Mental Health Services For Refugees Research Articles

Perceived discrimination and its association with self-rated health, chronic pain, mental health, and utilization of health services among Syrian refugees in Norway: a cross-sectional study.

There is a scarcity of research on discriminatory experiences and their association with health outcomes among Syrian Refugees in Norway. Thus, this study aims to examine the relationship between perceived discrimination, self-rated health (SRH), chronic pain, poor mental health, and healthcare utilization among Syrian refugees resettled in Norway. Cross-sectional data from the Integration for Health project were analyzed, including 154 Syrian refugees who resettled in Norway in 2018-19. Perceived discrimination, SRH, chronic pain, psychological distress, post-traumatic stress symptoms, and healthcare visits were assessed. Statistical analyses, including Poisson regression and multinomial logistic regression, were conducted. The significant statistical level was set at 0.05. Approximately 30% of participants reported experiencing discrimination, with no significant associations between sociodemographic factors and perceived discrimination. Perceived discrimination was significantly associated with psychological distress (adjusted PR: 2.07, 95%CI: 1.21-3.55), post-traumatic stress symptoms (adjusted PR: 11.54, 95%CI: 1.25-106.16), and 4 or more psychologist visits (adjusted OR: 12.60, 95%CI: 1.72-92.16). However, no significant associations were found between perceived discrimination and SRH; pain symptoms, or general healthcare utilization. Experienced discrimination is highly prevalent and seems to be associated with mental health outcomes, but not clearly with SRH, pain, or general healthcare visits among Syrian refugees living in Norway. Efforts should focus on reducing discrimination, promoting social inclusion, and improving access to mental health services for refugees. Public awareness campaigns, anti-discrimination policies, and cultural training for healthcare professionals are recommended to address these issues and improve the well-being of Syrian refugees in Norway.

An online tiered screening procedure to identify mental health problems among refugees

BackgroundMany refugees suffer from mental health problems due to stressful and traumatic events before, during, and after migration. However, refugees are facing a wide variety of barriers, limiting their access to mental health care. Internet-based tools, available in several languages, could be one way to increase the availability of mental health services for refugees. The present study aimed to develop and test a screening tool to screen for clinically relevant symptoms of psychiatric disorders common among refugees (i.e. Depression, Anxiety, Post-traumatic stress disorder, and Insomnia). We, designed, translated, and adapted an internet-based tiered screening procedure suitable for use with the largest refugee populations residing in Sweden. The tool aims to accurately identify symptoms of mental distress (Tier 1), differentiate between symptoms of specific psychiatric disorders (Tier 2), and assess symptom severity (Tier 3). We tested the overall efficiency of using a tiered screening procedure.MethodsSeven hundred fifty-seven refugees residing in Sweden, speaking any of the languages Arabic, Dari, Farsi, English, or Swedish, completed an online questionnaire following a three-tiered procedure with screening instruments for each tier. In this study, the Tier 3 scales were used as reference standards for clinically relevant symptoms, to evaluate screening efficiency in terms of accuracy and reduction of item burden in previous tiers.ResultsThe results show that the tiered procedure could reduce the item burden while maintaining high accuracy, with up to 86% correctly assessed symptoms and few false negatives with moderate symptoms and above (at most 9%), and very few with severe symptoms (at most 1.3%).DiscussionThis study generated an accurate screening tool that efficiently identifies clinically relevant symptoms of common psychiatric disorders among refugees. Using an adapted online tiered procedure to screen for multiple mental health issues among refugees has the potential to facilitate screening and increase access to mental health services for refugees. We discuss the utility of the screening tool and the necessity of further evaluation.

The Magic of the Margins: Rethinking Healing from the Perspective of Queer Exile

The Magic of the Margins: Rethinking Healing from the Perspective of Queer Exile

A Central Clearing Clinic to Provide Mental Health Services for Refugees in Germany.

