Refugee Mental Health Quick Guide

We gratefully acknowledge the expertise and collaboration of Andrea Northwood, PhD, from the Center for Victims of Torture in Minneapolis, who made significant contributions to this section.

On this page:
Assessment and Cultural Issues
Treatment
Rationale
Full Provider Guide Chapter: Mental Health

Assessment and Cultural Issues

Effects of War

  • There is great variability in the effects of war and torture, ranging from a few transitory symptoms to chronic psychiatric conditions; however, research has consistently found refugee populations to be at substantially elevated risk for PTSD and other psychiatric disorders. These include depression, other anxiety disorders, substance abuse, somatoform disorders, sexual dysfunction, and organic impairment (brain damage) due to head injury during torture, combat, or flight.

Effects of Migration

  • Leaving behind all that is familiar and starting a new life in a new country with a different language and culture produces an immediate family crisis that can have a long-term impact on mental health. Intergenerational conflicts due to different rates of acculturation and parent-child role reversal can result in strained relations within the entire family.

Evaluating Mental Health

  • The mental status examination is generally informal and may be carried out by clinicians throughout the routine screening.
  • While evaluating the refugee’s psychosocial history, inquire about the patient’s concerns or worries regarding him/herself and family members. Ask about sleeping and eating difficulties. Ask about sadness, nervousness, and irritability. Be alert for signs of stress, isolation, and the profound grief of multiple losses that may accompany resettlement. Adult patients may describe low energy, insomnia, loss of appetite, nightmares, memory and concentration problems, bodily aches/pains, and general fatigue.
  • Many refugees will not share a Western perspective or vocabulary in terms of psychology, so questions will need to be explained through specific examples or re-framed in culturally congruent terms with the assistance of an interpreter or bicultural worker.

Treatment

  • Three basic stages of recovery from psychological trauma have been identified: (1) establishing safety/stabilization, (2) going through a stage of remembrance and mourning (“coming to terms with” the trauma), and (3) reconnecting with life (rejoining the worlds of work and love). Moving through these stages can be facilitated through individual and/or group therapy; groups can be particularly helpful in providing peer validation and reducing isolation.
  • Early assessment and intervention reduces suffering and facilitates this recovery.
  • Refugees and torture survivors are, fundamentally, survivors who possess amazing resiliency, strength, and resourcefulness.

Rationale

  • Many refugees suffer traumatic experiences, including torture, in addition to leaving behind all that is familiar. Forced migration can have significant long-term effects following the initial stages of resettlement. Rates of post-traumatic stress disorder (PTSD) among refugees worldwide range from 30 percent to 60 percent (i).
  • Most new refugees are in temporary housing, have language and transportation barriers, and are new to the construct of western mental health services (ii, iii, iv).
  • Medical providers are in a position to develop a trusting relationship with their patients and guide them to mental health professionals, if indicated.

Full Provider Guide Chapter: Mental Health

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i. Minnesota Department of Health, Minnesota refugee health guide. 3rd ed. St. Paul, MN: MN Dept of Health; 2007; 10:5.

ii. Barnes DM. Mental health screening in a refugee population: a program report. J Immigr Health. 2001; 3(3):141-149.

iii. Jaranson JM, Butcher J, Halcon L, et al. Somali and Oromo refugees: correlates of torture and trauma history. Am J Public Health. 2004; 94(4):591-598.

iv. McCullogh-Zander K, Larson S. The fear is still in me: caring for survivors of torture. Am J Nurs. 2004; 104(10):54-64.

 


Updated Wednesday, November 23, 2011 at 01:04PM