In a groundbreaking initiative, Dr Arezoo Malihi’s AMRF-funded postdoctoral fellowship project "Capturing the Well-Being Dividend" delved into the mental health service utilisation and overall well-being of refugees in New Zealand.
Initially, Arezoo’s work aimed to evaluate service access and well-being indicators among refugees, immigrants, and the NZ-born population using comprehensive administrative and population-based datasets. However, significant data limitations, particularly concerning refugees, necessitated a pivot. She was then able to focus on analysing mental health service utilisation, incorporating insights on subjective well-being and barriers to access from available survey data.
Leveraging seven databases, including PRIMHD, NMDS, and the NZ Health Survey, Arezoo uncovered notable disparities in mental health service use. She found that quota refugees (those unable to safely live in their home country and resettled under the New Zealand Refugee Quota Programme as part of international humanitarian efforts) accessed mental health services earlier and more frequently after arrival compared to other refugee subgroups, though this trend diminished over time. Barriers such as transportation costs, financial constraints, and inadequate cultural or language support are and remain significant hurdles for refugees.
Arezoo’s research highlighted a stark contrast in psychological distress levels: 13.2% among refugees compared to 7.2% in the NZ-born population and 6.0% among immigrants, despite similar levels of life satisfaction. These findings underscore the urgent need for policy-level interventions to address inequities in mental health services, particularly for underserved refugee subgroups which is likely due to initial provision of specialist mental health services in the Mangere refugee centre. However, this trend diminished over time. Further studying NZ health survey showed that barriers such as transportation costs, financial constraints, and inadequate cultural or language support are and remain significant hurdles for refugees resettling in New Zealand.
This project has significantly advanced our understanding of mental health service utilisation patterns, key mental health issues, and the accessibility challenges faced by refugees compared to other groups in New Zealand. By highlighting key barriers to access through survey data and uncovering disparities in outcomes, the findings will inform discussions among policymakers and stakeholders, paving the way for evidence-based interventions to improve equity in mental health care.
The insights Arezoo has generated also catalysed further research, including longitudinal analyses of 1.5 and second-generation refugees (children and youth) to evaluate the long-term outcomes of compromised mental health service access and inconsistent service provision.
Additionally, gaps identified in administrative data (IDI) led to the development of a transdisciplinary research proposal that secured an additional $60,000 from the University of Auckland's Transdisciplinary Ideation Fund, as well as $30,000 from the Health Research Council's in a Health Delivery Research Activation Grant last December. The first new award funds a two-year pilot study to create a tailored survey and conduct qualitative interviews, laying the groundwork for larger studies to explore the intersection of cultural identity, integration complexities, and well-being using refugees’ voices as central to the research. The HRC funds will be used to investigate the second generation refugees’ mental health service utilisation and educational outcomes.
Arezoo says, “These ongoing and future investigations build upon the foundation established by this project, which has provided an invaluable opportunity to engage with former refugees and service providers in the sector. This collaboration ensures that the voices, concerns, and experiences of refugees and minority populations are meaningfully integrated into New Zealand’s health and social policy discussions and decision-making processes.
“I am profoundly grateful to the AMRF funders for their trust and generosity in supporting this fellowship. Their commitment to enabling research that directly benefits vulnerable communities has been instrumental to the success of this project. This work is a tribute to the resilience of refugees and a step toward fostering a more inclusive and equitable society.”
You can read more about Dr Malihi's mental health research journey here.