PERCEPTIONS OF MENTAL ILLNESS
3.1. THEME 1: UNDERSTANDING OF MENTAL HEALTH AND ILLNESS
3.1.2. Mental health problems and disorders
In keeping with their understanding of mental health, a range of responses were elicited from the participants on their understanding of mental illness. Interestingly, some described it as absence of awareness of either their own behaviour or cause of a physical health symptom.
“I think I’m a mental because I don’t know what I’m sometimes doing.”
Young person 1
“Mental is like you know, when you think you’ve got something wrong in your body and you haven’t. You think that, but you haven’t got it. And, you know, if you go to doctor and you say something, oh, I’ve got pain and they say you haven’t got and then, then in the future it might cause you a problem because if you have a real pain, they won’t trust you, they’ll think you’re mental.”
Young person 12
Others used a significant degree of negative language while attempting to describe mental illness. One young person gave examples of when he self-harmed, and emphasised the refusal to comply with others’ suggestions in his definition. This
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statement highlighted the negative meaning associated with his understanding of mental illness and the likely link with the stigma attached.
“And I was very crazy actually, because I try twice kill myself, I try hung myself. I cut myself, I really was crazy…… Yeah, it’s not like real crazy, you know, crazy boy. But it’s like crazy, because I didn’t listen to anyone.”
Young person 11
A number of young persons, however, expressed a more balanced understanding of the concept of mental illness. They defined mental illness either as an impaired state of mind and body manifested by difficult feelings like unhappiness or worrying; as problematic or negative thinking triggered by stress; or as worrying about some environmental or life stressors. These descriptions and definitions of mental illness, however, seem to be based more on self-attribution. The young persons contextualise their responses in relation to their own feelings and experiences, but not in a generalised or abstract way.
“Uh, I’m thinking my body. I’m thinking I just, I never feel happy any time, I just, I want to be anyone that been making fun, but my heart feels sad…… I think this is some illness in my mind, both of them, mind and body. You know, my body hurts my mind is no works proper.” Young person 2
“…… when you worry about something, you’re all the way, not in the same, the same you are before, because you worry about something. If you don’t worry about something, just nothing going to happen…… When you going to
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doctor, they will sort out your problems straight away, but my problem is thinking, worrying about that thing……” Young person 3
“…… the main problem was like I was stressed and it could come in loads of ways. As I said before, I could get stressed…… and I was just thinking negatively.” Young person 10
Their reference to such narratives does not necessarily reflect their conceptual understanding of mental illness. This difficulty in formulating a generalised interpretation was illustrated at length by one of the carers. She commented that many of the young persons acknowledged their difficulties with their feelings, cognitions, and symptoms like impaired sleep or flashbacks. Despite this awareness, many might not consider these difficulties as mental health disorder.
“I know a lot of them recognise that they feel sad and they’re not sleeping and they get flashbacks, but whether they recognise that’s just part of life…..
Sometimes they say depression or worried. PTSD they don’t, but they do refer to flashbacks…. it’s hard to know whether that’s just their English improving or whether they’ve conceptualised things differently. And language is so bound to your concepts, isn’t it anyway?” Carer 13
From the above description it seems that, the refugee young persons’ understanding of mental health and mental illness is variable. This ranges from lack of understanding of the concept as a whole to partial acknowledgement of the symptoms of mental health difficulties they have been experiencing, or a holistic view
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of this experience as part of an illness or disorder. Again, their perceptions did not seem to depend on their contact with CAMHS, as some young persons with significant contact had incomplete or mainly negative views of mental illness, whereas some of the young persons who shared comparatively more balanced understanding had only attended a small number of appointments prior to their participation. Young person 10, who had longer contact with CAMHS, and also was the only participant to be interviewed along with their carer, expressed a relatively better understanding of mental illness. Carers, in general, seemed to have an appreciation of the young persons’ struggle in having a full understanding of the concepts of mental illness. It is possible that their understanding of mental health and mental illness is constrained by the fact that English is their second language, thus making it difficult to articulate their perspectives; but it is also likely that this is influenced by their developmental age, their culture, and the healthcare system in their country of origin. Arguably, the extent of their understanding of mental illness will have an impact on their engagement with interventions and mental health services.