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|"The Relevance of Refugees: Reflections on Theory and Practice" Article appearing in Anthropology Newsletter, 1999 by Peter W. Van Arsdale, Ph.D.
MENTAL & PHYSICAL HEALTH Miscellaneous | Africa | Asia | Europe | Latin America | Middle East | North America
Click here for a special sub-section of bibliographic citations on refugee and immigrant mental health. These entries are divided into several categories: training of service providers, treatment of chronic mental health problems, and mental health issues for specific populations.
Impact of Immigration Detention and Temporary Protection on the Mental Health of Refugees
The British Journal of Psychiatry, 2006, vol. 188, no.1, pp. 58-64.
Steel, Z., Silove, D., Brooks, R., Momartin, S., Alzuhairi, B., and Susljik, I
Abstracted by: Laura Egan 
Policies directed towards refugees are currently shifting in Western developed countries with Australia leading the movement. With the changing attitudes and terms of visas, Steel et al set out to examine the long-term effects such policies have on the mental health of refugees when they are faced with mandatory detention and temporary protection. This study was based in Australia where policy in the past two decades has changed fundamentally in two ways. First, those arriving by boat or without valid entry visas are subjected to compulsory detention for the duration of the asylum determination procedure. Secondly, new temporary protection visas limit a holder’s access to healthcare, education and ability to work, with no opportunity for overseas travel; they are considered ineligible for migration to family reunions. The authors employed an applied multilevel model to test the hypothesis that each of these policies contributes to ongoing post-traumatic stress disorder (PTSD), depression and associated disabilities in refugees.
The group examined for this study is that of Sabaean-Mandaeans refugees, a small pre-Christian sect originating from Iran and Iraq who have suffered long-term discrimination and persecution which escalated prior to and during the Iraq war in 2003. A total of 241 refugees participated, with the group split almost evenly between those holding either a temporary or a permanent visa. A variety of measures, including two psychometrically tested symptom measures, were used to examine and compare pre-migration trauma, post-migration living difficulties, immigration detention experiences and symptoms along with psychiatric status and disabilities.
Through the study the authors concluded that the refugees who possess temporary protection visas have higher rates of PTSD, depression, and disability versus those who have permanent visas. Temporary protection leaves refugees with greater insecurity and more susceptibility to stressors, especially as the length of detention increases. The implication of this small study allows for the conclusions to reach across country borders, showing that prolonged detention has a long-term impact on the psychological well-being of refugees, and the idea of temporary protection leaves the sense of certainty out of the equation that is a fundamental part of permanent protection. With procedures changing in the developed world, the policies towards refugees and the repercussions on the refugees’ mental health need to be examined more in-depth and on a wider scale across Western developed countries.
Refugees' Responses to Mental Health Screening: A Resettlement Initiative
International Social Work, 1 April 2003 , vol. 46, no. 2, pp. 235-250(16)
Ovitt N., Larrison C.R., and Nackerud L.
Abstracted by: Cindy Bosley
Much research has shown a higher incidence of mental health problems among refugees as compared to the general population. In addition to the challenges of treating refugees' mental health problems, there is also a great challenge in diagnosing them. Other research has shown that there are several major barriers preventing or hindering diagnoses and subsequent treatment. These barriers include refugees not seeking help, lack of accessibility of services, linguistic and cultural barriers in diagnosis and treatment, and conflicting resettlement goals. This article describes a small study of a screening test used to identify mental health problems in Bosnian refugees shortly after arriving in the U.S. The screening tool that is used is the Hopkins Symptom Checklist (HSCL-25), which has been translated into four languages, including Bosnian. The HSCL-25 lists common symptoms of various mental health problems, and asks the respondents to identify any symptoms they are experiencing. The checklist was administered to eight recently-arrived, adult Bosnian refugees, and the results showed most of the refugees reporting at least some symptoms of mental health problems, with one refugee meeting the official criteria warranting treatment. The researchers immediately followed the HSCL-25 with a client questionnaire about the screening instrument and process. The client questionnaire asked questions such as: Was the checklist easy to understand, were the items in the checklist upsetting or difficult to answer, and do you feel that this was an appropriate time to consider these kinds of questions? The refugees responded quite positively to the screening process, noting that the HSCL-25 was helpful, important to refugees, and administered as an appropriate time. Most of the eight refugees also indicated that they had not been screened in this manner before in the resettlement process, nor had anyone even asked these types of questions. The overall conclusions of this study are that the HSCL-25 is an appropriate instrument to use with recently-arrived, adult Bosnian refugees resettled in the U.S., and the HSCL-25 can assist mental health professionals in identifying refugees with symptoms of mental health problems.
