Refugee Mental Health Access In the US

As I handed a Syrian refugee mother and her 12 year old son their refugee mental health

screener, I explained to them the importance of preserving and nurturing mental health. They

looked at me blankly, almost glassy-eyed and taken aback. The mother asks, “Miss, can we take

these home and bring them back tomorrow?” I knew that if she took the screener home I’d never

see those papers again. This was against the rules; therefore, I explained to her that they needed to

be completed today. In that instance, I realized I was unintentionally being insensitive to their

situation. I had completely disregarded the fact that these individuals have endured extreme levels

of trauma, anguish, and adversity. The mother again insists, “Please, Miss, let us take these

screeners home. I promise I will bring them back tomorrow with my son and my husband.” I saw

this profound desperation in her eyes. Her entire demeanor and tone of voice changed, and I could

tell she was being honest. At last, I relented and informed her that she may bring the screener back

tomorrow. The next day, I arrived at the clinic assuming still she may not bring those papers back

but alas she arrives at the clinic with her son and husband and hands me both screeners filled out

and signed. This Syrian family came to me for a reason, because they knew I could help in some

way. They asked to discuss something with me in private. It wasn’t long before both the mother

and husband broke down in tears in front of me as they explained the constant nightmares,

depression, and anxiety they have endured. The father was abducted by extremists and tortured,

repeatedly. The mother was raped and physically abused. And the young son experienced the

trauma of seeing his childhood friends die before his eyes. All are suffering from PTSD. The

facility I worked at provided refugees with mental health counseling, yet this is very rare to find

in the US.
Refugee Mental Health Access In the US

This is just one of the thousands of refugee families who have entered the United States.

Although refugee numbers have decreased in the past few years due to enacted immigration

policies under the new Presidency, refugee mental health is not pursued. Refugee Medical

Assistance through the Office of Refugee Resettlement (ORR) provides Medicaid access to newly

arrived refugees.1 This medical assistance is only offered for 8 months, after that they are on their

own to understand the healthcare system and apply for their own insurance. Due to language

barriers, and lack of health literacy navigating the healthcare system, refugees tend not to get

insurance which not only increases factors contributing to health disparities. Lack of access to

insurance also means lack of access to mental health providers.

Many Middle Eastern/Arab countries have encountered years of warfare, which has caused

much of the negative mental health issues refugees are dealing with today. According to the

Refugee Health Technical Assistance Center, “Different studies have shown rates of PTSD and

major depression in settled refugees to range from 10-40% and 5-15%, respectively.”2 War has

caused multiple health disparities to arise within refugee populations due to pre-and post-migration

and poor general access to and engagement in care.3 These disparities arise from many different

structural and internal barriers. Structural barriers refugees encounter include resettlement

challenges such as finding shelter, food, and employment insecurity; as well as factors such as

affordability, sustainability, lack of or limited mental health services, inadequate interpretation,

access to urgent care only, and poor provider cultural competency. There are also multiple internal

barriers that include mental health, i.e mistrust, and perceived discrimination. Another health

disparity many refugees encounter is stigma against mental health and surrounding topics. Talking

about mental health issues in many refugee cultures is considered taboo. Across the MENA region,
Refugee Mental Health Access In the US

not only is there a stigma around mental health but also an alarming lack of psychologists and very

poor access to any mental health organisations or practices.

In contrast, in the United States the issue is less stigmatized publicly yet there is still an

with access to mental health.4 In many refugee populations, religious and cultural values play an

important part in the discernment of psychological and social issues, including methods of

treatment. It is important that individuals, working with psychosocial and mental health support

programs, understand the cultural idioms of stress and explanatory models that have an impact on

coping strategies.4

Individuals addressing this mental health issue in the United States must take into

consideration cultural idioms and explanatory models to construct effective intervention

programs.4 In addition, when public health practitioners and mental healthcare providers are

generating mental health programs, not only does “gender, age, disability, sexual orientation and

experiences of violence be taken into consideration”5, but “the psychosocial and mental health

difficulties and coping strategies of refugees needs to be understood, and integrated, into health

promotion programmes and practice.”4One intervention program which started in Milwaukee,

called the Refugee Women's Wellness Program, takes into account health disparities, limitations

to participation, and cultural perspectives. The program is a womens exercise program where

refugee women engage in activities such as Zumba, health education talks, and roundtable

discussions around mental health sustainability in the community. Constructing interventions,

through non-profits, can build community, incorporate health education relating to stigma of

mental health, and also creating safe spaces for group discussion relating to mental health. This is

the best method to focusing on the mental health of many refugee individuals especially those who

do not understand the importance of mental health and those who lack access to mental health
Refugee Mental Health Access In the US

facilities. Due to a lack of access to mental health care non-profit organizations can help organize

such mental health programs. Refugees entering the US are the future and are now a part of the

United States, putting mental health issues on the side lines will not only be detrimental to the

refugee population but detrimental the society as a whole.

References
Refugee Mental Health Access In the US

1.) McNeely CA, Morland L. The Health of the Newest Americans: How US Public Health

Systems Can Support Syrian Refugees. Am J Public Health. 2016;106(1):13-

5.https://refugeehealthta.org/physical-mental-health/mental-health/

2.) Mental Health: Treatments and Services. Refugee Health TA.

https://refugeehealthta.org/physical-mental-health/mental-health/adult-mental-

health/treatments-and-services/. Accessed December 13, 2018.

3.) Watters C, Derluyn I. Wellbeing: refugee children’s psychosocial wellbeing and mental

health. Research Handbook on Child Migration. 2015:369-380.

doi:10.4337/9781786433701.00037.

4.) Mental Health and Psychosocial Needs of Syrian Refugees: A Literature Review and

Future Directions. Advances in Social Work. 2018;18(3):833-852. doi:10.18060/21633.

5.) Chahine LM, Chemali Z. Mental health care in Lebanon: Policy, plans and programmes.

Mental health care in Lebanon: policy, plans and programmes.

https://www.researchgate.net/publication/41892880_Mental_health_care_in_Lebanon_Po

licy_plans_and_programmes. Published 2009. Accessed December 13, 2018.