Objective: To determine migration related distress pattern in refugees and feasibility of a de novo established, central low-threshold outpatient clinic serving more than 80,000 newly arrived refugees in the metropole of Berlin.Methods: In an observational cohort study the relative prevalence of major psychiatric disorders by age, place of living within berlin, language and region of origin were assessed in a refugee cohort from 63 nationalities speaking 36 languages.Findings: Within 18 months, a total of 3,096 cases with a mean age of 29.7 years (11.7) have been referred from all 12 districts and 165 of 182 subdistricts of Berlin to the CCC. 33.7% of the patients were female. The three most frequent diagnoses were unipolar depression (40.4%), posttraumatic stress disorder (24.3%), and adjustment disorder (19.6%).Conclusion: The present data gives insight into the distribution of mental disorders in a large sample of refugees and provides evidence that a CCC is an effective service to quickly and broadly provide psychiatric consultations and thus to overcome classical barriers refugees usually experience in the host communities. In Berlin, Germany, and Europe treatment resources for this population should focus on stress and trauma related disorders.

Challenges to mental health services for refugees: a global perspective.

Challenges to mental health services for refugees: a global perspective.

Task-shifting for refugee mental health and psychosocial support: A scoping review of services in humanitarian settings through the lens of RE-AIM.

Decades of war, famines, natural disasters, and political upheaval have led to the largest number of displaced persons in human history. The refugee experience is fraught with obstacles from preflight to resettlement, leading to high rates of mental distress including post-traumatic stress disorder, depression, and anxiety. However, there is a paucity of mental health services for refugees in transit. To meet the needs of this vulnerable population, researchers are experimenting with teaching lay community members basic tools for the delivery of mental health and psychosocial support services (MHPSS). However, there are research gaps about the use of implementation science to inform the delivery of applicable interventions, especially within low resource settings, and even less in the humanitarian context. This review utilizes an implementation science framework (RE-AIM) to assess the reach, effectiveness, adoption, implementation, and maintenance of these interventions. Studies included varying interventions and modes of delivery within refugee camp and urban settings. A comprehensive search strategy led to the inclusion and analysis of 11 unique studies. While current research documents adaptation strategies, feasibility, and fidelity checks through routine monitoring, there is still a dearth of evidence regarding capacity building of lay providers in humanitarian settings. Barriers to this data collection include a lack of homogeneity in outcomes across studies, and a lack of comprehensive adaptation strategies which account for culture norms in the implementation of interventions. Furthermore, current funding prioritizes short-term solutions for individuals who meet criteria for mental illnesses and therefore leaves gaps in sustainability, and more inclusive programming for psychosocial services for individuals who do not meet threshold criteria. Findings contribute to the literature about task-shifting for MHPSS in humanitarian contexts, especially illuminating gaps in knowledge about the lay counselor experiences of these interventions. There is a growing number of refugees forced to make homes in temporary camps or urban centers as they await resettlement, a process that can last decades. These refugees are at risk of serious mental health outcomes due to ongoing stress and trauma. One strategy commonly used in global mental health is the training of lay providers to deliver basic mental health and psychosocial programming to communities. While this tactic is currently being tested in refugee settings, there is limited evidence about the implementation of this strategy. The following scoping review aims to assess the implementation of task-shifting interventions within refugee settings, through the use of a robust implementation science framework.

Task-Sharing Psychosocial Support with Refugees and Asylum Seekers: Reflections and Recommendations for Practice from the PROSPER Study

To address the unmet need for accessible mental health services for refugees and asylum seekers in high-income countries, the PROSPER study is testing implementation of the World Health Organization Problem Management Plus (PM+) intervention. Incorporating task-sharing strategies, the intervention is delivered by Peer Lay Therapists with lived experience of seeking asylum or migration. The PM+ training adopts a cascade apprenticeship model, where Master Trainers train and supervise Wellbeing Mentors; who subsequently train and supervise the Peer Lay Therapists. We describe application of this training and supervision approach in PROSPER, drawing on Master Trainer and Wellbeing Mentor perspectives. We then reflect on our experiences, highlighting logistical challenges when working with refugee and asylum-seeking Peer Lay Therapists, the strategies to promote their ongoing engagement and the opportunities for team and personal growth. A core learning point has been the role of straddling the intervention and research components of the PROSPER study. Based on our experiences, we make recommendations for others adopting a task-sharing approach by training refugees and asylum seekers as Peer Lay Therapists in high-income countries, so that this might inform service programming and/or associated research activity.

