The Need for Gentle Words: Bosnian Survivors

The Need for Gentle Words

A Community Needs Assessment of Survivors of Torture and Trauma from Bosnia Living at the Gold Coast

Published by
Ethnic Communities Council Gold Coast Inc.
PO Box 1701
Southport Qld 4215
ph: (07) 55324300
© Ethnic Communities Council Gold Coast Inc., 1997

Disclaimer:
The details of this report have been prepared in good faith, but are published on the basis that the author shall not be responsible for any errors herein or for any acts or omissions that may occur due to its use.

"We have a saying that doctors help with gentle words, not with medication only. Our people need a nice word."

48 year old Bosnian woman

Foreword

I am pleased to present this research report which is a community needs assessment of Bosnian survivors of torture and trauma living at the Gold Coast.

This report is the result of close collaboration between the Ethnic Communities Council Gold Coast Inc and a national mental health research project.

Recently arrived Bosnian people were the focus of this needs assessment as they represent a large and ever growing group at the Gold Coast. However, it should be pointed out that there are other survivors of torture and trauma living at the Gold Coast who have come to the region from many other countries over the years.

This report, I believe, will assist community organisations and Government Departments represented on the Gold Coast in a very constructive way in their efforts to jointly cater for the different settlement needs of refugee families, especially those who are survivors of torture and trauma.

I personally would like to express my appreciation to all involved in this needs assessment.

Eddy Sarroff
President
Ethnic Communities Council Gold Coast Inc.

Acknowledgments
Executive Summary
1.0 Introduction
2.0 A description of the problem
3.0 What we did
4.0 What we found
5.0 Discussion of findings
6.0 Recommendations
7.0 Conclusion
References
Appendices

Acknowledgments

A special thank you to the survivors of torture and trauma, without whose courage this project would not have been completed. We hope that this report will succeed in its efforts to provide services on the Gold Coast for them and other survivors of torture and trauma.

Thank you to Mr Nikola Gurovic, the bilingual interviewer who conducted personal interviews with survivors of torture and trauma. He conducted the interviews with care, sensitivity and integrity and was an integral link in the project with the Bosnian community.

Many thanks must go to a number of services that participated in the interviews and gave their time willingly and provided assistance and support to the project.

In particular, thanks should go to Ms Janine Worley and Mr Ivan Frkovic for their management of the project.

Thanks also to members of the research group - Ms Marina van Kooten-Prasad, Dr Ann Larson, Professor Lenore Manderson and Dr Ilse Blignault.

Thank you to Karen Barton, a social work student on placement with the Ethnic Communities Council Gold Coast.

Finally, thank you to the Australian Transcultural Mental Health Network for funding the project.

Executive Summary

A study into the needs of Bosnian survivors of torture and trauma living at the Gold Coast took place from June to September 1997. The needs assessment was a collaborative effort between the Ethnic Communities Council Gold Coast Inc. (ECCGC) and a national mental health research project.

Over the past few years people from the Former Yugoslavia represented the largest Special Humanitarian entry population living at the Gold Coast. The newly arrived Bosnian community living at the Gold Coast is predominantly comprised of Muslim people. As such, the needs assessment focussed on Muslim Bosnians, even though a small number of people of Croatian and Serbian background were also involved.

The focus of the needs assessment was personal experience interviews with three groups of need definers: survivors themselves, their carers and service providers. A bilingual interviewer conducted in-depth interviews with twelve survivors of torture and trauma. It was difficult to locate people in a caring role in this project, as refugee family members themselves had experienced torture or trauma. As such, two carers interviews were analysed with the survivors interviews. Ten service providers were also interviewed about their experiences with survivors of torture and trauma living at the Gold Coast.

Overall, the needs defined by survivors and service providers were quite similar in that both groups principally nominated psychosocial needs. Both groups saw that social contact and practical assistance in achieving an independent life in Australia were high priorities.

The area of negotiated need was as follows:-

The following recommendations came out of the needs assessment:-

Social contact

That the Gold Coast City Council Community Relations Committee advocate the need to undertake community development activities with Bosnians to increase their opportunities for social contact, to the Gold Coast City Council.

That the Ethnic Communities Council Gold Coast (ECCGC) or the Multicultural Women's Organisation (MWO) explore ways to undertake community development activities to assist Bosnians to increase their opportunities for social contact.

That the Gold Coast Mental Health Community Development Officer assist Bosnians in establishing structures and processes for greater social contact with others.

Counselling

That Queensland Program of Assistance to Survivors of Torture and Trauma (QPASTT) through its Early Intervention Program, allocate resources to service refugees at the Gold Coast.

That the Gold Coast Network for Survivors of Torture & Trauma advocate for culturally appropriate services to be offered through mainstream counselling services at the Gold Coast.

That the Ethnic Communities Council Gold Coast continue to explore funding possibilities for culturally appropriate counselling and support services to be provided at the Gold Coast to refugees.

Employment

That the Gold Coast Torture & Trauma Working Party target case managers in public and private employment agencies to undertake training to increase their understanding of the psychological issues related to torture and trauma survivors.

That the ECCGC and MWO provide a referral service for employment programs, training and employment placement options.

That the Migrant Liaison Officer at Centrelink organise training for agency staff with regard to service provision to refugees.

That the Migrant Liaison Officer be the link and broker within Centrelink for Bosnian refugees needing assistance to negotiate employment, training or income maintenance procedures.

That the Gold Coast Network for Survivors of Torture & Trauma advocate the need for more assistance to Bosnian refugees to employment organisations such as Job Club and Skillshare.

Interpreting

That the ECCGC and MWO identify and recruit Bosnian speakers who have adequate Bosnian and English language skills to obtain National Accreditation Authority for Translators and Interpreters (NAATI) accreditation.

That ECCGC and MWO organise pre-testing for those recruited to ensure that they have the required skills to successfully pass the NAATI testing.

That ECCGC and MWO negotiate with Centrelink for the testing to be funded.

Language programs

That TAFE increase the opportunity for Bosnian refugees to gain home tutoring where requested, to further assist them with their English language skills and to provide another avenue for social contact.

Information and settlement

That the ECCCG and MWO target Bosnians as a priority group through their settlement support programs and that at least one Bosnian Bicultural Community Advocate be employed through ECCGC.

That Centrelink staff undertake more targeted outreach work and be more visible in the Bosnian community.

Mental health

That the Gold Coast mental health service develop promotional and preventative programs targeted at Bosnian refugees.

That the Gold Coast Division of General Practice provide training to its members on service delivery to survivors of torture and trauma. This training could be adapted from a training program recently provided by the Brisbane Inner South Division of General Practice as part of its Continuing Medical Education Program.

Dental health

That QPASTT negotiate with the Dental Clinic through its Early Intervention Program for priority access for Bosnian refugees.

The needs assessment was successful in identifying and documenting the diverse needs of Bosnian survivors of torture and trauma living at the Gold Coast. As this community is a rapidly growing one at the Gold Coast, it is hoped that their needs will be better understood and appreciated by health and other service providers working with them.

1.0 Introduction

1.1 Background to the project

This study of the needs of survivors of torture and trauma from Bosnia who are currently living at the Gold Coast is the result of a partnership between the Ethnic Communities Council Gold Coast (ECCGC) and a national mental health research project.

In 1996-7 the Queensland Transcultural Mental Health Centre (QTMHC) led a national project to develop methods for assessing community mental health needs in immigrant communities. The Australian Centre for International and Tropical Health and Nutrition (ACITHN) based at the University of Queensland provided the research expertise for the project. The goal was to produce a user-friendly needs assessment manual for use by government and non-government services and community organisations.

