HomeHealthMental HealthMany refugees dealing with trauma face obstacles to mental health care

Many refugees dealing with trauma face obstacles to mental health care

Erica Zurek and Alander Rocha Kaiser Health News

As a young boy living in what was then Zaire, Bertine Bahige recalls seeing refugees fleeing the 1994 Rwandan genocide by crossing a river that forms the border between the two Central African countries.

“I didn’t know I’d be a few years later,” Bahige said.

Bahige’s harrowing refugee journey began when he was kidnapped and forced to become a child soldier when war broke out in his country, which became the Democratic Republic of the Congo in 1997. He escaped at the age of 15 to a refugee camp in Mozambique, where he lived for five years. years until he arrived in Baltimore in 2004 through a refugee resettlement program.

Bahige, now 42, said the way he grew up was to “just buckle up and fight it out,” and he applied that philosophy to adapt to life in the US. of Wyoming at a trade show. He is now principal of an elementary school in Gillette and said his coping strategy, then and now, is to keep himself busy.

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“In retrospect, I don’t think I ever worked through my own trauma,” he said.

Refugees are coming to the US in greater numbers this year after resettlement numbers under President Donald Trump hit a 40-year low. These newcomers, like the refugees before them, are 10 times more likely than the general population to have post-traumatic stress disorder, depression and anxiety. Many of them, like Bahige, fled their homeland because of violence or persecution. They then have to deal with the mental toll of integration into new environments that are as different as, well, Wyoming is from Central Africa.

This worries Bahige about the well-being of the new generation of refugees.

“The type of system a person lived in could be completely different from the new life and system of the world they live in now,” Bahige said.

Although their need for mental health care is greater than that of the general population, refugees are much less likely to receive such care. Part of the shortfall is due to social differences. But a big factor is the overall shortage of mental health providers in the US, and the myriad of barriers and barriers to receiving mental health care that refugees face.

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Whether they end up in a rural area like the Northern Rocky Mountains or an urban environment like Atlanta, refugees can wait months for care, plus a lack of clinicians who understand the culture of the people they serve.

Since 1975, approximately 3.5 million refugees have been admitted to the United States. According to the State Department, annual admissions during the Trump administration fell from about 85,000 in 2016 to 11,814 in 2020.

President Joe Biden raised the limit on refugee admission to 125,000 for the federal fiscal year 2022, which ends September 30. With fewer than 18,000 arrivals in early August, that ceiling is unlikely to be reached, but the number of people admitted is increasing monthly.

Refugees are screened for their mental health, along with a general medical assessment, within 90 days of their arrival. But the effectiveness of those tests depends largely on a screener’s ability to navigate complex cultural and linguistic issues, said Dr. Ranit Mishori, a professor of family medicine at Georgetown University and the senior medical advisor for Physicians for Human Rights.

Although the trauma rate is higher in the refugee population, not all displaced persons need mental health care, Mishori said.

For refugees dealing with the effects of stress and adversity, resettlement agencies such as the International Rescue Committee provide support.

“Some people will come in and ask for help right away, and some won’t need it for a few years until they feel completely safe, and their bodies have adjusted and the trauma response starts to subside a bit,” says Mackinley Gwinner. , the mental health navigator for the IRC in Missoula, Montana.

Unlike the Bahige-adopted state of Wyoming, which has no refugee resettlement services, IRC Missoula has in recent years placed refugees from the Democratic Republic of the Congo, Syria, Myanmar, Iraq, Afghanistan, Eritrea and Ukraine in Montana. A major challenge in accessing mental health services in rural areas is that very few providers speak the languages ​​of those countries.

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More translation services are available in the Atlanta suburb of Clarkston, which is home to a large population of refugees from Myanmar, the Democratic Republic of the Congo and Syria. Five mental health clinicians will work with IRC staff under a new program from the IRC in Atlanta and the Georgia State University Prevention Research Center. The clinicians will assess the mental health needs of refugees while the caseworkers assist with housing, employment, education and other problems.

However, seeking mental health care from a professional may be an unfamiliar idea to many refugees, said Farduus Ahmed, a Somali-born former mental health psychiatrist at the University of Colorado School of Medicine.

For refugees in need of mental health care, stigma can be a barrier to treatment. Some refugees fear that if US authorities find out they are struggling with mental health they could be deported, and some single mothers fear they will lose their children for the same reason, Ahmed said.

“Some people think looking for services means they’re ‘crazy,'” she said. “It’s very important to understand the perspective of different cultures and how they view mental health.”

Long waiting times, lack of cultural and language resources, and societal disparities have led some health professionals to propose alternative ways to meet the mental health needs of refugees.

Extending the scope of individual therapy to peer interventions can restore dignity and hope, said Dr. Suzan Song, a professor of psychiatry at George Washington University.

Spending time with someone who speaks the same language or figuring out how to use the bus to get to the grocery store is “incredibly healing and makes someone feel like they belong,” Song said.

In Clarkston, the Prevention Research Center is soon to launch an alternative that will allow refugees to play a more direct role in caring for the mental health needs of community members. The center plans to train six to eight refugee women as “lay therapists,” who will mentor and train other women and mothers using a technique called narrative exposure therapy to address complex and multiple trauma.

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The treatment, in which patients create a chronological narrative of their lives with the help of a therapist, focuses on traumatic experiences throughout a person’s life.

The therapy can be culturally adapted and implemented in underserved communities, said Jonathan Orr, coordinator of the mental health clinical counseling program at Georgia State University’s Counseling and Psychological Services.

However, the American Psychological Association only recommends conditional narrative exposure therapy for adult patients with PTSD, and advises that more research is needed.

But the method worked for Mohamad Alo, a 25-year-old Kurdish refugee living in Snellville, Georgia, after arriving in the US from Syria in 2016.

Al went to the state of Georgia while working full-time to support himself when the coronavirus pandemic began. While the downtime during the pandemic gave him time to think, he lacked the tools to process his past, which includes fleeing Syria and the threat of violence.

When his busy schedule got going again, he felt unable to cope with his newfound anxiety and loss of focus. The narrative exposure therapy, he said, helped him deal with that stress.

Regardless of treatment options, mental health is not necessarily the top priority when a refugee arrives in the United States. “If someone has lived a life of survival, the last thing you’re going to portray is vulnerability,” Bahige said.

But Bahige also sees resettlement as an opportunity for refugees to meet their mental health needs.

He said it is important to help refugees “understand that if they take care of their mental health, they can be successful and thrive in all facets of the life they are trying to create. Changing that mindset can be empowering, and it’s something I’m still learning.”

KHN (Kaiser Health News) is a national editorial that produces in-depth journalism on health issues. Together with Policy Analysis and Polling, KHN is one of the three major operational programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization that provides information on health issues to the nation.

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