Interpreters working in mental health settings with refugees: An interdisciplinary scoping review.

The consequences of language barriers are some of the most fundamental challenges refugees and asylum seekers face, undermining both the accessibility of mental health services and the quality of the services received. This scoping review provides the first synthesis of research on interpreters working in mental health settings with refugees, one of the most prominent yet understudied strategies to improving language access and the cultural appropriateness of services for this unique population. Comprehensive searches were conducted in PsycINFO, Medline, Web of Science, Social Services Abstracts CAIRN, and Erudit for relevant journal articles and book chapters published up to April 2019. A total of 84 peer-reviewed studies met the inclusion criteria. Publications represented a range of disciplines including social work, linguistics, psychology, anthropology, public health, medicine, psychiatry, and nursing. Six thematic areas were identified: (1) Lack of adequate interpretation as barrier to care; (2) Emotional impact of interpreting on the interpreter; (3) Training and supervision; (4) Impact of the interpreter on the process of psychotherapy/mental health intervention; (5) The impact of the interpreter on the intervention outcome; and (6) The role of the interpreter. The results indicate that despite undeniable challenges, including concerns around confidentiality and bias, when clinicians and refugee clients do not share proficiency in a common language, interpreters have a positive impact on refugee clients' quality of care and clinical outcomes. The implications of these findings for host countries providing mental health services for refugees globally are considered and recommendations offered. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mental Health Services for Syrian Refugees in Lebanon: Perceptions and Experiences of Professionals and Refugees.

We applied semi-structured and in-depth interviews to explore the perceptions and experiences of 60 practitioners/policymakers and 25 Syrian participants involved in mental health services for refugees in Lebanon. Refugees were found to view their distress as a normal shared reaction to adversity while professionals perceived it as symptomatic of mental illness. Practitioners viewed Syrian culture as an obstacle to providing care and prioritized educating refugees about mental health conditions. Policymakers invoked the state of crisis to justify short-term interventions, while Syrian refugees requested community interventions and considered resettlement in a third country the only solution to their adverse living conditions. The therapeutic relationship seems threatened by mistrust, since refugees change their narratives as an adaptive mechanism in response to the humanitarian system, which professionals consider manipulative. We discuss the implications of our findings for mental health practice in humanitarian settings.

PALOMA project – developing National mental health policies for refugees

IntroductionEarlier researches have established that migrants with refugee background have increased risk for variety of mental health problems due to often traumatic reasons for leaving their home country, hazardous journey and post-migration adversity. The challenge is that mental health work with refugees is not systematically organized in Finland. PALOMA (developing National mental health policies for refugees 2016-2018) project was launched to answer these challenges. The project is carried out through the combined effort of National institute for health and welfare, The Finnish association for mental health, Helsinki and Kuopio university hospitals, and the municipality of Hämeenlinna. PALOMA Project is founded by the Asylum, migration and integration fund (AMIF).ObjectivesPALOMA project focuses on exploring existing good practices and weaknesses in mental health services in use for refugees. The objectives of the project are to develop a national model for effective mental health services for refugees and implement it nationwide in Finland.AimsThe aim of PALOMA Project is to develop a national model for effective mental health services for refugees in Finland.MethodsPALOMA Project includes three phases: data collection (interviews, literature review, seminars), building the model in expert groups and implementing the model.ResultsAs a result of PALOMA Project, there will be guidelines for professionals working in different levels of administration with refugees in Finland.ConclusionRefugees’ mental health and wellbeing will be improved as a result of better prevention, recognition and appropriate care of mental health problems.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Mental health research in the Syrian humanitarian crisis.

