Mental Health of Iraqi Refugees in Australia

This assignment analyzes the mental health needs of Iraqi refugees resettled in Australia. It delves into common mental health issues like PTSD and anxiety, drawing upon a Delphi study that highlights important considerations for providing mental health first aid to this population. The assignment also incorporates findings from clinical research on post-traumatic stress disorder (PTSD) symptoms, assessment tools, therapeutic interventions, and the role of self-help in managing mild anxiety disorders.

Running head: MENTAL HEALTH: RAZZAQ’S CASE STUDY 1
Mental health: Razzaq’s case study
Student’s Name
University Affiliation

MENTAL HEALTH: RAZZAQ’S CASE STUDY 2
Contents
Introduction......................................................................................................................................3
The presenting symptoms of Razzaq...............................................................................................3
Assitance from an RN and other healthcare providers for Razzaq and his family........................4
Three mental health assessments required to assess Razzaq...........................................................5
PTSD Symptoms...................................................................................................................................5
Severity of depression symptoms........................................................................................................5
The rate of exposure to war.................................................................................................................6
The interventions to safely manage Razzaq’s PTSD.......................................................................6
Psychosocial..........................................................................................................................................6
Cognitive behavioural therapy (CBT)......................................................................................6
Cognitive restructuring.............................................................................................................7
Exposure therapy......................................................................................................................7
Medication.............................................................................................................................................7
Nursing care interventions to improve Razzaq's well-being............................................................8
Ethical and legal principles in providing patient-centred care........................................................8
Consent..................................................................................................................................................8
Human rights.........................................................................................................................................8
Do no harm............................................................................................................................................9

MENTAL HEALTH: RAZZAQ’S CASE STUDY 3
Respect others.......................................................................................................................................9
Cultural needs and culturally based care for Razzaq.......................................................................9
Cultural needs........................................................................................................................................9
Culturally based care for Razzaq......................................................................................................10
Conclusion.....................................................................................................................................10
References......................................................................................................................................11

MENTAL HEALTH: RAZZAQ’S CASE STUDY 4
Mental health: Razzaq’s case study
Introduction
Post-traumatic stress disorder (PTSD) is a disorder that develops in some individual after
exposure to a threatening, dangerous, scary or shocking event. For instance, victims of war are
likely to develop PSTD. This assignment is based on the case of Razzaq, a refugee from Iraq
who lives in Australia and has been experiencing symptoms of PTSD. Firstly, it will discuss the
symptoms of Razzaq and available help from an RN and other care providers. Secondly, the
assignment will explore the mental health assessments required to examine Razzaq. Thirdly, it
will discuss the interventions to manage Razzaq. Fourthly, it will examine the ethical and legal
principles to required in patient-centred care. Finally, the paper will determine the cultural needs
of the Razzaq and discuss culturally based care for the patient.
The presenting symptoms of Razzaq
Razzaq presented with several symptoms, which are intrusion, avoidance, and
hyperarousal symptoms. Intrusion symptoms are symptoms that cause a victim to re-experience
traumatic events and might be uncontrollable and unintentional. Razzaq presented with intrusion
symptoms including awful nightmares and flashbacks. According to the case study, the washing
machine reminds him of the noises from war, which is a disturbing flashback. Flashbacks are
disturbing because the event starts from what the victim regards to be the gravest point of their
past trauma (Hirsch & Holmes, 2007). Avoidance symptoms cause a victim to avoid places or
items that remind of their past trauma. Razzaq tends to hide away for days to avoid his family.
Avoidance behaviour symptoms make it challenging for victims to engage in social functions
and live a normal social life (Levin, Kleinman, & Adler, 2014). Hyperarousal symptoms include

MENTAL HEALTH: RAZZAQ’S CASE STUDY 5
irresponsible behaviour, anger as well as angry outbursts. Razzaq presented with hyperarousal
symptoms since he gets angry and yells at his wife and children. Also, he has hit his wife on
various occasions due to anger.
Assitance from an RN and other healthcare providers for Razzaq and his family
An RN is in a better position to provide support for Razzaq because he has discussed his
symptoms. The primary goal of the provider is to enable the victim and family to develop a sense
of empowerment and attain control over their symptoms. The RN and other healthcare
professionals should first understand how the symptoms make Razzaq feel for them to achieve
this objective. They should then strive to develop a communicative and trust-based relationship
with Razzaq to open up a pathway for recovery. The techniques that the nurse can use are
listening, normalising responses and reframing. The RN and other healthcare professionals
should be amenable and listen to Razzaq’s expressions of his feelings. As revealed through the
case study, the Razzaq’s feelings are negative and include the expression of anger, shock and
depression (Benson & Thistlethwaite, 2009). The nurse should allow Razzaq to express these
feelings because the primary role is to listen without judging the victim. To normalise Razzaq’s
responses towards the traumatic event, the RN and other healthcare professionals should
endeavour to support the victim’s strengths in the face of the trauma. Razzaq should then be
trained on coping techniques based on his strengths. The family should also be advised to accept
Razzaq as a member of the family and help him fit in the social life. Family therapy that involves
Razzaq’s wife and children might be helpful in this case. Approaching a victim based on their
strengths and capabilities is more therapeutic than emphasising on their problems and
shortcomings (Rumpler, 2008). Most importantly, the care provider should inform Razzaq that
the traumatic event did not occur because he is a horrible person or deserved it.