This methodology was based on an extensive literature review. It was trialed with six separate communities - each with their unique cultural, social and mental health issues - in Queensland and Western Australia. QTMHC worked closely with several community organisations that had already identified a mental health related need within their local community. These organisations were in need of further research so that the "need" could be explored and documented appropriately. The ECCGC had previously identified a number of problems with regard to survivors of torture and trauma living on the Gold Coast. Through the resources provided for the national project, QTMHC was able to provide technical assistance to ECCGC to conduct this needs assessment.

1.2 Rationale

In early 1995 the ECCGC identified the need to develop a Community Refugee Settlement Scheme (CRSS) group for the Gold Coast Region. A public meeting was held on 12th July 1995 and the ECCGC CRSS group commenced as a new service soon after. One of the issues raised by the then, Department of Immigration and Ethnic Affairs was the access by refugee families settling into the region to torture and trauma services. This need was also identified in the following year by the Migrant Services Network of the Gold Coast. As a direct response to this, a seminar was held by ECCGC with assistance from QPASTT and the Queensland Transcultural Mental Health Centre on the 16th May 1996. As an outcome of the seminar, ECCGC convened the Gold Coast Network for Survivors of Torture and Trauma, which held its inaugural meeting on the 13th September 1996, this group has continued to explore service options for survivors living on the Gold Coast. Members of the network comprise a wide range of health and other professionals working in the Gold Coast region. Many members of the network were becoming increasingly concerned about the situation for survivors of torture and trauma, given the lack of suitable support services available at the Gold Coast.

In June 1997 the network became active to explore the possibility of establishing a referral network of health and other professionals to commence servicing this client group whilst no other service possibilities were in existence. This needs assessment was conducted over four months, to document the needs of the Bosnian community, which represents the major ethnic group of survivors of torture and trauma living on the Gold Coast. The network will use the information gathered by the needs assessment to explore service options for this client group.

1.3 Project staff and management

The needs assessment was under the management of Janine Worley, of ECCGC and Ivan Frkovic, one of the principal investigators of the national mental health project. The other principal investigators of the national project, Dr Ann Larson, Professor Lenore Manderson and Dr Ilse Blignault also assisted with the needs assessment by offering guidance and assisting with the data analysis.

The needs assessment was coordinated by Marina van Kooten-Prasad, research assistant for the national project. Karen Barton, a student on placement at ECCGC conducted a literature review and interviewed some of the service providers. Nikola Gurovic conducted all the interviews with Bosnian respondents and also conducted a number of service provider interviews.

1.4 About this report

This report is divided into seven sections. A description of the situation of the Bosnian community is presented in Section 2 and an outline of the methodology used is provided in Section 3. Section 4 presents the findings of the needs assessment and uses quotes wherever possible so that the reader will get a sense of what interviewees said during the personal experiences interviews. Section 5 discusses the meaning of the findings and Section 6 makes a number of recommendations. Section 7 offers some conclusions to the information gathered in the needs assessment.

2.0 A Description of the Problem

This section provides a basic overview of the meaning of torture and trauma and its consequences for survivors. It also describes the differences between refugees and migrants in Australia. This section also introduces the Bosnian community on the Gold Coast, their experiences in settling in that area and the mental health services which are available to them.

2.1 What is torture and trauma?

2.1.1 Torture

There are many definitions of torture. The ones which are most widely used come from the World Health Organisation, and the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment:-

The inhuman infliction of significant, avoidable pain and suffering by an organised group according to a declared or implied strategy and/or system of ideas and attitudes. (WHO)

...any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him (sic) or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. (UN)

The common element in these and other definitions is the deliberate infliction of pain on other human beings in a repressive environment that is designed to disempower individuals as well as whole communities.

Torture methods can be physical and/or psychological. Whatever the method, torture is designed to break down a person's spirit and disempower him or her in every possible way. The following list of torture methods is by no means exhaustive, but represents the most common methods of torture used throughout the world (Freer, 1993):-

Physical torture - sexual assault; physical beatings; electrical shocks; water torture (the victim's head is forced under water); burning; mutilation; deprivation of food or water.
Psychological torture - deprivation of light, sound, sleep; threats of torture or death; witnessing of deaths or torture; mock executions; humiliation; prevention of personal hygiene.

The effects of torture vary from one person to the next, however a number of commonly encountered sequela have been found (Freer, 1993):-

Psychosomatic - pains, headaches, insomnia, nightmares, panic, tremors, weakness, sweating, diarrhoea etc.
Behavioural changes - withdrawal, irritability, aggressiveness, impulsiveness, self-harming behaviours, sexual dysfunction.
Affective - anxiety, fear, depression.
Mental function - confusion, disorientation, memory disturbances, loss of concentration, attention, blocking.
Physical damage - scars, burns, fractures, weight loss, torn tendons, skin rashes.

Other effects may include guilt, phobias, recurrent intrusive recollections, relationship problems, loss of self esteem, increased use of cigarettes, alcohol or other drugs. Survivors may also become mistrustful of other people (Arnold cited in Macdonald, 1994).

2.1.2 Trauma

Trauma can result from any distressful situation. It tends to be associated with a severe shock or stress that has an ongoing effect in a person's life. Macdonald (1994) gives specific examples of the many forms of trauma refugees may have experienced. These include state-sanctioned violence, death squads, random kidnapping, "disappearances", traumatic flights from countries of residence and long waits in refugee camps. The experience of forced detention in concentration camps would also constitute trauma.

2.2 Refugees and migrants - the difference

Refugees are characterised by their lack of choice in leaving their country of origin. They have often experienced distressful situations such as civil unrest, war, flight from their country of residence and refugee camps. The official definition of a refugee is:-

Any person, who owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion is outside the country of his nationality and is unable to or, owing to such fear, unwilling to avail himself (sic)of the protection of that country. (UN, 1951)

Lefley (1989, p.243) adds that refugees are characterised as a "subset of immigrants who have come under duress, to escape situations perceived as politically, economically, psychologically, and physically threatening to survival".

Some migrants may in fact fit the description of a refugee, but for whatever reason, entered Australia under a migration category other than the Refugee or Special Humanitarian Program categories. However, most migrants are quite different from refugees because they:

Choose their destination country and find out all they can before they leave
Plan their move
Pack their belongings and choose what to take and what to leave behind
Say good-bye to family and friends
Leave a forwarding address
May be able to go home if things do not work out in the destination country

In contrast, refugees:

Take the quickest way out, often without knowing their destination
Leave hastily, often to escape from harm
Leave secretly, unable to let loved ones know where they are going
Afraid to keep in touch with family or friends in their home country
May not be able to go home if things do not work out in the resettlement country

2.3 Service delivery

Recognition of torture and trauma issues in Australia dates the mid 1980s (Reid and Strong 1987). Since the early 1990s, Australia has seen a growth in the development and establishment of torture and trauma rehabilitation services for survivors of torture and trauma. Each capital city in Australia now has such a service. The philosophy that most of these services operate from is one that recognises survivors' health problems in the context of their socio-economic situation and need for resettlement in Australia. Furthermore, there is recognition that survivors are extremely resilient and strong people, who have endured great hardship. This is supported by such writers as Lefley (1989) who consider refugees to resemble disaster victims, rather than persons embodying personality or systemic deficit.

In Queensland, TRUSTT operated as the sole torture and trauma rehabilitation service from the late 1980s from the Mater Hospital in Brisbane. In 1993, the Brisbane Refugee Torture and Trauma Research and Support Project documented the needs of survivors living in Brisbane and recommended that a community-based service be established in Brisbane.