Mental health research in the Syrian humanitarian crisis.

Trauma History and Psychopathology in War‐Affected Refugee Children Referred for Trauma‐Related Mental Health Services in the United States

There is an increasing need to deliver effective mental health services to refugee children and adolescents across the United States; however, the evidence base needed to guide the design and delivery of services is nascent. We investigated the trauma history profiles, psychopathology, and associated behavioral and functional indicators among war-affected refugee children presenting for psychological treatment. From the National Child Traumatic Stress Network's Core Data Set, 60 war-affected refugee children were identified (51.7% males, mean age = 13.1 years, SD = 4.13). Clinical assessments indicated high rates of probable posttraumatic stress disorder (30.4%), generalized anxiety (26.8%), somatization (26.8%), traumatic grief (21.4%), and general behavioral problems (21.4%). Exposure to war or political violence frequently co-occurred with forced displacement; traumatic loss; bereavement or separation; exposure to community violence; and exposure to domestic violence. Academic problems and behavioral difficulties were prevalent (53.6% and 44.6%, respectively); however, criminal activity, alcohol/drug use, and self-harm were rare (all < 5.45%). These findings highlight the complex trauma profiles, comorbid conditions, and functional problems that are important to consider in providing mental health interventions for refugee children and adolescents. Given the difficulties associated with access to mental health services for refugees, both preventive and community-based interventions within family, school, and peer systems hold particular promise.

PW01-120 - Mental health, treatment response and utilization among Iraqi refugees as compared to non-war exposed Arab immigrants

ObjectivesAlthough refugees are at an increased risk to suffer from mental disorders, as compared to other immigrants, little is known about possible differences in treatment response and service utilization.MethodsThe current study includes data from two separate samples of Iraqi refugees and Arab immigrants. Prevalence of physician-diagnosed mental disorders along with treatment response and utilization data was collected from medical records or by surveys. Data was collected from 307 refugees and 326 immigrant controls.ResultsThe prevalence of depression was significantly greater in refugees as compared to immigrants (54% vs. 26%; p&lt; .001). There were no differences between groups in diagnosed anxiety disorders. In addition, self reported complaints of depression (33% vs. 3.1%; p&lt; .001), anxiety (20% vs. 4%; p&lt; .001), and sleep difficulties (15% vs. 2%; p&lt; .001) were more prevalent among refugees than immigrants. In general, treatment response was poor for both groups; however, for longer term patients, treatment response was significantly better (44% recovery vs. 15% recovery; p&lt; .001) for immigrants than refugees. Typical common psychosomatic symptoms were more prevalent and associated with increased health care utilization in refugees as compared to immigrants.ConclusionsResults suggest that treatment offered to refugees is far from effective. There is a need to review health systems factors in order to promote cost-effective and timely mental health services for refugees, not least with the current influx of Iraqi refugees commonly suffering from mental and adjustment disorders.

Evaluating A Multiple‐Family Group Access Intervention for Refugees with PTSD

The purpose of this study was to analyze the effects of a multiple-family group in increasing access to mental health services for refugees with posttraumatic stress disorder (PTSD). This study investigated a nine-session multiple-family group called Coffee and Families Education and Support with refugee families from Bosnia-Herzegovina in Chicago. Adults with PTSD (n = 197) and their families were randomly assigned to receive either the intervention or a control condition. The results indicated that a multiple-family group was effective in increasing access to mental health services and that depression and family comfort with discussing trauma mediated the intervention effect. Further well-designed studies of family interventions are needed for developing evidence-based interventions for refugee families.

International Family, Adult, and Child Enhancement Services (FACES): A community-based comprehensive services model for refugee children in resettlement.