Training Refugee Mental Health Providers: Ethnography as a Bridge to Multicultural Practice
Human Organization, Summer 2004, vol. 63, No. 2, pp 203-208 (6)
Elzbieta M. Gozdziak
Abstracted by: Alexandra Nichols
Over the past decade there has been a significant increase in the number of refugees and internally displaced people around the globe. While this number has increased and continues to do so, the number of programs providing psychological services to such refugees has also simultaneously grown. This significant and rapid expansion of mental health programs in both western and nonwestern countries leads us to the question of whether mental health professionals in this field are in fact adequately trained and prepared to address the particular needs of a diverse range of refugees. The article attempts to address this issue through a close look at the various aspects of Western training programs for mental health professions as well as an exploration of the ways in which anthropology can contribute to the mental health field. The article initially gives an explanation for the possible growth of this field, being due not only to a common assumption that all refugees having been exposed to armed conflict and civil strife are in need of immediate access to counseling and psychological service but also due to a substantial increase in the number of diagnoses of post-traumatic stress disorder (PTSD). Gozdziak provides us with several examples of the prominence of mental health professionals in refugee settings including such areas as Rwanda, Kosovo, Bosnia-Herzegovina and Croatia. It is important to note as Gozdziak points out that while these programs are developed and expanded in the West they are then implemented in nonwestern countries. Therefore these programs are implemented through the use of western trained mental health professionals which leads to various drawbacks and shortcomings. Gozdziak argues that Western psychiatry and psychology are not equipped to properly and adequately serve refugees. She initially focuses her argument on a variety of inadequacies and gaps in the training provided to these professionals. Some examples include training programs not providing certificate or degrees focusing on refugees and immigration issues, courses taught solely by adjunct professors, a lack of financial support for this area of study and inadequate course content. The largest problem according to Gozdziak however is the cultural and philosophical gap that remains. Western training programs for mental health professionals rely on biomedical models and Western diagnostic categories not taking into consideration indigenous cultural habits and ways of expressing distress and fear. To address this, the article continues with an analysis of what exactly suffering means and to then explore the term “to medicalize human suffering,” putting a medical slant on issues that were not previously considered medical issues. This has resulted in what is called the “trauma model.” Though many suggest the model is applicable to nonwestern societies, Gozdziak argues that in fact the value system by which it is supported is not in fact in line with the majority of the values refugees tend to hold true. To ameliorate this situation Gozdziak suggests an increase in the use of anthropological studies in training mental health professionals to work in the refugee field. By exploring the work and research of Harvard psychiatrist Arthur Kleinman, Gozdziak argues for an increased use of anthropological and ethnographic studies to bridge the gaps and to incorporate the social and cultural aspects rather than continuing a sole medical and psychiatric approach when working with refugees with respect to the mental health field.
Beyond the burqa: addressing the causes of maternal mortality in Afghanistan
Forced Migration Review, 2004, no.19, pp. 81-89(9)
del Valle, H.
Abstracted by: Teresa Braun
In this article, Herman del Valle, a humanitarian affairs officer for Médicins Sans Frontières (Doctors Without Borders), examines the status of Afghanistan’s reproductive health system in the post-Taliban era and the programs that have been implemented thus far by the United Nations (UN) and non-governmental organizations (NGOs). He addresses the restrictions in access to health care for women that existed under the Taliban regime, resulting in one of the highest maternal mortality rates in the world, and the focus that subsequent programs have given to gender inequalities as mechanisms for trying to reduce these rates. However, such programs have not had the anticipated improvement on maternal mortality rates, leading to the need for a less one-dimensional approach to the issue.
Del Valle lays out three reasons for the failure, thus far, of a women’s rights-based approach to alleviating high maternal mortality in Afghanistan. First, he points to the change in access to reproductive health care being regulated by restrictive government policies and legislation to being more greatly influenced by culture and traditions, which are much more difficult for outsiders to advocate against. Second is the context from which Western workers approach women’s rights as a tool for improving health care, which he argues must be questioned as an effective tool given its tendency to be at odds with tradition. Third, even more important than culture and tradition preventing women from accessing health care, is the lack of infrastructure and health facilities in Afghanistan, as those facilities that do exist are under-staffed, under-equipped, and extremely difficult to reach via roads and existing transportation networks.
