28 March 2018

GPs carrying burden of refugee disconnect

General Practice Mental Health

GPs seeing an increase in refugee patients with complex health needs are carrying the burden of poorly coordinated resettlement services.

In western Sydney’s Fairfield area, up to 7000 Syrian refugees have arrived in the past 18 months, says Professor Mark Harris, Scientia Professor at the University of NSW School of Medicine.

“The Arabic-speaking GPs in Fairfield are feeling a bit overwhelmed. They are not getting one or two new patients, but dozens. You can imagine what that does to a GP’s working day,” Professor Harris said.

“Patients will talk to GPs about housing, schools, finding work, the challenges they have – which is good, but the role of the GP is not to solve those problems but to put people in touch with services that can help them.”

However, poor communications at every level of the system make the situation more frustrating for new arrivals and often result in poor continuity of care.

Because of the disconnect between specialised refugee services and primary care, the growing numbers of sponsored refugees presented a special challenge, Professor Harris said.

“Sponsored refugees are brought along by their sponsor to a GP who speaks their language. These GPs are saying they are spending a lot of time sorting out their problems, such as housing.

“Someone who has been through a specific refugee health service will have their initial problems sorted out. Their immunisations will be up to date. They will have been checked for TB.

“By the time a GP sees them, those things will have been sorted out fairly quickly and they are linked up with housing and various community programs.

“But if they don’t go through that pathway, the GPs say, they are often complex; a lot of them have PTSD, or at least they have depression and anxiety about their families.”

Under Australia’s humanitarian refugee program, some 140,000 refugees were accepted in the 10 years to 2015. A further 29,000 were claiming asylum at the end of 2016.

Asylum seekers – those seeking international protection but whose status is undetermined – lack access to Medicare and working rights.  Some work illegally and can be exploited by employers who might pay cash at half the minimum wage.

“They can get Medicare for a period of time when their case is at a certain stage, for example, while they are waiting for a tribunal hearing.   They might get it for six weeks and go off it again. It is better than not having it all, but it is very disruptive.”

Professor Harris, who works one day per week as a volunteer GP at the non-governmental Asylum Seeker Centre in Sydney, a role he has filled for the past 18 years, says GPs dealing with refugees need to form relationships with specialised refugee health services run by state authorities.

Primary Health Networks also provide support and connections. “We had a workshop for GPs on refugee mental health last week,” Professor Harris said.

“Many of them didn’t know about STARTTS (the NSW Service for the Treatment and Rehabilitation of Trauma and Torture Survivors) for example. We need more of that education happening.”

Some GPs attending the workshop, in Canterbury, in southwestern Sydney, had refugees accounting for a quarter of their patients.

The PHN organised speakers with expertise on Syrian and Rohingan refugees, who are prominent among newcomers in the area.