Experiences and Challenges Faced by Young Migrants in Accessing Mental Health Services in Australia

This research proposal aims to determine the experiences and challenges faced by young migrants and refugees between the ages of 12-25 in accessing mental health services in Australia. The study will be based on mixed-method research and will explore the barriers that are encountered at the time of seeking mental health services, and the perceptions and outlooks that the migrants have in relation to seeking mental health services.

Running head: MENTAL HEALTH NURSING
What are the experiences and challenges faced by young migrants and refugees between the
ages of 12-25 in accessing mental health services in Australia?
Name of the Student
Name of the University
Author Note

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Executive summary
With unparalleled numbers of evacuated individuals worldwide, psychological health
clinicians working in high-income nations progressively come across asylum-seeking and
refugee patients, who are subjected to noteworthy adversity prior to and after their migration.
The assignment focuses on a research proposal that will be based on mixed-method research
and will determine the experiences and challenges faced by young migrants and refugees
between the ages of 12-25 in accessing mental health services in Australia.

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Table of Contents
Introduction................................................................................................................................3
Background................................................................................................................................3
Research question.......................................................................................................................5
Research objectives....................................................................................................................5
Study design...............................................................................................................................5
Study population and sampling..................................................................................................6
Data collection...........................................................................................................................7
Data analysis..............................................................................................................................8
Assuring quality of study...........................................................................................................8
Study period...............................................................................................................................9
Participants...............................................................................................................................10
Ethical considerations..............................................................................................................10
Resources required...................................................................................................................10
References................................................................................................................................12
Appendices...............................................................................................................................15
Interview questions..............................................................................................................15
Informed consent form for participants aged more than 18.................................................16
Informed consent form for parents of participants aged less than 18..................................18

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Introduction
A refugee is an umbrella term that refers to a displaced individual who has crossed
national borders and boundaries out of compulsion, which in turn results in their failure to
return home (Baines, 2017). These individuals are also referred to as asylum seekers and they
are generally granted the status of a refugee by the United Nations High Commissioner for
Refugees under circumstances when they seek an entitlement for asylum. Furthermore, once
a displaced individual is approved refugee position they enjoy positive rights as decided in
the 1951 Refugee agreement (Whitmill et al., 2016). Not all republics have signed and
approved this agreement and some republics do not have a lawful process for addressing the
rights of the asylum seekers. In addition, reports from the Youth Issue Briefs 2016
highlighted that young migrants formed a significant 12% of the total population of people
who were migrants in the year 2013 (UN Department of Economic and Social Affairs, 2016).
Furthermore, young people have been found to migrate for several reasons, such as, pursuing
higher education, starting work, or other life transitions. This assignment will contain a
research proposal that will explore the challenges and experiences of refugees and young
migrants, in relation to seeking mental health services in Australia.
Background
Time and again it has been found that there are different types of immigration in
Australia that are categorised under the groups of student visas, skilled occupation visas,
family visas, and investor visas (Robertson, 2017). According to reports from Australian
Bureau of Statistics (2017) the linguistic and cultural diversity of the resident population of
Australia has undergone reshaping in recent years. In addition, an estimated 28.5% of the
resident population was born overseas in 2016, which in turn demonstrated an increase from
2015. Persons who took birth in the United Kingdom sustained to be the major overseas-born

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residents, and accounted for roughly 5.0% of the total population. This was followed by
migrants from China (2.2%), New Zealand (2.5%), Philippines and Vietnam (both 1.0%), and
India (1.9%). Reports also state that the total number of humanitarian entrants and refugees
who have entered Australia has increased in recent years and the nation accepted more than
17,555 refugees in 2015-16. This number comprises of an estimated 5,032 special
humanitarian entrants, 1,277 females thought to be ‘at risk’, 6,730 refugees, 2,003 individuals
granted onshore safety visas, and 3,790 individuals granted visas from Iraq and Syria
(Settlement Services International, 2019).
Research evidences have also elaborated on the fact that migrants with hazardous
legal position live under great pressure and perpetual uncertainties in their relocation setting,
which may have an undesirable influence on psychological health (Levecque & Van Rossem,
2015). In addition, experiences that are related to detention of asylum seekers have also been
identified as underlying risk factors that increase the likelihood of the refugees to report
adverse mental health, with several research evidences providing confirmation for the
prevalence of PTSD and depression among the asylum seekers (Brunnet et al. 2018). The risk
factors for the onset and progression of mental health issues can be experienced by the
refugees and migrant prior to or after migration to a new nation, and they are often associated
to armed conflicts, persecution, and/or economic hardship. According to Close et al. (2016)
persecution for ethnic, political, religious or other underlying factors might generally
encompass imprisonment, human rights violation, torture, or witnessing the demise of friends
and family.
The diversity of religious beliefs and cultures often lead to the manifestation of loss,
anxiety, and grief amid the migrants. Furthermore, they most often encounter a range of
barriers that results in worsening of their mental health status such as, lack of adequate
employment opportunities, drop in socioeconomic background, isolation from culture, trauma

