elements of quality (Cypress, 2017). The consistency can be stated as the medium of validity
and reliability which must reflect application to the methods of qualitative research at the

time of inquiry in the place of post hoc evaluation (Cypress, 2017). Validity and reliability
must be received in consideration of qualitative questions while constructing the study,
assessing results and deducing quality(Cypress, 2017).
Consistency or Rigour of naturalistic medium of enquiry can be functionalized utilizing the
method of transferability, credibility, conformability and dependability (Cypress, 2017). For
the purpose of analysing credibility and conformability of extractions the four process of
triangulation were being considered, data source, theoretical triangulation, investigators and
methodological (Forero et al., 2018). The concept of Triangulation responds to the concerns
of validation through the use of more than two procedures of the method of data collection
for answering questions of the research (Barbour, 2001). The extraction of same findings
through various methods simply delivers the corroboration, which is reverse for the absence
but it delivers bases for the process of refutation (Barbour, 2001). The reason behind the
selection of various procedures is that the qualitative research method delivers parallel sets of
data and every affording specific partial opinion of the complete picture (Barbour, 2001).