ST. PAUL, Minn. — While many fortunate refugees manage to escape their home countries and relocate to safe and stable ones, their struggle continues. Even though their physical suffering has ended, refugees often suffer long term, negative, and overlooked mental health problems.
A refugee, according to a definition provided at the Refugee Convention, is someone who “owing to a well-founded fear of being persecuted… is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country.”
According to the Office of Refugee Resettlement, since 1980 the U.S. has admitted more than 2 million refugees, with as many as 75,000 admitted annually. The United Nations created a specialized U.N. Refugee Agency, a branch originally intended to aid World War II refugees. Since then, the U.N. Refugee Agency has given protection and assistance to tens of millions of refugees.
While rehabilitators may fear that making refugees talk about their previous lives will be too traumatic, refugees themselves have spoken out with the message that they want the historical causes of their symptoms acknowledged.
Dr. Patricia Shannon of the Center for Victims of Torture in St. Paul, Minnesota, states this about the center’s patients:
“Refugees who have survived torture may suffer in silence for decades before finding help for their mental health symptoms…. Primary care physicians can play a huge role in helping to identify refugees in need of mental health services earlier in their resettlement process.”
Dr. Megan Berthold from the University of Connecticut School of Social Work has published research on her work with Cambodian refugees, reporting that “it is vital the physicians directly ask refugees about their mental health, this should be done using straightforward language about symptoms that are commonly experienced, avoiding the use of the terms ‘mental health’ or ‘mental illness’ as those are stigmatizing in many cultures.”
She later goes on to explain how the trauma many of the refugees have gone through makes it difficult for them to trust other people in their new environment, including healthcare providers. Because of this, physicians should take their time in order to build a strong, trusting and therapeutic relationships with their refugee patients.
It is suggested that – even if not explicitly requested – each refugee should go through an initial health screening. Displaced persons are more likely to face health problems than others, especially problems stemming from poverty and impoverished conditions. These health problems include depression, substance abuse, HIV/AIDS, psychological trauma and other diseases.
This “preventive intervention” is requested in order to make the refugee’s transition go more smoothly, but it needs to be conducted thoughtfully. While screening patients, the physicians, psychiatrists or anyone involved in the process need to keep in mind the refugee’s cultural background. Refugees are going through a social, economic and cultural transition, and having basic knowledge of their cultural values, traditions, beliefs and practices will help their transition immensely.
One important part of refugee recovery often overlooked by the U.S. health care system is the involvement of the patient’s family. Dr James Griffith, who works with Program for Survivors of Torture and Severe Trauma, speaks about this issue:
“Outside of North America, the social unit for health care is the family. Perhaps the greatest error in our U.S. systems of health care and mental health care for immigrants and refugees is failing to engage families in provision of care. One must appropriately protect confidentiality and act with the patient’s permission. However, meeting with parents, siblings, extended family to hear their concerns, provide information, and engage them usefully in care of the patient is perhaps the greatest single step that could be taken to improve quality of care for immigrants and refugees.”
Another question that needs to be kept in mind is whether or not their modes of transition are working. Refugees are experiencing many stressors (traumatic, economic, familial, community, work and school), and have multiple systems attempting to help (resettlement agencies, schools, clinics, neighbors, families, workplaces and welfare). While none of the systems can address every issue a refugee is facing, taking account of these other dimensions and the communication between them can prevent the systems from clashing or creating negative effects in the long run.
While a refugee’s success in escaping his or her current situation is worth celebrating, if we can focus on the mental health of refugees, we can help ease the path to a successful transition for these displaced people.