This past summer I spent time with a startup organization developing a mental health program for refugees and asylum-seekers. It was an honor to have worked with the organization on expanding their services and programs. Refugees and asylum-seekers tend to neglect on their mental well-being. One reason is because their priorities are usually to find a home, jobs and education in their new countries. Second, many folks that grew up in non-Western cultures do not discuss their feelings and emotions with their family and friends. And lastly, the cost of mental health services are expensive and many do not see the value of spending their money on seeking help. I developed an educational booklet for people of all ages to help them understand their emotions. The book is translated to multiple languages and is distributed to new arrivals coming to the United States.
Mental health support is essential for our collective wellbeing, especially since the start of the pandemic. And for millions of refugees living on the margins of society, mental health care is needed now more than ever.
Mental health issues are a significant contributor to the stress of these vulnerable populations. It is essential to recognize that communities cannot recover or regain resilience without adequate support. This requires a close partnership between affected populations, organizations, and experts worldwide.
Stressors and mental health needs
Research shows that people who have access to mental health services after they arrive face better adjustment and integration in their new home country, which will lead to better outcomes for them and those around them.
But cultural barriers, lack of access to care, previous experiences with mental health, discrimination, and stigma, can frequently keep refugees from getting the care they need. Depending on their country of origin, experiences during travel, living conditions, amongst other factors, the needs and health issues of refugees may vary.
Refugees and asylum seekers may have been exposed to:
● Traumatizing events such as conflict and war
● Separation from family
● Loss of a family member
● A life-threatening journey to safety
● Long waiting periods
● Complexities with acculturation
However, refugee children, specifically those who have experienced trauma and adverse childhood experiences (ACE), have different developmental needs than their peers. Exposure to traumatic events shapes their development and can lead to various adverse outcomes throughout adolescence and adulthood, including anxiety, disruptive behavior, PTSD, and depression.
These factors and more put them at risk of developing psychological symptoms and mental health conditions that may persist for many years after they've resettled. The often traumatic reasons for leaving their host country, in addition to the long and hazardous journey of resettlement, only increases these risks for many mental health issues.
According to Refugee Health TA, The most common mental health conditions associated with refugees include:
● Post-traumatic stress disorder (PTSD)
● Major depressive disorder
● Generalized anxiety disorder, panic attacks
● Adjustment disorder
Refugees who are not educated already have a complex time understanding and treating certain illnesses and diseases in physical and mental health aspects. Alongside the barrier of lack of knowledge in physical health issues, many refugees deny mental illness existence, nor do many identify it as a part of their culture.
Even after resettling in their adopted country, the trauma continues to inflict damage to their mental health. And without adequate, culturally appropriate mental health care to accommodate the needs of resettled refugees, their mental health will exacerbate.
Systems of care for mental health
Refugees face several challenges when accessing medical and mental health services, as the current systems are not always specifically designed to meet their needs. While it may be challenging to address all challenges that refugees face in accessing these services, there are several areas where minor improvements can help tremendously.
Health education is a huge need within the nonprofits that cater to refugees. Not holistically addressing the wellbeing of refugees will cause secondary, intergenerational effects, alongside individual suffering resulting in social problems.
Work in partnership with the other social, cultural, and family supports. Improving all of these areas can be very helpful in improving mental health issues. However, due to cultural differences, language barriers, clinicians are having difficulty learning about patients' symptoms and understanding coping methods, increasing the chance of misdiagnosis.
The role of the clinician
Culturally aware: Clinicians working with refugees should be knowledgeable in cultural contexts. Many health care specialists are undergoing training to understand better how patients can express distress and illness.
Clear, concise language: Clinicians should be mindful of the ongoing stressors that one may face and overcome communication barriers by using simple, concrete language and focusing on the symptoms rather than diagnosis.
Educate and inform: Because the refugee experience is one of disempowerment, a clinician shouldn't assume there's an understanding of the context of a medical encounter and should clarify what their role is and what their intentions are.
Mental health is public health
And although there is still a lot of work to be done, it’s important that we use innovative methods, training and research to address the mental health needs of refugees, here and abroad.
Keywords: mental health, refugees