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experiences, and unrecognition of their professional qualification (Turrini et al. 2017). The
process of asylum seeking and/or migration also encompasses several event that lead to
physical harm together with infectious diseases, human trafficking, sexual violence, and
extortion. In several instances, the measures that need to be adopted for making asylum
applications are long-lasting, leaving the migrants in a relentless state of indecision.
Furthermore, decreased social integration also creates an increased likelihood among the
refugees and migrants to experience hostility, which also includes demeaning and offensive
comments from the native residents (Hynie, 2018). However, there is lack of a
comprehensive evidence on the challenges and discrimination that they have to encounter.
This calls for the need of determining the experiences and challenges that are experienced by
the target population, while they seek help from mental health services.
Research question
What are the experiences and challenges faced by young migrants and refugees
between the ages of 12-25 in accessing mental health services in Australia?
Research objectives
 To explore the barriers that are encountered at the time of seeking mental health
services
 To determine the perceptions and outlooks that the migrants have in relation to
seeking mental health services
Study design
The research that will seek explanations for the question and objectives stated above
will be dependent on multimethodology. The design will be a mixed method investigation
that will encompass gathering, evaluating, and integrating both qualitative and quantitative
investigation approaches. The primary reason for using this approach can be accredited to the

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fact that it will provide an enhanced understanding of the phenomenon under investigation
and will also yield a comprehensive evidence, thus allowing acquiring in-depth knowledge.
In addition, amalgamation of thematic approaches with statistics will also help in evading
over-reliance on any one particular data approach, thus strengthening the findings (Creswell
& Clark, 2017). Taking into consideration the concept of research philosophy, mixed
methods research will be based on the philosophy of pragmatism, thus facilitating conduction
of the investigation based on both deductive and inductive perspectives, and subsequently
enabling combination of hypothesis testing and theory generation within a single study.
The final results will therefore comprise of both statistical analysis and observations,
thereby establishing their validity. Combination of both qualitative and quantitative approach
will also reduce biasness of the researchers (Creswell & Creswell, 2017). In addition, the
philosophy of pragmatism will also be selected for this investigation since it accepts a
particular concept to be pertinent only if some kind of action is supported by the concept
(Johnson et al. 2016). In addition, the philosophy will also identify that there are a plethora of
approaches for interpreting the surrounding world, and that no particular outlook can provide
a comprehensive and all-inclusive picture. Hence, this research will be conducted in a manner
that is based on the notion that there are multiple realities.
Study population and sampling
The research will be conducted among study subjects who will be selected based on
the method of convenience sampling. Also referred to as grab or opportunity sampling, this
type of participant selection is a non-probability sampling that encompasses the people being
drawn out from a wider population that is in near proximity to the researcher. In other words,
the study participants will be selected based on their location, and whether they are close to
hand (Etikan, Musa & Alkassim, 2016). The sampling will be conducted across one
university, one school, one community centre, and one primary healthcare centre located

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across the district. This sampling procedure will be followed owing to ready availability of
the sample and its cost-effective nature. Pamphlets will be distributed across the
aforementioned areas, and will contain a description about the purpose and nature of study.
Data collection
The qualitative component of the research will be based on conducting interviews
among the participants. For the quantitative component, an online survey will be conducted.
Interview will be conducted since it will help in attaining extremely personalised information,
and will also provide the opportunity to conduct a probe for understanding the underlying
factors that govern the responses of the participants. The principle advantage of conducting
an interview among the study subjects is that it will offer a comprehensive and all-inclusive
description of the perceptions and outlooks of the migrants and refugees (Peters & Halcomb,
2015). Furthermore, when conducted face to face, one major advantage of conducting
interviews is that it will help in capturing non-verbal or verbal cues from the responses. In
addition, interviews will also facilitate paying attention to the expressions and language of the
participants, thus indicating if there is any discomfort or excitement among them. The key
features that have will influence the conduction of online survey is that it is a cheaper,
simpler and faster method of data collection and the entire period for data collection will be
significantly reduced.
The process will also ensure dynamic interaction between the researchers and the
respondents, besides providing the opportunity to immediate code responses to particular
questions that will be asked in a close-ended manner (Couper, 2017). Close-ended questions
will be provided in the survey since it will be easy for the respondents to provide answers.
The SurveyMonkey software will be used for conducting this online survey. In addition, the
response selections can also facilitate clarification of meaning of the responses from the study
subjects (Bentley, Daskalova & White, 2017). Survey has been selected as the data collection