The Queensland Program of Assistance to Survivors of Torture and Trauma (QPASTT) was established in 1995. QPASTT operates mainly in the Brisbane area and is funded by the Commonwealth Departments of Health and Family Services and Immigration and Multicultural Affairs, and Queensland Health.

The aim of QPASTT is to provide a range of flexible and culturally sensitive services to people who have been tortured or who have suffered refugee related trauma prior to migrating to Australia. Services address the range of physical, psychological, spiritual and social needs of survivors of torture and trauma. The model of service includes;

client centred approaches to healing which incorporate access to family members who are also torture survivors or have experienced refugee related trauma,
community development approaches which facilitates response from mainstream and ethnic specific service providers,
training functions to increase the skills and resource base of service providers who work with the refugee survivors of torture and trauma, and
research which assists in the development of effective and efficient practise models.

At the Gold Coast, the ECCGC Community Refugee Settlement Scheme (CRSS) group has settled into the region, five Bosnian Muslim families of all ages, since late 1995. The CRSS group is comprised of trained volunteers who accept families allocated to them by the Department of Immigration and Multicultural Affairs, before their arrival into the country. These families generally do not have any other family or friends who can support them in settling into Australia. The volunteers provide such services as, picking the family up from the airport, providing housing, assisting the family thorough the maze of Government Departments, and immediate general settlement needs. The CRSS Group continues to assist the family for approximately six months or until the family feels that they no longer need help. Assistance is generally intense for the first month and then gradually tapers off.

2.4 Refugee populations at the Gold Coast

In 1997, people from the Former Yugoslavia represented the largest Special Humanitarian entry population living at the Gold Coast. According to Department of Immigration and Multicultural Affairs (DIMA) statistics, people from the Former Yugoslavia were the fourth largest group to settle in the Gold Coast Region in 1991, and a further 208 new arrivals came during the 1991-1996 period. According to 1994-95 statistics, 583 people from the Former Yugoslavia entered Queensland. This is the largest migrant group to enter Australia and settle at the Gold Coast on Humanitarian and Special Assistance classification.

The DIMA statistics do not reflect immigrants' subsequent moves. It is probable that many immigrants have moved to the Gold Coast and that some who first settled in the Gold Coast subsequently moved. Figures on refugee populations living in the Gold Coast Region at any one time are difficult to obtain. The census taken every five years is a useful data source, but it also has shortcomings. It is known that there were 1,437 Former Yugoslavia migrants residing in the Gold Coast region at the time of the 1991 census with the majority of these being older and established migrants. Also from the 1991 Census, is the fact that there were approximately 400 Arabic, 1,700 Chinese, 50 Khmer, 550 Spanish, 80 Turkish, and 100 Vietnamese speakers at the Gold Coast (Gold Coast City Council, 1996). However, although these language groups represent the largest refugee communities in Australia not all of them can be assumed to be refugees. Nor do these figures reveal length of residency in Australia.

2.5 Target group

The project focused on survivors of torture or trauma living in the Gold Coast region who were of Bosnian background.

Although the needs assessment team acknowledged the needs of survivors from other ethnic communities, at the time of the project, people from Bosnia represented the largest newly arrived refugee group living in the Gold Coast region. Due to the complexity of conducting research on such a sensitive topic, and the essential need for using bilingual researchers, it was decided to limit the scope of this needs assessment to one community. For these reasons, the Bosnian community was chosen as the study group.

The newly arrived Bosnian community living at the Gold Coast is predominantly comprised of Muslim people. As such, the needs assessment also focussed on Muslim Bosnians, even though a small number of people of Croatian and Serbian background were also interviewed.

2.6 Policy environment

National and state governments are committed to the successful resettlement of refugees and to addressing needs arising from experiences of torture and trauma. DIMA allocated $6.1 million for refugee settlement programs, such as the Community Refugee Settlement Scheme. In Queensland the NESB Mental Health Policy acknowledges the need for the development of a community based service that meets the needs of survivors of torture and trauma. It also contains the pledge that "Mental Health Services will increase their responsiveness and sensitivity to the specific needs of survivors of torture and trauma."

While government support is clearly articulated, this has not translated into services accessible to Bosnian survivors of torture and trauma living in the Gold Coast area. Several shortcomings related to the delivery and style of services that are available, further limit the options of people who need care and support.

Survivors of torture and trauma are not eligible to use the community mental health service at the Gold Coast unless they have a severe mental illness. This is in line with eligibility requirements of other Queensland government mental health services.
QPASTT, the primary refugee torture & trauma rehabilitation service in Brisbane, is unable to provide ongoing services at the Gold Coast due to inadequate funds. This service is funded under a national funding program for torture/trauma services which makes funding allocations to services based in each capital city.
Free counselling through the CES is available to some people, but only for up to six hours.

2.7 Community/Cultural factors

Immigrants' reasons for migrating, experiences of resettlement and concerns about the future are all relevant to their current and future mental health. This section will outline the background information pertinent to understanding the Bosnian community living in the Gold Coast region. Like the rest of the report, this section will rely extensively on the voice of immigrants themselves to explain the social and cultural context of their lives in the Gold Coast. The following section will describe how we gathered this and other information.

In 1994-95 migrants from the Former Yugoslavia were the third largest source of new arrivals. A total of 208 new arrivals settled at the Gold Coast in the 1991-96 period. Reflecting the large influx of migrants from the Former Yugoslavia in the mid 1990s, all of the Bosnians interviewed for this study arrived in Australia in the past three years; most came under the Humanitarian Program. Typical responses about their migration circumstances were:-

"The decision to come to Australia was made because of the war."

"We were expelled from **** in Bosnia. Then we were imprisoned in the camp and after the exchange of prisoners we arrived in ****. It took almost 2 years to get here. I have a son in Australia, but for a long time we couldn't contact him".

"My brother sent me the papers from Australia. It was very hard. We lived in **** as refugees, there was no other choice but to come here."

Almost all interviewees expressed difficulties in their adjustment to Australia. Many spoke about the loss of social contacts as having a big impact on their current lives in Australia. Others found it difficult to relate to Australians:-

"I miss my friends, the country I was born, all the values were lost... I am still learning about this country, I am still adapting to it. The people in Europe were more open, more friendly. I like the democracy in this country".

"...we miss a lot of things we used to have in Bosnia. We have a new life here. I cannot say I am happy, the language is still not satisfactory".

"This is a completely different life. We had a different way of life. The people here are more preoccupied with material values ... Here people have more opportunities but some kind of emptiness exists."

Almost all interviewees expressed great frustration about their employment prospects in Australia. Some also discussed the difficulties of having been a professional in Bosnia and not being able to work in this area in Australia:-

"I also don't like the job prospects, they are poor although I am looking for anything I can get. I used to be a secretary in Bosnia, but here I would accept any job."

"We have a high work ethic and we like to live off our work, not on social security. The only obstacle is the language."

According to DSS statistics, people from the Former Yugoslavia are the largest migrant group in receipt of DSS benefits at the Gold Coast in 1997, with 690 in this category, followed by Philippines with 90 people in receipt of DSS benefits.

The interviewees expressed frustration at the difficulty of learning a new language. Older interviewees in particular, found that learning a new language was very difficult for them:-

"...the only obstacle is the language. That is the most difficult, the rest is more or less the same"

"...I was insisting to get back to school in order to feel better. For the youngsters it is easier."

"I feel lonely, especially because my English is still not sufficient to read as much as I would like to, to follow up the newspapers, the events in Australian society..."

Many respondents spoke about the importance of having their family members nearby. Some interviewees were separated from loved ones.

