To our knowledge, this is the first longitudinal study of experiences of specific social support types received by humanitarian migrants and their mental health in a high-income host country.
Medium- and long-term benefits for mental health
Our findings show that increased emotional/instrumental support received in the initial phase of resettlement (three to six months) may be more beneficial for mental health in the medium-term (first three years of resettlement). This observation could reflect the sudden loss in emotional and instrumental support from family and community that humanitarian migrants feel after displacement, which may be more pronounced during the initial years of resettlement [
37]. This loss of support may increase psychological distress as experienced by resettled Sudanese refugees in Canada [
37]. Our findings also demonstrate that more informational support received three years after resettlement is beneficial for the long-term mental health (five years after resettlement) of humanitarian migrants. Hence, knowledge on how to integrate and thrive in society may enable a greater sense of control over their lives and improve long-term mental health [
8].
For humanitarian migrant women, we found more informational support received within three to six months of resettlement improved mental health five years after resettlement. This finding suggests more focused informational support in the initial months of resettlement is beneficial for the long-term mental health of women. As observed in a group of Syrian refugee women, those who received more informational support when they were first resettled were able to problem-solve more efficiently and had greater control over their lives which reduced psychological distress [
8,
38].
For men, informational support received three years after resettlement was beneficial for their mental health five years after resettlement. This observation was not made between social support types received in the initial months of resettlement and long-term mental health. Hence, our finding may indicate that informational support is more important for mental health of men years into resettlement after they would have exited formal services such as the HSP.
Among humanitarian migrants aged 18 to 29 years old, emotional/instrumental support received three to six months after resettlement was beneficial for mental health three years after resettlement. In contrast, among humanitarian migrants aged between 45 to 75 years old, informational support received three to six months after resettlement was beneficial for mental health five years after resettlement. Our findings suggest different types of social support provisions may benefit the mental health of younger and older humanitarian migrants [
39]. Minicuci et al. [
40] found less received financial support to be significantly associated with depression in older men; however, emotional support provisions were not associated with mental health [
40]. In Australia, Bartolomei [
41] highlights insufficient provisions of support after resettlement, such as knowledge of how systems operate and the rights of refugees, and lack of clear advice on how to access benefits and seek employment affected the mental health of older Sudanese refugees. We found no effect of social support on psychological distress among people aged between 30 to 44. Other forms of support not included in this study, such as financial or childcare support, could have a greater effect on the mental health of humanitarian migrants aged between 30 and 44, given that this age group could most likely be parents and in paid employment. However, further research would be needed to determine whether these forms of support are associated with mental health in this age group.
For humanitarian migrants with refugee status, informational support received three to six months after resettlement was beneficial for their mental health five years after resettlement. For humanitarian migrants who arrived in Australia as asylum seekers, we found informational support received three years after resettlement improved their mental health five years after resettlement. We also found more emotional/instrumental support received three to six months after resettlement improved the mental health of refugees three years after resettlement. Our observations indicate that specific sources of emotional/instrumental and informational support received by refugees in the initial months of resettlement are beneficial for their medium- and long-term mental health. However, asylum seekers may require more informational support provisions years into resettlement to benefit their long-term mental health.
Subgroups who receive more (or less) specific social support types
Our findings demonstrate that those with lower English proficiency received less of each form of social support at all time points. Older humanitarian migrants received less informational support across all times and less emotional/instrumental support three and five years after resettlement.
Women received more emotional/instrumental support compared to men across all time points, and humanitarian migrants residing in regional Australia than in major cities within the initial months of resettlement. Those with refugee status also received more emotional/instrumental support three and five years after resettlement than those who arrived as asylum seekers.
Humanitarian migrants born in Central Asia received less emotional/instrumental support than humanitarian migrants born in Africa at every time point. Those with 12 or more years of schooling also received less emotional/instrumental support compared to those with six or fewer years of schooling during initial resettlement and after five years of resettlement.
More informational support was provided to men than women and individuals with 12 or more years of education compared to those with six or fewer years of schooling at each time point.
Less informational support was provided to humanitarian migrants who received government payments as their main source of income than those who were reliant on their own or their spouse’s salary or savings when they were initially resettled and at five years after resettlement. Less informational support was also provided to humanitarian migrants who arrived in Australia as refugees compared to those who arrived as asylum seekers in the first five years after resettlement, and those born in South-East Asia than humanitarian migrants born in Africa across all time points.
Why certain subgroups may receive more (or less) social support
The Australian Government provides mainstream social support services to Australians, which includes health and aged care services, housing, transportation, education, employment and training, and childcare and support [
42]. Accessibility to these services is often facilitated by financial benefits delivered predominantly by the Centrelink Master Program, an Australian Government agency providing government payments and services for eligible groups such as students, the unemployed, and people from diverse cultural and linguistic backgrounds [
43]. Employment support is facilitated by the Australian Government’s mainstream employment service Jobactive, which seeks to connect job seekers with employers [
44]. Furthermore, all Australians have access to Medicare, the universal health care insurance scheme in Australia [
45]. While humanitarian migrants have access to specialised settlement services upon arrival, such as the HSP and SETS, they may also be able to access these mainstream services. However, eligibility for these mainstream support services depends on humanitarian migrants’ visa type [
46].
