June 20th marked World Refugee Day. Around the world, events acknowledged the nearly 44 million persons who have been forcibly displaced as well as the 60th anniversary year of the United Nations High Commission for Refugees (UNHCR). In the United States and other resettlement countries, World Refugee Day is an opportunity to raise awareness of refugees in our communities, to share cultural traditions and to celebrate the many contributions refugees make each day as they rebuild lives. At the Refugee Health Technical Assistance Center (RHTAC), we honor refugees who work to foster healthy refugee communities and the many, many refugees we collectively serve.
Refugee Mental Health
Since 2000, over 600,000 refugees have been settled throughout the United States, coming from countries as disparate as the former Soviet Union, Somalia and Vietnam. The often traumatic reasons for leaving the host country as well as the potentially long and hazardous journey and resettlement process increase the risk for refugees to suffer from a variety of mental health issues. Identification and treatment of mental health problems has lagged far behind screening and treatment for infectious diseases. Complex and varied cultural contexts and languages, scattered refugee populations and the relative lack of evidence-based interventions have made it difficult to carry out concerted and standardized efforts.
The more common mental health diagnoses associated with refugee populations include post-traumatic stress disorder (PTSD), major depression, generalized anxiety, panic attacks, adjustment disorder and somatization. The incidence of diagnoses varies with different populations and their experiences. Different studies have shown rates of PTSD and major depression in settled refugees to range from 10-40% and 5-15%, respectively. Children and adolescents often have higher levels with various investigations revealing rates of PTSD from 50-90% and major depression from 6-40%. Risk factors for the development of mental health problems include the number of traumas, delayed asylum application process, detention and the loss of culture and support systems.
Traditionally the refugee experience is divided into three categories: preflight, flight and resettlement. The preflight phase may include physical and emotional trauma to the individual or family, the witnessing of murder and social upheaval. Adolescents may also have participated in violence, voluntarily or not, as child soldiers or militants. Flight involves an uncertain journey from the host country to the resettlement site and may involve arduous travel, refugee camps and/or detention centers. Children and adolescents are often separated from families and at the mercy of others for care and protection. The resettlement process includes the loss of culture, community and language as well as the need to adapt to a new and foreign environment. Children may learn new languages and cultural norms more quickly than their elders. All of these experiences may play a role in the acquisition of, or protection from mental health conditions in each individual within a refugee population.
Challenges in the detection and effective treatment of mental health problems in refugees include language and cultural barriers between the refugee and provider and a lack of evidence-based treatment strategies. Much work remains in developing culturally competent means of screening refugees for mental health issues and implementing evidence-based interventions at an individual and community level for these common and frequently debilitating diagnoses.
It is RHTAC's hope that you, as stakeholders in this issue, will continue to contribute to this effort by engaging in discussion and sharing best and promising practices. Moving forward, RHTAC intends to provide you with more resources, including screening tools and approaches, and facilitate this dialogue so that we may work toward improving the mental health of refugees.
News, Conferences & Trainings
Temporary Protected Status (TPS) for Haitians
Secretary of Homeland Security Janet Napolitano announced the extension of Temporary Protected Status (TPS) for Haiti beneficiaries as well as opportunity for new applications from Haitians who have continuously resided in the United States since January 12, 2011. TPS beneficiaries will be allowed to remain in the United States through January 22, 2013.
July 27, 2011, 2 PM EDT
Webinar: Addressing the Mental Health Needs of Refugees in Primary Care Settings
Presenters: Allen Keller, M.D., and Samantha Stewart, M.D.
August 1-2 2011, Washington D.C.
ORR 2011 National Consultation: Bridges to a New Future
August 1-26, 2011, University of Minnesota, Minneapolis, Minnesota
In-Person Global Health Course
October 24-26, 2011, Seattle, Washington
4th Annual National Immigrant Integration Conference 2011
November 7-8, 2011, Chicago, Illinois
National Refugee and Immigrant Conference: Issues and Innovations
Due August 1, 2011
Voluntary Agencies Matching Grant Program
The Administration for Children and Families (ACF), Office of Refugee Resettlement (ORR) is soliciting applications for the implementation of the Voluntary Agencies Matching Grant Program. The Voluntary Agencies Matching Grant Program is an alternative to public cash assistance providing services to enable ORR-eligible populations (refugees, asylees, Cuban and Haitian entrants, certain Amerasians from Vietnam, Victims of Severe Forms of Trafficking, and Special Immigrant Visa Holders (SIVs)) to become economically self-sufficient within 120 to 180 days of program eligibility. Services required under this program include, but are not limited to, case management, employment services, maintenance assistance and cash allowance, and administration.
Addressing the Mental Health Needs of Refugees in Primary Care Settings
with Allen Keller, M.D. and Samantha Stewart, M.D.
Wednesday, July 27, 2011
2:00-3:15 pm EDT
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Webinar (slides and recordings)
HIV and Refugee Resettlement (Webinar - June 23, 2011)
Suicide Among Refugees: Understanding the Social and Cultural Context for Prevention Strategies (Webinar - May 17, 2011)
Guidelines for Mental Health Screening during the Domestic Medical Examination for Newly Arrived Refugees
Centers for Disease Control and Prevention (CDC), 2011
Rapid Assessment of Mental Health Needs of Refugees, Displaced and Other Populations Affected by Conflict and Post-Conflict Situations
World Health Organization (WHO), 2000
Review of Refugee Mental Health Interventions following Resettlement: Best Practices and Recommendations
American Journal of Orthopsychiatry, Vol. 80, No. 4,
Mental Health of Immigrants and Refugees
Community Mental Health Journal, Vol. 41, No. 5, October 2005
Mental Health Interventions for Refugee Children in Resettlement National Child Traumatic Stress Network Refugee Trauma Task Force, 2005
International Family, Adult, and Child Enhancement Services (FACES): A Community-based Comprehensive Services Model for Refugee Children in Resettlement
American Academy of Child
and Adolescent Psychiatry, Vol. 78, No. 1, 2008
Review of Child and Adolescent Refugee Mental Health
American Academy of Child
and Adolescent Psychiatry, Vol. 43, No. 1, January 2004