"Our children are keeping us alive here, we came here for their future."

"My aunt was the most helpful ... she took me to the doctors or any other place I needed to go".

3.0 What we did

3.1 Project objectives

The Ethnic Communities Council Gold Coast is committed to meeting the needs of survivors of torture and trauma. In order to accomplish this, a partnership was formed with a national mental health project with the goal of devising a method for identifying those needs. Based on work done in the national project, it was recognised that there were at least three groups of people who could legitimately claim to be able to define the 'needs' of Bosnians at the Gold Coast for torture and trauma related services. These were survivors of torture and trauma, family members providing care to survivors, and service providers. It was not expected that all three groups would perceive the same needs. Furthermore, the national project had found that needs are strongly influenced by government policies, the availability of services, premigration and settlement experiences, cultural and social factors affecting the ethnic community and the mental health issue. All of these dimensions were explored in the needs assessment to be able to better understand the needs.

The specific objectives were:-

To document the needs of survivors of torture and trauma living in the Gold Coast region for recovery from the perspectives of survivors, carers and service providers
To produce a report outlining these needs.

3.2 Use of bilingual interviewer

The success of the needs assessment was mainly attributed to the use of a skilled bilingual interviewer. The interviewer was selected because of his skill in conducting interviews, personal philosophy and ethics, and ability to gain the trust of interviewees. Although the interviewer was not of a Muslim background, his high profile occupation (TV current affairs host) in Bosnia meant that many people recognised him and felt familiar with him. There was some concern at the outset of the project that some women may not wish to speak to a male interviewer, but this was not found to be true. The interviewer in fact interviewed more women than men for this project.

The bilingual interviewer conducted all personal interviews in the Bosnian language. All but one interviewee agreed to have their interview tape recorded. Interviews were conducted at a mutually convenient location such as the interviewee's house, or at a nearby coffee shop. The interviewer then prepared interview notes in the English language and had regular meetings with the research coordinator to discuss the findings of the interviews. The tapes of the interviews were then destroyed as they were no longer needed.

3.3 Statement by bilingual interviewer - Mr Nikola Gurovic

Over 20 years in my career as a journalist I had the privilege to interview ordinary people, artists, sporting heroes, professional soldiers, scientists, politicians ... I enjoyed numerous opportunities to share thoughts and experiences, to try to find some answers or at least to formulate the right questions regarding large scale topics. Having such significant experience I accepted without any hesitation the offer to interview my compatriots who recently came to Australia.

I thought I would be able to hold at least four interviews a day and I would complete my task in a short time. I started to ring the people who agreed to talk about their health needs, especially about mental health. Most of the Bosnians I talked with were not at all enthusiastic about the idea to open their hearts and minds, to talk about their painful past, to reflect about the anxious present and insecure future.

But when they agreed to talk they accepted me in the way they only knew, with their heart open, showing me all the wounds and scars they are still trying to heal. After only a couple of interviews I realised that I was not as resilient as I thought I was. Listening to all those stories about the horrors of the war, suffering, pain and loss I had been drowned by waves of sadness. My travels to the Gold Coast became very hard. I enjoyed the kindness and hospitality of beautiful people. I found the way to earn their confidence, but at the same time I felt very bad because I was not capable of finding other cures for their sorrow, but kind words.

One of my journalist colleagues who lived in this country for several years used to say that "nostalgia is one of the most creative human emotions". Maybe this applies for people who are changing countries in times of peace, not for people who are forced to leave their war-torn homelands.

They miss their native country, but most of all they miss the way of life they had - the openness and solidarity between people. They like Australia, they are very grateful to the Australian people for giving them a chance to rebuild their lives. Still they dream about Bosnia. Time is not always a healer.

3.4 A word on qualitative research

The focus of the needs assessment methodology was the use of a qualitative research tool - in-depth interviews. Rather than collecting statistical data from a large number of people, the emphasis was on collecting in-depth and quality information from a select group of people with direct personal experience of the 'problem'. In the past, data for needs assessments were gathered from statistical data collected for other purposes (eg. clinic attendance, hospitalisation records, and so on). This data is limited because 'need' can only be extrapolated from the number of known consumers. There is no way of knowing, for example, whether such figures reflect only a small proportion of potential consumers or people in need of special services, or whether they reflect the majority of service users.

Therefore, rather than deriving representative data on the basis of superficial information collected across a population, the needs assessment methodology used here identified the key issues through informed discussion with providers and consumers of services, and then explored the variability in experience and need through a limited number of high quality interviews. This approach is conventional within anthropology, and is increasingly emphasised in public health research. It is the most appropriate for mental health needs assessments, because it is best able to explore the social and cultural dimensions of mental health-related behaviour and use of health services, the reasons behind people's use or non-use of services, and the wide range of attitudes and experience which influence them.

The people who were invited to participate in the assessment were not selected on a random basis, but were purposively selected. This ensured that we were able to document a variety of experiences. Individuals were recruited through personal networks and through a Former Yugoslavia community forum. The reliability of information was determined by the quality of the interview. Results were balanced against other information such as published material and views of service providers.

3.5 The needs assessment steps

The methodology involved four steps:-

Problem definition
Collecting existing information
Interviewing key informants
Conducting personal experience interviews

Please refer to Appendix A for the problem definition which formed the basis of this needs assessment. The student on placement, Karen Barton, collected existing information at the outset of the needs assessment, such as existing reports on refugees; survivors of torture and trauma; service delivery models; refugee population statistics at the Gold Coast; and other related topics.

Key informants were then purposively selected and interviewed to shed more light onto the needs assessment topic before the personal interviews commenced. These key informants were a religious leader and two ethno-specific health/welfare workers.

3.6 Personal experiences interviews

The focus of the needs assessment was personal experience interviews with three groups of need definers: survivors themselves; their carers; and service providers.

3.6.1 Survivors

The bilingual interviewer accessed survivors from a list of volunteers that had been gathered by the research team. Approximately 6 weeks before the commencement of the project, the Gold Coast employment sector organised a series of three forums for people from the Former Yugoslavia on employment and settlement issues. Ivan Frkovic from QTMHC spoke about the needs assessment at the forum and invited people to offer their names and telephone numbers if they were willing to be interviewed. A total of 16 people volunteered themselves for the project. The bilingual interviewer contacted everyone who had volunteered their name, as well as using his personal networks.

The personal experiences interviews with survivors focussed on:-

Cultural identity and resettlement
Background mental health information
Service experiences
Support systems

The interviews did not focus on the traumatic experiences of survivors, but rather on the health consequences of their background and their experience of using services in Australia.

Each interviewee received a project information-sheet which was translated into Bosnian. This fact-sheet contained information about the project with a follow-up telephone number if interviewees wanted to ask further questions or raise any issue of concern. On the reverse of the fact-sheet was a list of services at the Gold Coast and in Brisbane that may have been used for follow-up support, if needed.

3.6.2 Carers

Although the methodology identified carers as one of three groups of need definers, it was difficult to locate people in such a role in this project. Two people were interviewed in their capacity as caring for someone. However, during these interviews it became obvious that the carers themselves had in fact also experienced war trauma and consequently answered most questions from the perspective of a 'survivor' rather than a 'carer'. This itself became an important finding of the needs assessment, but a practical implication is that this report does not contain a separate section on the perspective of carers in the findings section, since the carers' contributions were analysed together with the survivors'.

3.6.3 Service providers

Service providers both at the Gold Coast and Brisbane were interviewed. Survivors of torture and trauma face a number of issues as they resettle in Australia. Mental health support is only one of many services which they may need. In addition, providers of other services often have the opportunity to identify probable mental health issues and make appropriate referrals. Therefore, interviews were conducted with both service providers who were direct providers of mental health services and providers of other services who have regular contact with Bosnian people from the Gold Coast.