Compounding these infrastructure issues are the large numbers of returning Afghans living in temporary services outside of Kabul, along with officially-recognized internally displaced persons (IDPs). These two factors have combined to result in a programmatic approach of quick impact projects, often being implemented in the limited space of IDP camps, that deal with safe environments and health education initiatives that do not prove to be sustainable or have a long-term impact on maternal mortality rates. Del Valle stresses the need to combine initiatives focused both within camps and the rest of the country, especially in rural areas, that allow for comprehensive restructuring and support of the Afghan administration in developing a nationwide infrastructure and policy. He stresses the need to meet four conditions in order to address the needs of IDPs and the general public. Reproductive health should be incorporated within a larger public health plan that is sustainable and accountable to the public, not just dependent upon NGOs. Linked to this is the need for support of the Afghan administration in delivering care and supplies, developing an infrastructure and building capacity in both rural and urban communities. Strategies to reduce maternal mortality, which incorporate the necessary equipment and staff, must target all three levels: pre-natal care, assistance during deliveries, and post-natal care. Finally, basic needs in rural and urban areas, including safe water, nutrition, and security, must become a priority. The failure to reduce maternal mortality rates cannot simply be attributed to, and excused by, entrenched social cultural traditions that diminish the importance of women’s health. The national and international communities must work together to rehabilitate the Afghan health system, including reproductive health services.
Understanding Mental Health Needs of Southeast Asian Refugees: Historical, Cultural, and Contextual Challenges
Clinical Psychology Review , 1 May 2004 , vol. 24, no. 2, pp. 193-213(21)
Hsu E., Davies C.D., and Hansen D.J.
Abstracted by: Cindy Bosley
Providing mental health services for refugees is challenging for many reasons, most notably language and cultural barriers. Many clinicians tend to make generalizations about refugees as one group, and still others group large geographic regions of refugees together (i.e. Asians). This article explores the historical, cultural, and contextual challenges of providing mental health support to Southeast Asian Refugees (SEARs). After exploring these challenges, the authors then give an overview of common mental health problems among SEARs, followed by an outline of clinical implications. This information is obtained from a variety of prior research over the past 25 years, including numerous clinical research studies. The authors' primary conclusion is that the complex background and experiences of each individual SEAR must be thoroughly examined if any treatment of mental health problems is to be effective. Examining historical factors is important because the type of loss or trauma that a refugee has faced can influence their mental health problems (and associated symptoms) as well as their reactions to treatment. Thus, historical factors should be taken into account during diagnosis and treatment. Cultural factors will also affect the types of mental health problems and their reactions to treatment, but these factors will also influence refugees' attitudes towards treatment and clinicians in general. For example, children and adolescent SEARs often learn English very quickly and thus acquire large responsibilities within their family. Because this runs counter to the value of respecting and obeying elders, SEARs often develop mental health problems because of their conflicting roles within the family. These, and other issues such as gender roles, sexuality, and religious beliefs, must be taken into account when diagnosing and treating SEARs. Contextual factors in the resettlement process can include financial strains, language difficulties, the employment situation, discrimination, safety, and others. These challenges must also be explored to develop a holistic picture of SEARs and their mental health situation. The most common mental health problems among SEARs are depression, anxiety, posttraumatic stress disorder (PTSD), adjustment disorder, and somatization of mental problems. The authors provide numerous statistics of various mental health problems among particular groups with Southeast Asia , as well as statistics among Southeast Asian youth. Resilience against mental health problems among SEARs can be attributed to factors such as language proficiency, presence of close family members, social support networks within the ethnic community, and others. Based on these examinations of the common mental health problems and associated challenges, the authors conclude with an assessment of clinical implications. These implications include recommendations for assessing mental health problems and for treating mental health problems (long and short-term). The primary recommendation of the authors is to approach each patient (or potential patient) as an individual, and explore the often complex situation of each SEAR. Classifying all SEARs into one, monolithic group will only lead to false generalizations, errant diagnoses, and ineffective treatment.
Community Contact and Mental Health Amongst Socially Isolated Refugees in Edinburgh
Journal of Refugee Studies, Volume 15, Number 1, pp.71-80, 2002
Ager, Alastair, Margaret Malcolm, Sana Sadollah, and Fiona O’May
Abstracted by: Kim Bell 
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