Refugees and humanitarian migrants with a valid visa are granted the right to reside temporarily or permanently, work, and study [
47]. They may also have access to government benefits such as Centrelink, Jobactive and Medicare [
47]. However, those who have entered Australia without a valid visa and are, thus, seeking asylum and awaiting the outcome of their visa application, may not have access to most formal, mainstream social services [
48]. Instead, they can access the Status Resolution Support Services (SRSS), a program that offers temporary needs-based support in accessing accommodation, healthcare and education for children, and financial benefits [
49,
50].
In addition to mainstream support services, Australians also receive informal sources of support from their neighbours, family, and social networks [
51]. In 2021, 10% of Australians provided informal support as an informal carer, a person who assists in carrying out tasks, provides transportation, and in-home supervision [
52]. In addition, 24% of Australians also provided informal support through volunteering with organisations such as sports, recreation, education and training [
51]. Though these informal sources of support are often less accessible by humanitarian migrants, especially those newly-arrived or with no pre-existing connections such as extended family, existing ethnic community in the host country [
53].
From our findings, in Australia, older humanitarian migrants may be provided with less social support because they may find it more difficult to navigate support services such as finding accommodation and accessing financial support [
41]. This could be due to a lack of knowledge or understanding of how the Australian system functions compared to younger humanitarian migrants [
41]. This support may not be readily provided or available to them [
41]. Older Sudanese refugees have reported not having anyone to help them in their neighbourhood after resettlement in Australia [
41].
Humanitarian migrants who are more proficient in English may know how to navigate support systems more effectively than those with less proficiency in English. Studies have demonstrated the difficulty experienced by migrants in engaging with services without some fluency in the host language, which limits access to resources [
39,
54]. The lack of readily available and affordable interpreters to assist humanitarian migrants in engaging with services may further limit access to services for those with lower English proficiency [
55]. The Adult Migrant English Program (AMEP) in Australia provides free English language training to permanent protection visa holders to improve their English skills. However, only a maximum of 510 hours of English tuition were offered to each humanitarian migrant throughout the BNLA study period [
56]. This was insufficient for humanitarian migrants to gain a level of proficiency required for success in employment and education [
34]. Since April 2021, the AMEP has been reformed to allow unlimited English tuition until migrants reach a level of English needed to succeed in vocational education and training [
56].
Humanitarian migrant men were provided with less emotional/instrumental support services and more informational support than women which could indicate a difference in service provision between men and women [
8,
57]. The complex nature of service delivery and lack of flexible access to services catering to the specific circumstances of humanitarian migrant women [
58] could explain why they received less informational support than men. In Australia, resettled refugee and migrant women may bear greater responsibility than men in maintaining the household and providing childcare, which could impede their access to English language training, and finding and retaining employment [
58]. This dynamic can persist years into resettlement and can often result in women finding precarious employment whilst lacking sufficient knowledge on their rights, and how to seek secure employment [
58].
In an online survey of service providers, De Maio et al. [
58] also demonstrates that humanitarian migrant women face barriers such as low English language skills, location and transport issues, and family responsibilities to a greater extent than Australian-born women when accessing support services. This is reflected in humanitarian migrant women’s lower employment rate than Australian-born women when comparing women with similar education levels and the same number of children [
58]. While services are available to migrant women, such as language classes and parenting support, they may not be aware of these services nor confident in accessing them [
58]. Men may receive less emotional/instrumental support because services that provide such support may not be readily available and accessible to men as they may be to women. Our finding is consistent with previous studies demonstrating that women offer and receive more emotional support than migrant men [
59,
60]. While migrant and refugee women are also more likely to seek help than men [
61], further research is needed on why humanitarian migrant men may receive less emotional/instrumental support.
Humanitarian migrants residing in regional areas of Australia received more emotional/instrumental support within the initial months of resettlement which could be explained by the regional resettlement scheme, a government-led effort to revitalise regional areas and provide a welcoming community [
62]. Refugees residing in regional areas of Australia have identified friends, family and a welcoming community as reasons to remain in those regions [
62].
Differences in provisions of social support for humanitarian migrants may also be present for those with different cultural backgrounds. From 2010 to 2011, many government grants for the SETS program focused on African communities [
63]. These grants may have assisted in supporting African communities in Australia and could explain the higher level of support received by African communities compared to other ethnic communities [
64]. Furthermore, in Australia, De Maio et al. [
58] found that service providers may lack training on the cultural specificity of different humanitarian migrant ethnic groups which is required to deliver appropriate and adequate support. Our finding is also consistent with a study in the United States demonstrating the variation in social support provided from family and friends to immigrant minority groups based on ethnicity [
65].
Humanitarian migrants with six or fewer years of education or who are reliant on government payments may find it challenging to engage with support services. These services may not be designed to accommodate a range of education levels or financial situations [
41,
55]. For example, humanitarian migrants often need to pay for an interpreter when engaging with services as they are not readily provided [
55]. Furthermore, low education levels, unemployment and low income have been associated with less received support [
60]. In contrast, humanitarian migrants with six or fewer years of education may be provided with more emotional/instrumental support compared to those with 12 or more years of education which could indicate more focused emotional/instrumental support from providers for those who are less educated. However, further investigation into this observation may be needed to understand why those with fewer years of education received more emotional/instrumental support.
Similarly, further investigation into the difference in social support provisions between refugees and asylum seekers on permanent protection visas is needed. Our findings indicate asylum seekers may not be provided with sufficient emotional/instrumental support within the first three years of resettlement and those with refugee status may not be provided with sufficient informational support three or more years after resettlement. However, literature on the difference in social support service provision between humanitarian migrants who arrive in a host country as refugees or asylum seekers is limited.