3.7 Profile of interviewees

A total of 23 interviews were conducted for this needs assessment - 20 personal experiences interviews and 3 key informant interviews. The breakdown of interviewees is as follows:-

12 Bosnians
1 Community spokesperson
10 Service providers

3.7.1 Bosnian respondents

A total of 12 Bosnian people were interviewed by the bilingual interviewer. The interviewer conducted the interviews in Bosnian. Two of these people were interviewed in their capacity as caring for someone with mental health problems. However, during these interviews it became obvious that the carers themselves had in fact also experienced war trauma and consequently answered most questions from the perspective of a 'survivor' rather than a 'carer'.

Seven of the Bosnians were female and five were male. Nine interviewees were Muslim, 2 were Serbian and 1 was Croatian. The length of stay in Australia varied from 3 years to only four months. The average was 25 months. The youngest person interviewed was 25 years old and the oldest was 63, with an average age of 43.

3.7.2 Community spokespersons

It was difficult to find community spokespersons living in the Gold Coast area. As such, religious leaders (Muslim and Christian) in Brisbane were approached. One priest held services at the Gold Coast on a regular basis, but the other priest did not and was not able to comment on the situation at the Gold Coast. Only one community spokesperson was interviewed. Two ethno-specific service providers were also interviewed as key informants.

3.7.3 Service providers

Eight people were interviewed about their personal experiences in providing services to Bosnians living at the Gold Coast. Some of these providers were actually located in Brisbane but were accessed by Gold Coast residents. Five people interviewed were providers of mental health services, two worked for employment services and one provided general welfare and settlement services.

4.0 What we found

This section presents the findings of the interviews with survivors of torture and trauma and service providers. Quotes are used whenever possible to highlight the experiences and thoughts of those who were interviewed.

4.1 Mental health problem

The interviews with survivors did not explore details about their experiences of torture and trauma. Nor was there any intention to 'diagnose' or label individuals' mental health conditions. What did emerge was a consistent picture of a group of people facing similar, distressing problems.

The interviewer broached the issue of "mental health" sensitively and gently. He often referred to "the heart" , "the soul", "the psyche" or "emotional problems," so that interviewees could relate to the questions. A wide range of responses was gained from the question "how would you describe your problem, do you consider it a mental health problem?" Some interviewees preferred to focus on their physical health problems, but also mentioned "nervousness" and "anxiety". Others spoke openly about their mental health problems:-

"When I arrived here I was very depressed. I was avoiding company and used to spend 3 days in a room without talking to anyone..."

"Pain is the name of the problem..."

"We had mental health problems, we still have them, we can't say we overcame them 100 percent".

"It is fear of the future. I can't sleep, I get up at 1am, I am sweating, taking pills, remembering the bad events from my past. We have suffered a lot."

"There were many signs of mental health problems, but insomnia was the worst. I cried every morning for 6 months".

4.1.1 Symptoms

The symptoms experienced by the interviewees can be divided into seven categories:

Depression and isolation

"I avoided company... I was isolated, I didn't want any contact".

"...when you don't wish to get up on time to do your housework, when you don't want to prepare food or clean the kitchen...you just sit all day long focussing on one point".

"I am a closed person. I withdraw into my fear, I don't know where to go - to my compatriots whose views I don't share, or to Australians who would consider me a stranger, an alien?"
Insomnia and nightmares

"I can't sleep, even if I sleep I have a feeling I am awake. I am always experiencing nightmares. When I get up I'm exhausted and it goes like that day after day".
Anxiety and nervousness

"Here I am fine, but I am nervous, I don't speak the language".

"I didn't have enough air, I had difficulties breathing, I prayed to God to die. Those symptoms first started in Bosnia".
Body pains

"When I first arrived I had different symptoms, my body was sore, I was thinking about heart problems. I visited different doctors... I felt really sick. Even now I have a neck ache. I made the necessary tests. I wanted to know if it was my imagination or I was really sick. The tests were ok and I felt better. I was told not to worry, to walk, to rest, to go fishing"."

"During our trip as prisoners I was beaten and I still have pain in my head. Even today I can't sleep, it is hard for me to find peace".

"I feel the pain in my chest".
Fear

"When I arrived I felt bad, I had a wish to avoid people, to go out, I was scared. I couldn't go back into the house, I was crying, I was terrified".
Sadness

"Those waves of sadness come suddenly and then I start to cry without reason".
Helplessness

"Simply the helplessness to solve the smallest problem. There is no need to know too much about those symptoms, you can see that every morning looking into the mirror".

In recounting experiences with clients, service providers mentioned some of the same presenting symptoms, especially isolation, insomnia and depression. Aggression and irritability were also symptoms mentioned by service providers as a stimulus for survivors seeking care or being referred to mental health services by family members or other services.

Several providers noted that survivors typically had co-existing mental and physical health problems. They stressed that frequently the most important physical problems were the most pressing and considered referrals to appropriate medical specialists as one of the major contributions to clients' well being.

4.1.2 Interpretation

Survivors were asked whether they had a name for their problem. Several interviewees did not offer an interpretation or name for their problem, but others said:-

Alienation

"I would like to call that foreign country alienation. I can't find myself - how if I don't have communication?"

"Most of the Bosnians according to my knowledge are suffering of the same problem, they can't recognise their own people."
Loss

"It is maybe the nostalgia, I had a good life. I am not too old to have desires and dreams, but I don't have enough time to start once more. I feel lonely,...I regret that time is running out, so I am not advancing, I am stagnating."

"I was shocked, I was close to my mother (mother died). But even now I feel bad, I feel an unclear conscience because I left her. I feel bad very often".
Results of war

"My nervousness was not caused by my dilemma about this country. I felt really sick. Even now I have a neck ache.... I was told that most of my compatriots suffer from the same symptoms".

All of the service providers mentioned post traumatic stress disorder as a defining characteristic. Other labels depended on professional background. Providers who were experienced in treating torture and trauma survivors bluntly said that the cause of the problems was the war.

4.1.3 Recognition and treatment patterns

The vast majority of people interviewed recognised their mental health and other problems themselves. However, not all people decided to seek assistance for these problems.

"I feel very bad often, but I didn't ask for assistance. I succeeded to overcome the problem on my own, my husband is kind and gentle, I didn't have the need to talk to someone else.... our friends were supportive" (Bosnian friends).

Many others were referred to health professionals by their family members or friends. Interviewees had used a wide range of services such as QPASTT, TRUSTT, the Croatian Mental Health Program and a variety of private doctors and counsellors. One respondent said that seeking help was now too late - she needed it three years ago.

4.2 Supportive Structures

People interviewed were asked who had been helpful to them in the past and who was helpful to them today. Service providers were also asked about any support structures they were aware of for their clients. This section will be presented under five headings - cultural beliefs, migration experience, situation in Australia; community supports; family support; non-mental health services; and mental health services.

4.2.1 Cultural beliefs; migration experience; situation in Australia

Only two support structures were identified under this heading. A small number of people identified a safer political climate as being of assistance to them and spoke about their appreciation of democracy in Australia. One person was employed and identified this as a very positive factor in their life.

4.2.2 Community supports (organisational and personal)

The most commonly mentioned support was social contact. This was very much desired by most people interviewed. Typical comments were:-

"The only help was if someone invited me for a cup of coffee and a chat about different issues, that was helpful."

"We don't need money, we need human talk, to listen and to be listened to".

