Abstract
There has been an increasingly large number of refugees in the U.S. and worldwide. Compared to the general population, historically, refugees presented a higher prevalence and incidence of mental disorders due to their traumatic/stressful experiences. However, the unmet needs of mental healthcare among refugees remain significant. The purpose of this study is to systematically review the current literature and identify the challenges that refugees were facing to receive mental healthcare in western countries as well as clinical and non-clinical ap- proaches that may effectively address their mental healthcare needs. A total of 79 peer-reviewed journal articles, reports, and book chapters published between 1985 and 2018 and obtained from major databases were included in the final analysis. Data were extracted and synthesized into categories of barriers for refugees to utilizing mental healthcare in the U.S. and other western countries, and effectiveness of current approaches to address refugees’ mental illnesses. Results indicated that the vast majority of barriers existed in both U.S. and other western countries were common. In response, four themes emerged to improve refugees’ utilization of mental healthcare, including adopting effective westernized trauma-focused mental health treatment; recognizing traditional and culturally relevant mental health coping mechanism; overcoming existing practical barriers within both refugee communities and western mental healthcare systems; emphasizing comprehensive/integrative mental healthcare models. Future endeavor should focus more on systematically integrating planned cultural competency training and education into existing curriculum, strengthening the quality of mental healthcare research with refugees, and advocating for funding support for mental healthcare services, training, and research.
Highlights
According to the United Nation Refugee Agency (UNHCR) (2018), currently, worldwide, approximately 65.6 million people have been forcibly displaced and hosted by countries or districts in Africa, Middle East and North Africa, Europe, Americas, and Asia and Pacific, which raised the annual financial burden up to 1.1 billion dollars in 2018 [1]
32 articles explicitly discussed the barriers to utilizing mental healthcare ser- vices among refugees resettled in western countries, 47 articles illustrated the effectiveness of mental healthcare approaches, and 8 articles discussed both
Refugees were not used to scheduling an appointment for their medical needs, having a long wait for their appointment, and following up with multiple counseling sessions for treatment, which was very different from the care they received in their home countries [24,25,26,27,28,29,30]
Summary
According to the United Nation Refugee Agency (UNHCR) (2018), currently, worldwide, approximately 65.6 million people have been forcibly displaced and hosted by countries or districts in Africa, Middle East and North Africa, Europe, Americas, and Asia and Pacific, which raised the annual financial burden up to 1.1 billion dollars in 2018 [1]. About 22.5 million people are refugees, and 55% of the refugees fled from countries, including Syria, Afghanistan, and South Sudan. In the United States, since 1975, more than 3 million refugees have been admitted and resettled throughout the country with about 40% being aged 17 years old or younger [2]. U.S refugees came from countries in Africa, Europe, Latin America and Caribbean, and Near East and South Asia. As of July 30, in the fiscal year of 2018, 5,0479 refugees have already been admitted to the U.S compared to a total of 8,4994 admissions in the fiscal year of 2016 [2]
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