The development of evidence-based mental health interventions for refugees is complicated by the cultural and linguistic diversity of the participants, and the need to balance treatment of past traumatic experiences with ongoing support during the process of acculturation. In an effort to gather "practice-based evidence" from existing mental health services for refugees, a collaborative study of International Family, Adult, and Child Enhancement Services (FACES), a comprehensive, community-based mental health program working with refugee children, was conducted to describe the program participants and service delivery model and to assess whether participants improved over time as a function of services. Results showed that participants improved, but that the improvement was not related to dosage of services. Implications of these findings for refugee mental health services are discussed and suggestions are made for future evaluation research of mental health services with refugees.

Locations of care: meeting the mental health and social care needs of refugees in Europe

This article describes the results of a study (Watters et al., 2003) that was carried out for the European Commission (European Refugee Fund) during 2002 and 2003. The primary aims of the project were to identify mental health services for asylum seekers and refugees in four European countries, to identify examples of good practice in service provision, and to assess the potential for transferring good practice in the field from one country to another. In focusing on the comparative study of mental health services for refugees, the study was a departure from the main areas of research in this field. In general terms, research has focused primarily on epidemiological studies within refugee populations, often aimed at formulating preventive strategies. Much, but by no means exclusive, emphasis has been placed on ascertaining the prevalence of Post Traumatic Stress Disorder within specific refugee groups. Ahearn has argued that btrauma and, in particular PTSD, is perhaps the most popular descriptor of refugee health or lack of health todayQ (Ahearn, 2000, p. 10). Emphasis has also been placed on assessing the impact of external stressors, such as displacement, on refugees’ mental health. These stressors have been grouped and categorized in a

Satisfaction of Vietnamese patients and their families with refugee and mainstream mental health services.

The study examined levels of satisfaction with mainstream mental health services and specialized mental health services for refugees among Vietnamese psychiatric patients and their relatives. Demographic, diagnostic, symptomatic, and service-related issues that might influence satisfaction were investigated. Eighty-six Vietnamese patients were identified from case notes of mainstream inpatient services (N = 31), mainstream community services (N = 7), and a specialized refugee treatment unit (N = 48). During an interview, a scale measuring satisfaction with treatment as well as measures of anxiety, depression, and posttraumatic stress disorder was administered to them. A modified satisfaction scale was administered to 56 relatives. Patients and relatives were, on average, moderately satisfied with treatment. Patients expressed greater satisfaction with the specialized treatment unit for refugees than with mainstream services, a finding that was not influenced by diagnostic differences or symptom levels at the time patients responded. Further analyses controlling for multiple comparisons revealed that the extent of the information provided and the ease of negotiating changes in treatment were the most salient variables in distinguishing satisfaction levels across the two types of treatment centers. Patients' fluency in English and their relatives' level of education were inversely associated with satisfaction scores, tentatively suggesting that the greater the ability of patients and their families to evaluate services, the less likely they were to express satisfaction with treatment. Specialized mental health services for refugees may be more acceptable to refugee populations than their mainstream counterparts, perhaps because better communication with patients and their families is possible in the specialized services. Patients and families who are in a position to evaluate services fully are more likely to be critical of treatments offered.

Mental Health Services for Refugees

Mental Health Services for Refugees

A review of mental health services for refugees between 1975 and 1985 and a proposal for future services.

A lack of federal planning and foresight and an uneven and poorly coordinated network of state services have resulted in fragmented mental health care for the large number of Southeast Asian and other refugees who have entered the United States since 1975. The author reviews the history of mental health services for refugees between 1975 and 1985 and proposes the development of separate mental health and health services for refugees that are responsive to their political, social, economic, and cultural needs. Ideally the services would be provided within existing medical institutions and staffed by medical, psychiatric, and social services personnel assisted by culturally sensitive translators. The author outlines the role of government and organized psychiatry in shaping new programs for refugees and promoting their mental health.