"Our friends were the most helpful, they guided us from one institution to another, to the doctors etc.; they know the system, in the difficult moments in terms of mental health."

A number of interviewees mentioned their appreciation of friends who acted as interpreters for them when needed. Only one interviewee mentioned that her church was very helpful for her.

"They gave me the items I needed, but most of all they gave us spiritual support".

A small number of people discussed that the environment in which they lived or spent time in was important to them. One person mentioned fishing, another mentioned wanting to live by the sea and another person mentioned that buying a car and being able to be on the move was good.

"Even today I can't sleep, it is hard for me to find peace. That was the reason to find a place to stay with a little garden in order to get out during the sleepless nights."

4.2.3 Family supports (immediate and extended)

Almost all interviewees mentioned that their family had been helpful for them. This included both immediate relatives and extended family members. A number of service providers also recognised the support structure that families were able to offer, despite their own troubles.

"I wouldn't be able to cope without my daughters."

"His family members were very helpful, as much as possible, considering they too had experiences of war etc." (service provider)

4.2.4 Non-mental health services

The most supportive non-mental health service mentioned by interviewees was English language classes. A small number of interviewees mentioned particular teachers who had noticed that something was wrong and referred them onto health services.

"No-one except my teacher **** (helped). She knew that we feel bad and she was always asking about our problem. Not even my husband's brothers knew about our hardship."

4.2.5 Mental health provider supports

Both Bosnian interviewees and service providers mentioned that general practitioners (GPs) were supportive. One service provider mentioned that although her service couldn't provide 24 hour care, some GPs could and therefore provided an essential backup system to her care. Only two Bosnian interviewees found their counsellors supportive whilst almost all service providers mentioned that counsellors would be a major support for survivors of torture and trauma.

4.3 Constraints

People interviewed were asked about any problems they may have encountered whilst using community and government services. Service providers were also asked about difficulties experienced in serving this client group. Once again, this section will be presented under five headings - cultural beliefs, migration experience, situation in Australia; community supports; family support; non-mental health services; and mental health services.

4.3.1 Cultural beliefs; migration experience; situation in Australia

It is clear that the situation of Bosnians at the Gold Coast, together with their migration experience, constitutes a major constraint, rather than support structure. Socio-economic issues such as unemployment, isolation, migrant status and alienation from a new system were frequently mentioned by interviewees.

Unemployment

Most people interviewed were desperately trying to obtain employment and spoke about their frustrations in doing so. One service provider working in the employment sector said that she had only had one successful outcome for a Bosnian client in recent times.

"I know I must work, but why humiliate us, why put us in a position to work the entire day for 15 or 20 dollars only?"

"We want only a chance to work and a chance to not be second class citizens. That's it".

"I have worked for more than 20 years, I feel terrible when I receive DSS payments. Over the years I was working hard and I used to be punctual. It is painful for me to hand in the form and wait for the social security allowance with very problematic individuals. That is the hardest moment of my Australian experience, but I don't have any choice."
Loneliness and isolation

Many people talked about wanting to make more friends and wanting more opportunities to socialise with other people. Some found Australians difficult to relate to.

"I don't like the fact that the Australians are cold".

"I miss my friends and a social life. We don't have that any longer."
Lack of choice to come to Australia

Some people attributed their negative experiences in Australia to their lack of choice to come to Australia.

"Australia is only a necessary lodging, regardless of the fact we accepted all this ... we were forced to come."
Migrant status

Several interviewees spoke eloquently about their experiences of being a 'migrant' in Australia and found this a negative experience. Service providers also acknowledged this barrier but discussed it in terms of not understanding the system which was new to people. Both Bosnian interviewees and service providers discussed the loss of status for some people as having a detrimental effect on them. Examples were given of highly successful people in Bosnia not able to find work in Australia and having their high hopes shattered.

"We feel the difference, our accent means 50 percent less chance to solve the problem".

"We were given promises that this is an open country with equal opportunities for everyone. It is not like that.... We sow the future here, but day after day we can't see the light in the end of the tunnel"
Language barriers

Language barriers were mentioned by everyone interviewed - both Bosnians and service providers. The issue will be further explored in the section on interpreter services.
Poor physical health

Several examples were given by both Bosnian interviewees and service providers of very poor health which impacted on the person's mental health and general situation in Australia.

"She was also very sick and suffered liver problems and headaches from being wounded during the war". (service provider)
Counselling a new concept

This issue was only mentioned by service providers who spoke about the difficulty of broaching the subject of counselling, or mental health with their clients.

"My clients don't know about psychologists and so don't ask for it".

"There is some resistance to talking about mental health issues. We talk about nervousness and use everyday words, not jargon. We talk about how extreme stress can effect the whole body and the nervous system, which is acceptable to people".
ESL classes

One service provider mentioned the need to advocate on behalf of clients to delay their English classes until they were more stable. The pressure of classes was too much for them. This was not mentioned by Bosnian interviewees who in fact found it important to work on their English.

4.3.2 Within the community (cultural and interpersonal constraints)

Many people spoke about the difficulties of living in the Bosnian community where some friends had not experienced the war, others wanted to forget about the past and others may not be trustworthy. It was a source of distress for several interviewees.

Political entanglements and mistrust of other Bosnians

"There are many of them, I didn't want to discuss my problem. Those were Bosnians, my former neighbours from the same town, different ethnic background. We grew up together, but today there is no communication ... I avoid the discussions. Sometime my home was their home, not today".

"I have very few contacts with Bosnians simply because I don't want misunderstandings. People are nervous, frustrated, it is easy to have confrontations. So I made a decision about contacts with a small circle of people who understand the causes and consequences".

"I don't want to discuss politics, and many of the Bosnians even in this country are poisoned with politics."
Friends who don't understand

"Friends say to not worry, to reject the pain and the past"
Don't want to burden others

"All of us came here with similar problems, some personal experiences, some of us have lost family members, or their house was burned, our destinies are similar."
Loneliness and isolation

Many people talked about feeling lonely and wanting to make friends with Bosnians and Australians. Others said they wished there was a social group to go to so that making friends might be easier.

"We are here almost two years but still don't have Australian friends, we make every effort to create friendships but people don't want any contact".

"I don't know if it's related to the mentality of our people ... we were not able to knock on someone's door and say listen we have an emotional problem".

4.3.3 Within the family

Although most interviewees mentioned that their family had been a major source of support, several people also mentioned that their family was not a source of support. Service providers also recognised the difficulty and complexity of family members providing support.

Immediate family in Australia doesn't understand

Some interviewees discussed the difficulty of having family members who had not experienced the war and who could not understand or believe the experiences of their loved ones.

"My brother couldn't understand my troubles, he didn't believe what happened to us".

"Our people are doing their best to learn, but there are many reasons why they are not successful. The relatives are not able to understand, they came a long time ago when this country was different."
Protect immediate family

Several interviewees talked about not wanting to "burden" their family members and their wish to protect family members from their problems and pain.
Violence in the family

This was not mentioned by any of the Bosnian interviewees but was mentioned by a service provider who had clients experiencing family violence.

"This client presented with many difficulties in his relationships with his wife and two children. He was very aggressive in his temperament towards his family. He also wasn't sleeping well." (service provider)
Children affected by the war

A number of interviewees discussed how their experiences had impacted on their children. Several mothers discussed their inability to support and be there for their children because they could barely look after themselves. One woman related her son's distress as causing her further distress:-

"I had problems with my younger son. He would escape from school and return home, and I was lost, I couldn't find the way back to our place (after taking him back to school). I would start to cry again."

"I don't have any tears left, I am not interested in going out. The children can feel that. My younger son is still dreaming about Bosnia."

