Over the next several years, the US will become home to nearly 70,000 Bhutanese refugees who have been driven out of their country, with up to 10,000 people who will likely resettle in North Carolina. These facts, and a recent trip to Nepal by Duke faculty members, helped to cultivate a possible DGHI project focused on the mental health needs of refugees.

 

In an effort to explore potential research opportunities, DGHI Associate Director of Research John Bartlett, Suzanne Shanahan of the Kenan Institute for Ethics and Fiona Terry, humanitarian leader and Kenan Practitioner-in-Residence in fall 2009, visited a refugee camp in eastern Nepal in April.

 

"The fact that this population has great disparities and will be resettling in

our backyard after spending 18 years in the camps has spurred our interest," said Bartlett, "to better understand the needs of refugees." (View photos)

 "DGHI wants to engage in research and service projects that focus on the health needs of the refugees, the challenges they face in the camps, and the issues they arrive with in North Carolina and the Triangle area," said Bartlett. "Our trip to Nepal has verified that there are, for example, significant mental health needs in the camps."

At a recent Global Health Exchange event recapping the trip, Bartlett presented research on the prevalence of post traumatic stress disorder, anxiety and depression among the Bhutanese population, especially among refugees with a history of torture during the expulsion from their home country. During the trip, Bartlett was surprised to find that some mental health services already exist in the refugee camps and is jointly being provided by Transcultural Psychosocial Organisation (TPO) and the Asian Medical Doctors Association (AMDA). "I had the sense that services were lacking," said Bartlett. "But, we found that mental health services were well-coordinated between TPO and AMDA to address counseling needs and use of medications. We certainly have something to learn from this approach."

The mid-level provider from AMDA sees approximately 50-60 patients one day per week and prescribes a variety of treatments, including antipsychotics and antidepressants, in addition to counseling and bi-weekly home visits by TPO community workers. However, mental health records are not well-documented and existing data on diagnoses related to mental health interventions and health outcomes are largely unavailable to the public.

DGHI is exploring the possibility of helping with improved documentation of mental health services in refugee camps, as well as providing additional training for therapeutic group leaders and mid-level management of medications. In light of other concerns about gender-based violence and alcohol abuse in the camps, the Institute may also work with its partners to provide a community-based algorithm for alcohol detoxification.