MENTAL HEALTH: RAZZAQ’S CASE STUDY 6
Three mental health assessments required to assess Razzaq
The mental health assessments that are needed for Razzaq are PTSD symptoms, the
severity of depression and the exposure to war. Cross-cultural sensitive and refugee adapted
assessments that can be used for Razzaq are IES-R, Hopkins Symptom Checklist and Afghan
War Experience Scale.
PTSD Symptoms
For Razzaq, the symptoms of PTSD can be assessed using the impact of events scale-
revised (IES-R). The IES-R is a self-report scale that is widely used to assess PTSD symptoms.
In the past, this tool has been used to measure the symptoms of PTSD in Afghan and Iraq
refugees in Australia. This assessment tool has solid psychometric properties and a good internal
consistence. One study was designed to test the diagnostic utility of the IES-R as an assessment
tool for PTSD in individuals exposed to war. Two independent samples, n=854 and n=3313 were
used for this study for this study (Morina, Ehring, & Priebe, 2013). Based on this analysis, the
IES-R will be an appropriate tool for assessing the mental health status Razzaq.
Severity of depression symptoms
The severity of depression symptoms will be a fundamental mental health assessment for
Razzaq. The mental health assessment can be performed using the Hopkins Symptoms
Checklist-25 (HSCL-25). This diagnostic tool is a 25-item questionnaire consisting of two scales
for anxiety and depression symptoms (Rickels, Khalid-Khan, Gallop, & Rickels, 2009). The
depression symptoms scale contains 15 items while the anxiety symptoms consist of 10 items. In
the diagnosis of depression, the HSCL-25 portrays high internal consistency, test-retest
reliability and good validity. Thus, the HSCL-25 is an appropriate assessment tool for Razzaq.

MENTAL HEALTH: RAZZAQ’S CASE STUDY 7
The rate of exposure to war
Razzaq should be assessed mentally to determine the level of exposure to war and
violence. The Afghan War Experience Scale (AWES) can be applied to assess the level of
exposure to war. This assessment tool is a scale that asks candidates or victim whether they have
been exposed to the indicated 17 war-linked experiences or loss or violence (Slewa-Younan,
Yaser, Guajardo, Mannan, Smith, & Mond, 2017). There are three possible choices for
participants including once (1), more than once (2), or never (0). The possible scores for a
participant range from 0-34 (Yaser, Slewa-Younan, Smith, Olson, Guajardo, & Mond, 2016). A
candidate who has a high score indicates that they have been exposed to war-related experiences.
The interventions to safely manage Razzaq’s PTSD
Psychosocial
Cognitive behavioural therapy (CBT)
CBT is a kind of psychotherapy that intends to help victims realise negative thoughts,
perceptions, feelings or behavioural pattern and consequently trains the victim how to replace the
negatives with positives. This therapy identifies and modifies misinterpretations that cause
patients to overestimate their current threat as well as interpreting their behaviours during the
trauma (Bisson, Cosgrove, Lewis, & Roberts, 2015). Also, this psychotherapy teaches the
victims on how to embrace healthy patterns. CBT will be useful and safe for Razzaq because it
focuses on the symptoms of PTSD, depression and phobias. One study by Rhoads and colleagues
found that CBT was helpful for patients and delivered good outcomes (Rhoads, Pearman, &
Rick, 2007). This study revealed that even if a nurse has minimal training on CBT, she can be
helpful to the patients.

MENTAL HEALTH: RAZZAQ’S CASE STUDY 8
Cognitive restructuring
Cognitive restructuring teaches the victims that negative thoughts occur due to unhealthy
thinking. In turn, the patient experiences behavioural problems like poor social relationships and
substance abuse. When the victim acknowledges the link between negative feelings and
unhealthy thinking, they are in a position to identify and avoid the deleterious behaviours and
symptoms (Rickwood & Bradford, 2012). This therapy is appropriate for Razzaq because he has
harmful thoughts that need to be replaced with positive thinking.
Exposure therapy
In exposure therapy, a victim is exposed to a situation that is similar to their past trauma
with the aim of teaching that negative symptoms happen due to their past trauma. Additionally, it
aims to teach the patient that a potential trigger is controllable. A patient can be helped to
confront their past trauma through verbal or written narrative, delineating the course of the
traumatic experience (Bisson, Cosgrove, Lewis, & Roberts, 2015). Patients are trained through
continuous exposure although some experiences might be unpleasant. Razzaq requires exposure
therapy because of his past traumatic events. For instance, when the washing machine is turned
on, he hears a car backfire.
Medication
The medication option for treating Razzaq is SSRIs. This class of medicines has been
found to be effective in managing the symptoms of PTSD. Besides, the SSRIs have been
assessed for a wide range of trauma types such as witnessing injury, physical abuse and compact
(Sullivan & Neria, 2009). Sertraline and paroxetine are the two main drugs under this class of
medicine (Rhoads, Pearman, & Rick, 2007). Sertraline will be the most effective medicine for
Razzaq due to its effectiveness in improving hyperarousal and avoidance symptoms.

