Many refugees struggling with trauma face barriers to accessing mental health care

As a young boy living in what was then Zaire, Bertine Bahige remembers watching refugees flee the Rwandan genocide in 1994 by crossing a river that forms the border between the two central African countries.

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

Bahige’s harrowing journey as a refugee 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 Congo in 1997. He escaped to age 15 in a refugee camp in Mozambique, where he lived for five years. years until arriving in Baltimore in 2004 as part of a refugee resettlement program.

Bahige, now 42, said the way he grew up was “just to buckle up and endure”, and he applied that philosophy to adapting to life in the United States. He held several jobs and took classes at a community college until he went to college. from Wyoming on a scholarship. He is now an elementary school principal in Gillette, Wyoming, and said his coping strategy then and now was to keep busy.

“In retrospect, I don’t even think I dealt with my own trauma,” he said.

Refugees are arriving in the United States in greater numbers this year after the number of resettlements hit a 40-year low under President Donald Trump. These newcomers, like the refugees who came before them, are 10 times more likely than the general population to suffer from post-traumatic stress disorder, depression and anxiety. Many of them, like Bahige, fled their home countries because of violence or persecution. They then have to deal with the mental cost of integrating into new environments as different as, well, Wyoming is from Central Africa.

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

“The type of system a person was living in can be completely different from the new life and the new system of the world they are living in now,” Bahige said.

Although their needs for mental health services are greater than those of the general population, refugees are much less likely to receive such care. Part of the shortfall comes from societal differences. But a significant factor is the overall shortage of mental health care providers in the United States and the myriad obstacles and barriers to obtaining mental health care that refugees face.

Whether they end up in a rural area like the Northern Rocky Mountains or an urban setting like Atlanta, refugees can face months of waits for care, as well as 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. Annual admissions have plummeted under the Trump administration, from about 85,000 in 2016 to 11,814 in 2020, according to the State Department.

President Joe Biden raised the cap on refugee admissions to 125,000 for the 2022 federal fiscal year, which ends September 30. With less than 18,000 arrivals at the start of August, this ceiling will probably not be reached, but the number of people admitted is increasing monthly.

Refugees receive a mental health screening, as well as a general medical assessment, within 90 days of arrival. But the effectiveness of these tests largely depends on an examiner’s ability to navigate complex cultural and linguistic issues, said Dr. Ranit Mishori, professor of family medicine at Georgetown University and senior medical adviser to Physicians for Human Rights.

Although trauma rates are higher in the refugee population, not all displaced people need mental health services, Mishori said.

For refugees struggling with the effects of stress and adversity, resettlement agencies like the International Rescue Committee provide support.

“Some people will come and seek services immediately, and some will not need them for a few years until they feel completely safe, and their bodies have adjusted, and the trauma response has begun. to dissipate a bit,” Mackinley Gwinner said. , the mental health navigator for the IRC in Missoula, Montana.

Unlike Bahige’s adopted state of Wyoming, which does not have refugee resettlement services, IRC Missoula has placed refugees from the Democratic Republic of the Congo, Syria, Myanmar, Iraq , Afghanistan, Eritrea and Ukraine in Montana in recent years. A major challenge in accessing mental health services in rural areas is that very few providers speak the languages ​​of these countries.

In the Atlanta suburb of Clarkston, which has a large population of refugees from Myanmar, the Democratic Republic of the Congo and Syria, translation services are more available. Five mental health clinicians will work alongside IRC social workers through a new program at IRC Atlanta and the Center for Prevention Research at Georgia State University. Clinicians will assess the mental health needs of refugees while social workers will help them with housing, employment, education and other issues.

Seeking mental health care from a professional, however, may be an unfamiliar idea for many refugees, said Farduus Ahmed, a Somali-born former refugee mental health clinician at the University of Colorado Medical School.

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

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

Long wait times, lack of cultural and linguistic resources, and societal differences have led some medical professionals to suggest other ways to meet the mental health needs of refugees.

Broadening the scope beyond individual therapy to include peer-to-peer interventions can rebuild dignity and hope, said Dr. Suzan Song, professor of psychiatry at George Washington University.

Spending time with someone who shares the same language or figuring out how to use the bus to get groceries is “incredibly healing and makes someone feel a sense of belonging,” Song said.

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

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

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 Counseling and Psychology Services.

The American Psychological Association, however, only conditionally recommends narrative exposure therapy for adult patients with PTSD, indicating 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 United States from Syria in 2016.

Alo was attending Georgia State while working full-time to support herself when the covid-19 pandemic began. While downtime during the pandemic gave him time to reflect, he lacked the tools to process his past, which included fleeing Syria and the threat of violence.

When his busy schedule resumed, he felt unable to deal with his newfound anxiety and loss of concentration. Narrative exposure therapy, he said, helped him deal with that stress.

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

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization not affiliated with Kaiser Permanente.


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