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method for the quantitative research component since it will be relatively easy to administer
the survey to the participants and a broad range of information can be easily gathered such as,
the opinions, values, beliefs, and attitudes.
Data analysis
No separate statistical evaluation will be performed for the collected responses owing
to the fact that the online survey cloud based software will provide a customised and
complete data analysis, based on the responses that the participants will give for the close-
ended questions. The qualitative response obtained from interviews will be initially audio
recorded and later on transcribed verbatim. These responses will then be categorised based on
the approach of thematic analysis (Vaismoradi et al. 2016). The obtained responses will be
read and re-read, followed by writing down the pieces of information that are considered
valid. Special focus must be placed on the answers, followed by indexing or coding of the
data. Patterns or themes that comprise of similar concepts, ideas, interactions or phrases will
be recognised and retrieved. This will be followed by making connections between the
identified patterns. The final step will encompass interpretation of the data and explanation of
the findings.
Assuring quality of study
The nature and type of qualitative and quantitative data often makes it difficult for the
researcher to separate oneself from data. Assistance must be taken from two researchers for
coding the data collected from interviews, since it will generate consistency between the
interpretations, and prevent any conflict. The study subjects will be allowed the opportunity
to review their responses, both for the survey and for the interview, in order to ensure
representativeness of the answers with their beliefs. Checking for alternative explanations of
the responses and asking a supervisor to review the conclusions will also ensure that the

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research is of a reliable quality. Interviewer bias can be prevented by standardising the
interaction with the patient and blinding the interviewer to exposure status of the participants.
Furthermore, efforts will also be taken to store all collected responses at a location that
cannot be accessed by third parties.
Study period
The research will be conducted over a period of six months.
Stages Septembe
r
October November December January February
Research
question
development
Literature
review
Data
collection-
interview
Data
collection-
online survey
Data analysis
Writing the
report
Dissemination
of findings

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Table 1- Timeline of the research
Participants
Some of the key criteria that will be followed for selection of prospective research
participants in the investigation would include namely, (i) proficiency in English, (ii) age
between 12-25, (iii) asylum seeker or migrant, (iv) born overseas, (v) diagnosed from mental
disorder.
Ethical considerations
All participants will be treated in the form of autonomous individuals. Care should be
taken to not harm them and the research should be conducted such that the benefits are
maximised, and the harm is minimised. The risks and benefits of the research will be fairly
distributed. In addition, care will be taken to maintain participant confidentiality. After
establishing contact with the participants (or parents for children below 18 years of age), they
will be provided with an informed consent sheet in a sealed envelope that will provide them
necessary information about the advantages and potential drawbacks of the research (if any).
Those participants who will provide informed consent will be recruited for the study (Metcalf
& Crawford, 2016). In addition, they will also be provided with the opportunity to refuse
participation or withdraw from the investigation, at any point of time.
Resources required
The table provided below provides an overview of the estimated budget for the
research resources:
Categories Budget
A. Personnel 216
B. Fringe Benefits 263
C. Travel 251

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D. Equipment 325
E. Supplies 397
F. Contractual 178
G. Other 150
Grand Total $1780 -
Table 2- Budget for research

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References
Australian Bureau of Statistics. (2017). 3412.0 - Migration, Australia, 2015-16. Retrieved
from https://www.abs.gov.au/ausstats/abs@.nsf/previousproducts/3412.0main
%20features32015-16
Baines, E. K. (2017). Vulnerable bodies: Gender, the UN and the global refugee crisis.
Routledge.
Bentley, F. R., Daskalova, N., & White, B. (2017, May). Comparing the reliability of
Amazon Mechanical Turk and Survey Monkey to traditional market research surveys.
In Proceedings of the 2017 CHI Conference Extended Abstracts on Human Factors in
Computing Systems (pp. 1092-1099). ACM.
Brunnet, A. E., Bolaséll, L. T., Weber, J. L., & Kristensen, C. H. (2018). Prevalence and
factors associated with PTSD, anxiety and depression symptoms in Haitian migrants
in southern Brazil. International Journal of Social Psychiatry, 64(1), 17-25.
Close, C., Kouvonen, A., Bosqui, T., Patel, K., O’Reilly, D., & Donnelly, M. (2016). The
mental health and wellbeing of first generation migrants: a systematic-narrative
review of reviews. Globalization and Health, 12(1), 47.
Couper, M. P. (2017). New developments in survey data collection. Annual Review of
Sociology, 43, 121-145.
Creswell, J. W., & Clark, V. L. P. (2017). Designing and conducting mixed methods
research. Sage publications.
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and
mixed methods approaches. Sage publications.

