Men’s health

Key Points

  • Men and boys make up half of our humanitarian intake
  • As a result of their experiences and human rights abuses, men from refugee backgrounds may have a range of health issues additional to those of men in the wider Australian community
  • Identity issues following resettlement can be a significant issue 
  • Men may be hesitant to participate in counselling
  • A cardio-vascular risk assessment may be warranted from age 35 years

Overview

Men from refugee backgrounds have often witnessed, or experienced, physical or sexual violence, including war and torture, which can result in depression, anxiety and post-traumatic stress. 

Some have been combatants in war; others have been imprisoned and/or tortured because of their roles as community leaders, activists or professionals. A small number have been child soldiers or arrived as unaccompanied minors. 

For many new arrival communities, the role of the man has historically been that of decision-maker, provider and ‘head of household’. Some men find it difficult to adjust to new expectations and the new freedoms of their wives and children (especially daughters) when they arrive in Australia. 

Identity issues associated with loss of social and occupational status, racism and changes in gender roles can contribute to mental health problems, long-term unemployment, substance use, domestic violence and family breakdown. 

The provision of services to refugee men may be limited by difficulties for some in developing trust, and reluctance to seek help or disclose a history of torture and trauma. Many men can show a reluctance to admit they are not coping, or acknowledge that post-traumatic stress may be the cause of their anxiety or their depressive or somatic symptoms. They may be hesitant to participate in counselling due to stigma associated with mental health problems, so care is needed in explaining a referral for counselling or assessment. Group approaches that are activity-based and get men talking to each other in a non-threatening environment can sometimes be a way of reducing barriers to talking about problems they are facing in adjusting to Australian life. For some, religious/spiritual guidance or rituals such as prayer may be beneficial. 

Approach to care

  • Some men from refugee backgrounds may prefer to see a male GP.
  • A cardio-vascular risk assessment is warranted, potentially at a younger age than in Australian-born men (i.e. from 35 years of age). 
  • Smoking rates may be high.
  • Men from refugee backgrounds, like their female counterparts, may suffer from war- and torture-related injuries, including the physical effects of sexual torture.
  • Other physical health problems may include poor dental health, diseases associated with long-term exposure to the elements and poor diet, as well as chronic conditions such as hypertension, diabetes and obesity.4 5
  • Bowel cancer screening (FOBT) is recommended for men 50 years and above; also, prostate cancer testing in anyone with relevant history or symptoms

Considerations

Some communities have traditionally had a lack of access to condoms, and religious or other stigma associated with their use; however teenagers and adult men may be sexually active, needing regular advice on safe sex practices as well as screening for STIs.

In some cultures, the age of consent is different from that in Australia; thus it may be advisable to discuss Australian practices and laws concerning sexual relations including age of consent. Australian laws vary between states and also according to the gender of sexual partners.

Specific Groups at Risk

  • Asylum Seekers  – experience high rates of depression, PTSD, psychological trauma as well as limited access to health services and social supports.
  • Former Soldiers – likely exposure to extreme violence, threats to life and abuse. May include boys and adolescents forced into combat roles from a young age.
  • Elderly Men – Physical and mental consequences of the refugee experience may first present in old age. Painful memories can resurface at times of illness or other stress.

Links

Andrology Australia

Australasian Men’s Health Forum

Foundation 49

Male Health Victoria

Men’s line Australia

Men’s Health Week

Prostate Cancer Foundation of Australia


References

1.Byrne, M. (2006). The Other 50%: Refugee Men’s Health NSW Refugee Health Service, Sydney. See also: NSW Refugee Health Service. (2009). Fact Sheet 9: Refugee Men. Retrieved from: < www.sswahs.nsw.gov.au/sswahs/refugee/pdf/Resource/FactSheet/FactSheet_09.pdf >. 

2. Brownhill, S. (2014) Practitioners’ Guide to Men and Mental Health, Men’s Health Resource Kit 4, Penrith, MHIRC, University of Western Sydney 

3. Johnston, V., Smith, L. & Roydhouse H. (2011). ‘The health of newly arrived refugees to the Top End of Australia: results of a clinical audit at the Darwin Refugee Health Service’. Australian Journal of Primary Health, published online December 2011. < dx.doi.org/10.1071/PY11065 >

4. Chaves, NJ., Gibney, KB., Leder, K., O’Brien, DP., Marshall, C. & Biggs, B-A. (2009). ‘Screening practices for infectious diseases among Burmese refugees in Australia’. Emerging Infectious Diseases, (15)11, 1769-72.

5. Webster, K. & Kaplan, I. (2003). ‘Refugee Women and Settlement: Gender and Mental Health’ in Allotey, P. (ed.) The Health of Refugees: Public Health Perspectives from Crisis to Settlement. Oxford University Press.

6. Mathews, B. (2011). Female genital mutilation: Australian law, policy and practical challenges for doctors. Medical Journal of Australia, 194(3), 139-141.

7. Correa-Velez, I & Gifford, S. (2011). Health and settlement among men from refugee backgrounds living in South East Queensland, La Trobe Refugee Research Centre, La Trobe University. Retrieved from: < www.latrobe.edu.au/__data/assets/pdf_file/0009/144945/Correa-Velez,-et-al.-SettleMen-WEB.pdf >.

8. Williams, N. (2011). ‘A Critical Review of the Literature: Engendering the Discourse of Masculinities Matter for Parenting African Refugee Men’. American Journal of Men’s Health, 5(2), 104-117.

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The Australian Refugee Health Practice Guide received funding from the Australian Government.

Disclaimer

The information set out in the Australian Refugee Health Practice Guide (“the Guide”) is current at the date of first publication and is intended for use as a guide of a general nature only and may or may not be relevant to particular patients or circumstances. Nor is the Guide exhaustive of the subject matter. Persons implementing any recommendations contained in the Guide must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular circumstances when so doing. The statements or opinions that are expressed in the Guide reflect the views of the contributing authors and do not necessarily represent the views of the editors or Foundation House. Compliance with any recommendations cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional and the premises from which the health professional operates.

Whilst the information is directed to health professionals possessing appropriate qualifications and skills in ascertaining and discharging their professional (including legal) duties, it is not to be regarded as clinical advice and, in particular, is no substitute for a full examination and consideration of medical history in reaching a diagnosis and treatment based on accepted clinical practices.

Accordingly, Foundation House and its employees and agents shall have no liability (including without limitation liability by reason of negligence) to any users of the information contained in the Guide for any loss or damage (consequential or otherwise), cost or expense incurred or arising by reason of any person using or relying on the information contained in the Guide and whether caused by reason of any error, negligent act, omission or misrepresentation in the information. Although every effort has been made to ensure that drug doses and other information are presented accurately in the Guide, the ultimate responsibility rests with the prescribing clinician. For detailed prescribing information or instructions on the use of any product described herein, please consult the prescribing information issued by the manufacturer.