MENTAL HEALTH: RAZZAQ’S CASE STUDY 9
Nursing care interventions to improve Razzaq's well-being
The nurse can train Razzaq on how to reduce anxiety and depression. Razzaq can be
trained on relaxation techniques, breathing techniques as well as exercises that enhance social
skills. Teaching the victim on the symptoms of PTSD can also be helpful because it will help
him to identify detrimental symptoms. The nurse can also ensure that the victim takes prescribed
medications correctly and assess the response to medication. The nurse can also refer Razzaq to
other places for social support like community organisations. In this case, the patient will learn
coping skills by participating in social activities.
Ethical and legal principles in providing patient-centred care
Consent
When offering patient-centred care, the patient should be involved in decision-making
towards their treatment plan (Thomas & Chaperon, 2010). The involvement of the patient is a
fundamental aspect towards designing the treatment plan. The patient should then offer consent
for the kind of treatment that will be administered. Thus, informed consent is important in
patient-centred care.
Human rights
The healthcare provider should observe and promote human rights when offering patient-
centred care. They should know that embracing the principles of human rights in health care,
entails identifying, respecting, constantly enhancing and safeguarding the rights of the patient.
Violation of these rights might result in severe health implications (Thomas & Chaperon, 2010).

MENTAL HEALTH: RAZZAQ’S CASE STUDY 10
Do no harm
The healthcare professionals should deliver holistic, safe as well as evidence-based care
to realise the patient’s outcome. Any treatment, intervention or action that might harm the patient
should be avoided (Brophy, Roper, Hamilton, Tellez, & McSherry, 2016). The patient should be
monitored progressively to determine their outcomes.
Respect others
Every patient should be respected regardless of their ethnic background. RNs should
observe the ACSQHC recommendations. These recommendations support the need to practice
cultural respect and diversity (Thomas & Chaperon, 2010). The patient should then be supported
to realise better outcomes.
Cultural needs and culturally based care for Razzaq
Cultural needs
Razzaq and the family require a comprehensive understanding of PTSD. Within the Iraqi
community, a person who has a mental illness is viewed as “crazy” and might be stigmatised.
Hence, knowledge of PSTD will be fundamental in addressing the issue of stigmatisation.
Another cultural requirement is the assistance for cross-cultural communication. Razzaq is a
refugee from Iraq and might have limited English skills (Guajardo, Slewa-Younan, Santalucia, &
Jorm, 2016). He needs help to communicate to the registered nurse and other healthcare
providers. Besides, the victim requires help to overcome the barriers to seeking professional care.
Based on their Muslim belief, Iraqi refuges might prefer to read the Koran rather than seek
professional assistance for mental health.

MENTAL HEALTH: RAZZAQ’S CASE STUDY 11
Culturally based care for Razzaq
The culturally based care for Razzaq should include various pertinent principles which
result in improved mental health. The care should be offered by a multidisciplinary team
comprising of a psychiatrist, psychologist, registered nurse and culture-specific healthcare
provider (mostly from Iraq). Due to language differences, the care should include an interpreter
(Kirmayer, et al., 2011). Health care information on the symptoms of PTSD and importance of
treatment should be included in Razzaq’s therapy. The victim’s beliefs especially the Muslim
religion should be respected throughout the therapy. Razzaq’s family should also play a central
role in advancing his treatment and offering social support. Finally, the provider should observe
the legal and ethical principles when offering care.
Conclusion
Appropriate diagnosis and management of PTSD are important in helping the patient to
lead a normal life. Registered nurses and other healthcare professionals play a fundamental role
in diagnosing, treating and training the patients with PSTD how to manage their symptoms. As
discussed in this paper, Razzaq requires support and empowerment to overcome the intrusion,
avoidance, and hyperarousal symptoms. Due to his background, Razzaq requires culturally
suitable treatment. This paper has proposed culturally suitable mental health assessments and
treatments that can be used for Razzaq since he is a refugee from Iraq. Conclusively, culturally
appropriate treatment should focus on meeting the cultural needs of the patient and their family.

MENTAL HEALTH: RAZZAQ’S CASE STUDY 12
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