"My family also suffered at that time, I was not able to help my daughter with school. The family is like a machine, one part is missing and the machine is not working".

4.3.4 By non-mental health services

Lack or non-use of interpreters

Most people interviewed had negative experiences related to the lack of interpreters or the unwillingness of service providers to arrange for an interpreter. One person had used an interpreter for her counselling sessions but dropped out of counselling after the interpreter started making her own comments.

"I used the interpreter but during the session with ***, the lady interpreter made her own comments, so I was not happy with that."

"It is hard to talk to the doctor, we don't have interpreters here at the Gold Coast".

"The real problem was that the surgeon by mistake removed the appendix (from son) and he admitted that. So you see what kind of trouble you can have if you don't speak the language and you don't know the reality".

"I went to DSS and one hour before the appointment I was told that they don't have an interpreter and I have to help myself".

Only one service provider had the language skills to communicate directly with this group. A number of other providers discussed the difficulties of not having easy access to interpreters and the difficulty of having to use family and friends. However, some seemed satisfied with the ad hoc arrangements of using family or friends.
Lack of understanding by health services

Several people talked about their experiences with doctors, particularly general practitioners. Although they liked their doctors, they felt that their doctors did not know how to treat their problems and did not understand their predicament.

"My husband has serious health problems and he visits different doctors ... there is no understanding for our circumstances."

"My husband and me, we were not too successful with the doctors. I decided not to take the medications given by my doctor. He is telling me the same story, everything will be fine, this is your country, take a walk along the sea, relax..."

"My doctor says it is stress. You have to accept this country as yours, you have to live your life...It is not so simple, it is the easiest way to say stress is your problem."
Lack of understanding by other services

One person had a particularly distressing experience with a non-health service:

"I had a very bad experience with DSS, the official was very rude, nervous and frustrated. I had a feeling he was coming from the war zone, not me".
Cost of health services

Almost everyone interviewed complained about the cost of dentists and the long waiting list at the dental clinic. One interviewee showed the interviewer an appointment card she had with the dental clinic for 1999. A small number of interviewees also complained about the cost of doctors.

4.3.5 By mental health services

Distance

A number of people had received a couple of counselling sessions in Brisbane but found it too difficult to get to Brisbane and so dropped out from counselling altogether. One woman said that if she could see her QPASTT counsellor at the Gold Coast, then she would gladly resume counselling.
Lack of resources

This was mentioned by most service providers who were interviewed. One service provider talked about the CES paying for 6 hours' counselling but that this was not sufficient and that it was unrealistic to do adequate work in such a short period of time.

4.4 Needs

In this section, the needs identified by the Bosnian interviewees and the service providers will be presented and compared. In the next section the area of negotiated need will be presented.

4.4.1 Bosnian interviewees said:

Social club

"It would be nice to have some club or cultural association, not for me only, but for my daughter also."

"We are alienated, we don't meet, we need to socialise, we are divided, we need friends, most of us are sick".
Jobs

"I wish I could forget the past. I wish I could find a job".

"I think that most of us need a service regarding the job prospective - that would be useful, that is the chief problem, fear of the future is dominant."
Dentists

"I have an appointment in 1999; I can show you the booking".
Counselling

"I would like to have that, but Brisbane is far away".

"I have my GP and I talk to him, but his explanation is that everything is related to stress, you have to adapt and to accept Australia as your country. That is fine and I agree, but there are questions I cannot resolve. I need the expert to help to talk to me".

"It would be nice to have some professional to talk to about frustrations and insomnias, those counsellors would be helpful and I would go for sessions especially if I knew that they had helped my colleagues".
Bilingual counsellor

"I wouldn't be ashamed but that professional should speak my language, in the presence of an interpreter I would not be able to speak from the bottom of my heart".
Interpreters

"First of all we need an interpreter when we visit the doctors".

"Using family members as interpreters is only a necessity. That is not the appropriate solution".
Information

"I think that DSS should give us a social worker to talk to us about our rights and duties. We get the information from our acquaintances".

"It is difficult to get the information. When we are here we need to be told especially in the start. We rely on friends' information."
Services for Bosnians

"There are many Bosnians here, they are ready to help, they would help, it would be good to have some of them in different services. It would be good to have a GP who speaks our language."

4.4.2 Service providers said:

Ongoing appropriate counselling at the Gold Coast

"What's needed is counselling and emotional and psychological support."

"It is important not to refer these clients to those free counselling services as they're mainly Christian or Catholic based. This is not appropriate."
Settlement services

"I am always being called on to help with other things like housing, legal issues, but that is not my role."

"She needed more assistance with community settlement - the kind of things that a psychiatrist cannot do."
Interpreters

"I couldn't get an appropriate interpreter - a male, Bosnian, Muslim. So on his fourth visit he brought his own interpreter with him. However the problem was that we ended up focussing more on the interpreter's problems in English than the client's which made him very angry. On the 5th session we found an appropriate interpreter through TIS".
Education program

"There should be a program for educating new arrivals on living in Australia. It should cover differences etc, skills recognition, social system, lodging tax forms, seeking help."
Employment programs

"People say - give me a job, security, money and then I'll have my health back. They think as soon as I have a job, everything will be all right."

"We need more employment programs - what's available is not enough".
Social contact

"She needs just someone to pop in for a few minutes to sit with her and brighten her day - to bring flowers - be kind to her..."

5.0 Discussion of findings

It is useful to compare the needs expressed by the two groups of need definers - Bosnians and service providers. The area in the box is the area of "negotiated need" - or the overlap area where both service providers and potential clients agree on what's needed.

Overall, the needs defined by survivors and service providers were quite similar in that both groups principally nominated psychosocial needs (solutions). Both groups saw that social contact, and practical assistance in achieving an independent life in Australia were high priorities.

Even the felt needs for medical assistance was sought for psychosocial support rather than physical interventions with the single exception of dentists. This is particularly true for the survivors. The providers also believed that more mental health services - or better access to existing ones - was necessary. However, they also discussed physical health needs. There was also a tendency for service providers to feel that survivors who sought care, had their needs met, although this was not a universal sentiment. In contrast, survivors who had sought mental health services felt they still had unresolved problems.

Survivors' principal complaint was that they had no one who understood them. Empathetic listening is a major therapeutic intervention for post traumatic stress syndrome. Indeed, these people who have identified themselves as having a problem say that they would like to talk to a professional who would understand them.

Interventions need to take into account:

People are not 'cured' of the effects of torture and trauma. Research suggests that consequences of these experiences can re-emerge at any time of life. Finding ways to cope with the effects and minimising them when possible is the only feasible therapeutic goal.
Some service providers recognised that clients were extraordinarily isolated. They also noted that family members, who had the same experiences of the war were not always able to provide effective support to one another. Nonetheless, the feeling of loneliness and isolation which dominated the interviews with survivors did not feature strongly in the interviews with service providers. This suggests that these types of ameliorating or exacerbating factors are not appreciated by service providers. They may be unaware of the lack of social supports for their clients.
At present there is no Bosnian 'community' at the Gold Coast. This may be because, as one service provider says, there is not a 'critical mass.' But it is more likely that the explanation of the survivors is more accurate. The war experiences fractured a sense of solidarity; there is no trust or shared perspective of their past between Bosnians and therefore people are reluctant to make friends. A reluctance to discuss mental health problems with each other compounds this isolation from other Bosnians. A consequence is that the 'community' cannot be expected to provide a source of support without being strengthened itself.
Language skills are not sufficient to ensure effective utilisation of services. Survivors and providers gave many examples of inappropriate people used as interpreters. Furthermore, many people with the right language skills belong to different ethnic groups and may not be acceptable. Therefore language skills alone will not ensure good interpretation.
Survivors mentioned very few institutions (or workers) which were helpful. Surprisingly, this includes religious institutions. If these institutions are expected to be involved in addressing torture and trauma issues, they will need to change their current approaches.

