Many Traumatised Refugees Face Barriers To Mental Health Care

Bertine Bahige, born in what was then Zaire and grew up there, witnessed Rwandan refugees crossing the river separating the two Central African states as they fled the 1994 genocide.

That’ll be me a few years from now,” Bahige remarked.

When conflict broke out in Bahige’s native country—which became the Democratic Republic of the Congo in 1997—he was abducted and forced to become a child soldier. By age 15, he had escaped to a refugee camp in Mozambique, where he stayed for five years until he resettled in Baltimore.

Bahia, now 42, said he adopted the American way of life with the same mentality as a child: “just belt up and tough it out.” Before getting a ride to the University of Wyoming, he held down several jobs and enrolled in community college. He is the principal of an elementary school in Gillette, Wyoming, and has remarked that being active has helped him through difficult times in the past and currently.

“I don’t even believe I coped with my trauma,” he said, looking back.

After reaching a 40-year low under President Donald Trump, the number of refugees entering the United States this year is higher. Like the migrants who came before them, the new newcomers are ten times more likely to suffer from PTSD, depression, and anxiety than the average population. Some, like Bahige, had to leave their homes due to persecution or violence. And then there’s the mental toll of adjusting to places as dissimilar to Wyoming as Central Africa is.

Bahige now fears for the future of the next generation of refugees.

“The kind of system that a person lives in can be radically different than the new life and system of the world they live in now,” Bahige added.

Although they have a more significant need for mental health services than the average population, refugees are significantly less likely to obtain treatment. Social factors can explain some of the deficits. However, many refugees have challenges accessing mental health services due to a lack of available physicians and other factors.

When seeking medical attention, migrants may have to wait months, regardless of whether they wind up in a remote place like the Northern Rocky Mountains or an urban environment like Atlanta.

About 3.5 million refugees have been allowed into the United States since 1975. According to the State Department, yearly admissions fell during the Trump administration, from over 85,000 in 2016 to 11,814 in 2020.

Many Traumatised Refugees Face Barriers To Mental Health Care

For the 2022 federal fiscal year, which ends on September 30th, President Joe Biden increased the limit on refugee admissions to 125,000. The number of new entrants has been rising steadily each month, though it is unlikely to reach the 20,000 cap by the beginning of August when only about 18,000 individuals have so far been expected.

Within the first 90 days after their arrival, refugees are given a complete medical examination, including a mental health screening. Yet, according to Dr. Ranit Mishori, a professor of family medicine at Georgetown University and the senior medical consultant for Physicians for Human Rights, the success of such screenings is highly dependent on the screener’s ability to handle complex cultural and language challenges.

Refugees experience more excellent rates of trauma than the general population, but not all of them require mental health care, Mishori argued.

Support is available from resettlement organizations like the International Rescue Committee for refugees suffering from the impacts of stress and trauma.

Mackinley Gwinner, the IRC’s mental health navigator in Missoula, Montana, stated, “Some people will come in and instantly need treatment, and some won’t require it for a few years until they feel entirely secure, and their body has adjusted, and the trauma reaction has started to subside a little bit.”

Refugees from the Democratic Republic of the Congo, Syria, Myanmar, Iraq, Afghanistan, Eritrea, and Ukraine have all been resettled in Montana thanks to the International Rescue Committee (IRC) work in Missoula. There are no such services in Bahige’s adoptive home of Wyoming. A significant barrier to receiving mental health care in rural locations is the scarcity of clinicians who are fluent in the local language.

Because of the high concentration of refugees from Myanmar, the Democratic Republic of the Congo, and Syria in the Atlanta suburb of Clarkston, language assistance is more widely offered there. In a new initiative from the IRC in Atlanta and the Prevention Research Center at Georgia State University, five mental health physicians will work with IRC caseworkers. Clinicians will evaluate the psychological care required by refugees whose caseworkers also address concerns of housing, job, education, and other necessities.

According to Farduus Ahmed, a former refugee mental health therapist from Somalia who now works at the University of Colorado School of Medicine, the notion of seeking professional help for mental health issues is foreign to many refugees.

Stigma can be a significant obstacle for refugees seeking mental health care. When asked about the concerns of refugees and single moms, Ahmed noted that some are afraid of being deported if U.S. officials learn that they are experiencing mental health issues.

Some people assume that getting help means you’re insane, she added. “It’s crucial to learn how people from various cultural backgrounds see mental health care.

For various reasons, including lengthy wait periods, a shortage of cultural and linguistic resources, and social inequalities, several medical experts have proposed non-traditional approaches to meeting the mental health needs of refugees.

Dr. Suzan Song, a professor of psychiatry at George Washington University, argues that expanding treatment beyond individual therapy to incorporate peer interactions is an effective way to restore pride and optimism.

Time spent with a language partner or learning to use public transportation to the grocery store is “very soothing and helps someone to have a feeling of belonging,” according to Song.

The Prevention Research Center of Clarkston is launching a new program to provide refugees with a more significant opportunity to meet the community’s mental health care needs. Six to eight women from the refugee community will be trained to become “lay therapists” and advise and coach other women and mothers in using narrative exposure therapy to treat complex and multiple traumas.

Treatment involves patients writing a life story in chronological order with the guidance of a therapist, with an emphasis on traumatic events that have occurred during the patient’s life.

Jonathan Orr, a coordinator of the clinical mental health counseling department at Georgia State University’s Counseling and Psychological Services, said that the technique might be modified for impoverished populations.

Despite its promise, the American Psychological Association (APA) has issued a qualified recommendation for narrative exposure therapy in treating PTSD in adults, stating that additional study is needed in this area.

However, this strategy was successful for Mohamad Alo, a 25-year-old Kurdish refugee currently residing in Snellville, Georgia, after having fled Syria in 2016.

Alo was a full-time student at Georgia State University and a worker when the covid-19 epidemic hit. Pandemic downtime provided him with an opportunity for introspection, but he lacked the resources to deal with his troubled history (which included escaping Syria and the danger of violence).

When things at work began back up, he found himself overwhelmed with worry and unable to concentrate. He found that story exposure treatment helped overcome his anxiety.

Mental health care is sometimes not given first attention when a refugee arrives in the United States, even if effective treatment alternatives are available. Bahige remarked, “When someone has lived a life of survival, the last thing you’re going to depict is vulnerability.”

Bahia, however, thinks that relocation provides a chance for refugees to deal with their emotional well-being.

He stressed the significance of educating refugees on the importance of maintaining positive mental health to achieve success in all areas of the new life they are attempting to build. That’s why I’m working so hard to learn how to shift my perspective and embrace the liberating effects of doing so.

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