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Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and
purposive sampling. American journal of theoretical and applied statistics, 5(1), 1-4.
Hynie, M. (2018). The social determinants of refugee mental health in the post-migration
context: A critical review. The Canadian Journal of Psychiatry, 63(5), 297-303.
Johnson, R. B., Onwuegbuzie, A. J., de Waal, C., Stefurak, T., & Hildebrand, D. (2016). 12
Unpacking Pragmatism for Mixed Methods Research. The BERA/SAGE handbook of
educational research.
Levecque, K., & Van Rossem, R. (2015). Depression in Europe: does migrant integration
have mental health payoffs? A cross-national comparison of 20 European
countries. Ethnicity & health, 20(1), 49-65.
Metcalf, J., & Crawford, K. (2016). Where are human subjects in big data research? The
emerging ethics divide. Big Data & Society, 3(1), 2053951716650211.
Peters, K., & Halcomb, E. (2015). Interviews in qualitative research. Nurse Researcher
(2014+), 22(4), 6.
Robertson, S. (2017). Infrastructures of insecurity: Housing and language testing in Asia-
Australia migration. Geoforum, 82, 13-20.
Settlement Services International. (2019). How many refugees does Australia settle each
year?. Retrieved from https://www.ssi.org.au/faqs/refugee-faqs/141-how-many-
refugees-does-australia-settle-each-year
Turrini, G., Purgato, M., Ballette, F., Nosè, M., Ostuzzi, G., & Barbui, C. (2017). Common
mental disorders in asylum seekers and refugees: umbrella review of prevalence and
intervention studies. International journal of mental health systems, 11(1), 51.

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UN Department of Economic and Social Affairs. (2016). YOUTH AND MIGRATION.
Retrieved from https://www.un.org/esa/socdev/documents/youth/fact-sheets/youth-
migration.pdf
Vaismoradi, M., Jones, J., Turunen, H., & Snelgrove, S. (2016). Theme development in
qualitative content analysis and thematic analysis.
Whitmill, J., Blanton, C., Doraiswamy, S., Cornier, N., Schilperood, M., Spiegel, P., &
Tomczyk, B. (2016). Retrospective analysis of reproductive health indicators in the
United Nations High Commissioner for Refugees post-emergency camps 2007–
2013. Conflict and health, 10(1), 3.

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Appendices
Interview questions
1. How long have you been living in Australia?
2. Have you been diagnosed with any mental disorder?
3. Do you think you have been provided sufficient help?
4. Have you seen a general practitioner in the past one year for your mental health?
5. Have you been admitted to any mental health service in the past one year?
6. Have you obtained any help from psychiatrist, social worker or psychologist in the
past one year?
7. Is it easy for you to seek mental health services?
8. Are the healthcare professionals helpful?
9. Do you face any discrimination?
10. What kind of barriers do you encounter?

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Informed consent form for participants aged more than 18
I have read the foregoing information, or it has been read to me. I have had the opportunity to
ask questions about it and any questions I have been asked have been answered to my
satisfaction. I consent voluntarily to be a participant in this study
Print Name of Participant__________________
Signature of Participant ___________________
Date ___________________________
Day/month/year
Statement by the researcher/person taking consent
I have accurately read out the information sheet to the potential participant, and to the best of
my ability made sure that the participant understands that the following will be done:
1.
2.
3.
I confirm that the participant was given an opportunity to ask questions about the study, and
all the questions asked by the participant have been answered correctly and to the best of my

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ability. I confirm that the individual has not been coerced into giving consent, and the consent
has been given freely and voluntarily.
A copy of this ICF has been provided to the participant.
Print Name of Researcher/person taking the consent________________________
Signature of Researcher /person taking the consent__________________________
Date ___________________________
Day/month/year

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Informed consent form for parents of participants aged less than 18
I have read the foregoing information, or it has been read to me. I have had the opportunity to
ask questions about it and any questions that I have asked have been answered to my
satisfaction. I consent voluntarily for my child to participate as a participant in this study.
Print Name of Parent or Guardian __________________
Signature of Parent of Guardian___________________
Date ___________________________
Day/month/year
Statement by the researcher/person taking consent
I have accurately read out the information sheet to the parent of the potential participant, and
to the best of my ability made sure that the person understands that the following will be
done:
1.
2.
3.
I confirm that the parent was given an opportunity to ask questions about the study, and all
the questions asked by him/her have been answered correctly and to the best of my ability. I
confirm that the individual has not been coerced into giving consent, and the consent has
been given freely and voluntarily.

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A copy of this Informed Consent Form has been provided to the parent or guardian of the
participant __________
Print Name of Researcher/person taking the consent________________________
An Informed Assent Form will ____ OR will not ____ be completed.