6.0 Recommendations

This section presents the recommendations that have come out of the needs assessment of Bosnian survivors of torture and trauma living at the Gold Coast. The recommendations primarily attempt to address the needs which fell in the area of negotiated need - or the needs which both Bosnians and service providers agreed on. A small number of other needs are also addressed.

Social contact

That the Gold Coast City Council Community Relations Committee advocate the need to undertake community development activities with Bosnians to increase their opportunities for social contact, to the Gold Coast City Council.

That the Ethnic Communities Council Gold Coast (ECCGC) or the Multicultural Women's Organisation (MWO) explore ways to undertake community development activities to assist Bosnians to increase their opportunities for social contact.

That the Gold Coast Mental Health Community Development Officer assist Bosnians in establishing structures and processes for greater social contact with others.

Counselling

That Queensland Program of Assistance to Survivors of Torture and Trauma (QPASTT) through it Early Intervention Program, allocate resources to service refugees at the Gold Coast.

That the Gold Coast Network for Survivors of Torture & Trauma advocate for culturally appropriate services to be offered through mainstream counselling services at the Gold Coast.

That the Ethnic Communities Council Gold Coast continue to explore funding possibilities for culturally appropriate counselling and support services to be provided at the Gold Coast to refugees.

Employment

That the Gold Coast Network for Survivors of Torture & Trauma target case managers in public and private employment agencies to undertake training to increase their understanding of the psychological issues related to torture and trauma survivors.

That the ECCGC and MWO provide a referral service for employment programs, training and employment placement options.

That the Migrant Liaison Officer at Centrelink organise training for agency staff with regard to service provision to refugees.

That the Migrant Liaison Officer be the link and broker within Centrelink for Bosnian refugees needing assistance to negotiate employment, training or income maintenance procedures.

That the Gold Coast Torture & Trauma Working Party advocate the need for more assistance to Bosnian refugees to employment organisations such as Job Club and Skillshare.

Interpreting

That the ECCGC and MWO identify and recruit Bosnian speakers who have adequate Bosnians and English language skills to obtain National Accreditation Authority for Translators and Interpreters (NAATI) accreditation.

That ECCGC and MWO organise pre-testing for those recruited to ensure that they have the required skills to successfully pass the NAATI testing.

That ECCGC and MWO negotiate with Centrelink for the testing to be funded.

Language programs

That TAFE increase the opportunity for Bosnian refugees to gain home tutoring where requested to further assist them with their English language skills and to provide another avenue for social contact.

Information and settlement

That the ECCCG and MWO target Bosnians as a priority group through their settlement support programs and that at least one Bosnian Bicultural Community Advocate be employed through ECCGC.

That Centrelink staff undertake more targeted outreach work and be more visible in the Bosnian community.

Mental health

That the Gold Coast mental health service develop promotional and preventative programs targeted at Bosnian refugees.

That the Gold Coast Division of General Practice provide training to its members on service delivery to survivors of torture and trauma. This training could be adapted from a training program recently provided by the Brisbane Inner South Division of General Practice as part of its Continuing Medical Education Program.

Dental health

That QPASTT negotiate with the Dental Clinic through its Early Intervention Program for priority access for Bosnian refugees.

7.0 Conclusion

The needs assessment set out to explore and document the needs of Bosnian survivors of torture and trauma at the Gold Coast. This was achieved through the personal experience interviews by the Bosnian interviewer, and the numerous interviews with service providers.

The Bosnian community has grown rapidly in the past five years at the Gold Coast and their needs will have to be understood and addressed by local service providers. As there are currently no specific torture and trauma rehabilitation services at the Gold Coast, mental health service providers, counsellors, general practitioners, social workers and community workers will continue to service the Bosnian community, hopefully with a renewed understanding about the situation and predicament of their Bosnian clients, as a result of the needs assessment.

It is hoped that the recommendations can achieve the changes needed to facilitate the recovery process of survivors of torture and trauma, and increase their opportunities to participate in the new society they find themselves in. The contact and dialogue established with survivors through the needs assessment must not be lost but built upon in the coming months, particularly if community development initiatives are to be implemented with the Bosnian community so that they may get the social contact they have expressed they so desperately need.

References

Freer, R. (1993) Spirit is stronger than force: How torture affects the individual and community, Victorian Foundation for Survivors of Torture Inc., Melbourne.

Gold Coast City Council (1996) Indigenous and Ethnic Communities of the Gold Coast, Social Research Studies Research Unit, Gold Coast City Council.

Lefley, H. P. Counselling Refugees: The North American Experience in Pederson, P. B., Draguns, J. G., Lonner, W. J. & Trimble J. E. (eds) (1989) Counselling across cultures, third edition, University of Hawaii Press, Honolulu.

Macdonald, C. (1994) Reclaiming the Power Within, Women's Health Centre Inc (Brisbane), Spring Hill.

United Nations Convention on Status of Refugees, 1951, Geneva.

Appendeix A - Problem Definition

Which groups or group are we concerned about?

People who have arrived in recent years from Bosnia.
Ethnic group?

People from Bosnia. This may include people who also identify as Croatian or Serbian, but who have come from Bosnia. The biggest group may however be Bosnian-Muslims.
Geographic area?

Gold Coast - from Beenleigh down to Coolangatta
Age?

Adults
Sex

Both women and men
Affected by a particular mental health condition?

Yes, people who have been affected by war trauma. This could include post-traumatic stress disorder, as well as any number of survivor syndromes which have now been documented. We are interested in people who have experienced war trauma, regardless of how the sequela have manifested.
What is the mental health issue that is of concern?

In particular, post-trauma stress, but can also include other manifestations of the effects of war trauma.
Diagnosed condition?

Not necessarily. Some people may never have been seen by a psychologist or psychiatrist. However, the condition post-traumatic stress disorder (PTSD) is a condition that can be diagnosed. However, this will not be the most important thing. We are interested in whatever manifestation of the effects of war trauma - PTSD is but one.
Risk factor?

Anyone who has come from a war trauma background.
Type of service provision?

There are no special services at the Gold Coast. There is a community mental health service, but it doesn't see any Bosnian people. An important service at the Gold Coast is the community health centre at Southport. In Brisbane there is QPASTT, which is seeing a small number of Bosnian people from the Gold Coast, and Dr Aidene Urqhart (TRUSTT) who is also seeing people from the Gold Coast.
Why is this topic important?

It has been of grave concern to a number of community workers. The case managers in particular have been left to support people as best as possible.
Current and topical?

Yes - the National Forum of Services for Survivors of Torture and Trauma has recently consolidated its efforts. There is now a federal funding program for toorture/trauma rehabilitation services. However, these are all located in the capital cities. We need to find a way of supporting war survivors in regional areas too.
Widespread?

Not sure at this stage. It certainly is in the capital cities around Australia. At the Gold Coast it is of major concern to community workers, who have felt the greatest burden in trying to support people with no resources.
Relevant to a particular programme or service?

Ethnic Communities Council of Gold Coast is most interested in obtaining resources for this problem.
Is it a priority for the government, community representatives, popular press, etc?

Not a high priority for government or popular press. But it seems to be amongst Gold Coast community workers.
What will be done with the results of the needs assessment?

The data obtained will go straight into a funding submission by the ECCGC.