How Do We Help Refugees Address Mental Health Issues? Here’s What You Need to Know
Today, more than 65 million people have had to flee their home countries because of war, armed conflict, or persecution based on their ethnic, religious, or political identities. Over the past few decades, the percentage of refugees forced to cross national borders has steadily increased. A 2016 report from the United Nations Refugee Agency projected that if prevailing trends continue, one out of every 100 people on earth will become a refugee at some point in their life.
Demographic Shifts
Today, about 75 percent of refugees resettle in developing countries. However, since 1975, about 3.5 million have come to the United States in search of safety. More than 25,000 refugees came to the US in 2022, a year-over-year increase of more than 120 percent.
Human migration patterns and refugee demographics have changed dramatically in the last decade. In the first months of 2023, most refugees admitted legally into the United States were from Africa—43 percent, in fact. The next largest group of people, 28 percent, came from the Mideast and South Asia, followed by East Asia (13 percent), the Caribbean/Latin America (11 percent), and Europe/Central Asia (4 percent).
In 2012, the picture looked quite different. At that time, 52 percent of refugees to the US came from the Mideast and South Asia, while 25 percent were coming from East Asia, 18 percent from Africa, 4 percent from the Caribbean/Latin America, and 2 percent from Europe/Central Asia. That means the percentage of displaced persons from Africa and the Caribbean/Latin America each more than doubled, and the percentage coming from the Middle East and South Asia almost halved.
Refugee Trauma
From wherever in the world refugees start their journeys, they carry with them common responses to the brutality, fear, and uncertainty they’ve faced. Many refugees of all ages and backgrounds have experienced natural disasters, physical threats and physical violence, sexual assault, the loss of loved ones in violent circumstances, family separation, and other traumatic events.
International law protects refugees and accords them specific rights. However, they often continue to experience harassment or violence in day-to-day life in their countries of refuge. This means that some very specific mental and emotional health concerns are common among people in any refugee community. The American Psychiatric Association estimates that one-third of all refugees and asylum-seekers who resettle in wealthier nations experience post-traumatic stress disorder, anxiety, or depression.
Some of the most common mental health challenges experienced by refugees include anger, social anxiety, suicidal ideation, and nightmares or daytime flashbacks to traumatic events. Some refugees’ mental health conditions can turn into psychosis, making early care even more critical. The nature of the traumatic experiences, and the severity of these experiences, has a big influence on the type and severity or mental health symptoms. Someone who has been tortured, for example, will need intense and trauma-specific intervention.
Special Considerations
Child refugees need supportive, age-appropriate treatment. Many have had to make their journeys to new countries alone, a factor that significantly increases the risk of developing mental health issues. These young refugees may also have had to take on caretaking roles for younger siblings. Further, they may experience years-long family separations as they spend formative years with foster families.
Child refugees have sometimes been the victims of torture and other forms of violence themselves. Or they may have witnessed horrific violence against adult family members. Enlisting the support of all available family and community support networks is especially vital to the success of the treatment of young refugees.
Sexual violence is another special consideration, and the data are far from complete. Researchers’ findings in a 2014 study suggest that more than 20 percent of female displaced persons experienced sexual violence. Due to the universally low rate of reporting for crimes like these as well as the additional communication and cultural barriers, however, researchers believe the number is far higher.
Researchers haven’t even begun to estimate instances of sexual violence against other genders, children, or the elderly. Further, sexual violence can be motivated by any of the factors for which people were persecuted in the first place.
Barriers to Seeking Help
Before they even leave their countries of origin, refugees, asylum-seekers, and other displaced persons have often already been the target of persecution, which is an extremely traumatic mental health challenge. Yet seeking out mental health services is socially unacceptable in many cultures. As a result, at least partly because of ingrained cultural norms, refugees who need it may avoid treatment, fearing stigmatization and appearing “weak.”
As a result, many refugees, who are caught up in the daily struggle for survival, are not even aware they’re experiencing mental health issues until they’ve already reached a crisis point. According to an expert working in the office of the United Nations High Commissioner for Refugees in 2016, people experiencing extreme forms of abuse and post-traumatic stress disorder feel they constantly must keep moving. Their minds are on everything except self-care.
Additionally, in many parts of the world, such assistance isn’t readily available. Displaced persons may also be socially isolated and not know the process for seeking mental health support in a completely new cultural and linguistic environment. It’s also understandable for refugees to become frustrated and give up on using systems that are hostile to them. Refugees who develop substance-use disorders confront the same barriers.
Respecting Refugee Culture
Experts point out the necessity of culturally relevant and culturally competent mental health services for refugees. Applying Western-style treatment in the context of other cultures is unethical, ineffective, and inappropriate. For many displaced people, talking with a stranger from outside their community about their mental health challenges is unthinkable. A more holistic, collectivistic approach that draws on their own cultural wisdom is much more helpful.
Professionals who work with refugees and other displaced persons need advanced, comprehensive training, as well as a deep knowledge of cultural norms and intragroup dynamics among the populations they treat. It’s this type of informed, specialized response that provides the best hope for refugees to successfully rebuild their lives after they’ve lost so much.