Mahanam Bhattacharjee Mithun
(Mahanam is a MA student under European Masters in Migration and Intercultural Relations Programme. He is presently an intern in Calcutta Research Group)
Canadian Mental Health Associations webinars provides some very important insights into the mental health issues among the refugee population (http://ontario.cmha.ca/public-policy/capacity-building/refugeemh/). The guidelines and recommendations provided by CMHA put light on the fact on how to better deal with mental health issues specially regards to child and adult refugees mental health. These also help us to better understand the concept of mental health, factors affecting mental health, people that are more vulnerable to mental health problems and most if all provides an important guideline how to enhance our capacity in support refugees with mental health issues.
Due to ongoing war, violence and persecution in home countries, a lot of people continue to be forced to leave their own country and seek refuge in other countries. It is very important for us to understand the concept of mental health, mental health condition of the refugee population and how to support the refugees most effectively. According to the public health agency of Canada, mental health is the capacity of each and all of us to feel, think and act in ways that enhance our ability to enjoy life and deal with challenges to face. It is a positive sense of spiritual and emotional well being that respects the importance of culture, equity, social justice, interconnections and personal dignity.
Mental health is much more than just the absence of mental illness. It is not static, it changes over time and our experience of mental health also changes. There are different factors that impact on our mental health; for example,losses of job, loss of someone close social determination of health etc. Experience of discrimination and violence, social exclusion, experience of poverty and access to economic resources are also important factors when it comes to the issue of mental health. World Health Organization projected that refugee populations are much more vulnerable to mental health problems than any other groups due to violence in home country, situations in refugee camps, forced migration, loss of family, self -identity etc., all contributing to mental health problems of the refugee population. Most relevant mental disorders found among the refugees are anxiety disorder, post-traumatic stress disorder and depression. Among other refugee groups: older adult, unaccompanied children, persons with pre-existing mental illness, people with previous trauma, people with disabilities, single adult without family or community support are more vulnerable to mental health problems.
According to Canadian experts, refugees are at a high-risk for mental health issues and often suffer spiked rates of depression and substance abuse (Kirkup, 2015). Anxiety, depression, stress and post-traumatic stress disorder (PTSD) were found to be the most common types of psychological problems in asylum seekers and refugees (Burnett & Peel, 2001). A report by Germany's chamber of psychotherapists found that half of refugees are experiencing psychological distress and mental illness resulting from trauma and one fifth of refugee children are also suffering from PTSD (Finnerty, 2015).
Several studies suggest that exile-related stressors may be as powerful as events prior to flight (Pernice& Brook, 1996; Gorst-Unsworth& Goldenberg, 1998). The period between applying for refugee status and a decision being made varies between countries from a number of hours to a number of years. This is an extremely stressful and uncertain time, when asylum-seekers are unable to make plans for the future and may be terrified of being returned to their country of origin. This may be a time when psychological well-being is extremely fragile (Tribe,2002).
While dealing with mental health issues of refugee populations, a support giver must be culturally sensitive, aware of power differences and always keep in mind that refuges came from different geographical locations and have their distinct cultures. When providing support to refugee populations, especially children, a caregiver should first check in with other supporting adults, clarifying their role and maintaining confidentiality. We should always be non-judgmental when dealing with mental health issues. It’s also necessary to listen to the problems calmly and be empathetic towards care receivers. Focus should be given to the present needs rather than past traumatic experiences. In various countries around the world psychiatrists have worked alongside community leaders, helping them to develop community-based interventions and to recognize when referral may be appropriate (Tribe & de Silva, 1999).When we can understand the extent of the problem and strengthen the support to people with mental health conditions, then it will help the refugees with mental health conditions in the most effective way.
Burnett A and Peel M. Health needs of asylum seekers and refugees.BMJ 2001;322:544–7.
Finnerty, Deirdre; Migrant crisis: Trauma takes toll on mental health, BBC, 22 December 2015, retrieved from: http://www.bbc.com/news/world-europe-35102320
Gorst-Unsworth, C. & Goldenberg, E. (1998) Psychological sequelae of torture and organised violence suffered by refugees from Iraq. British Journal of Psychiatry, 172, 90–94.
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Kirkup, Kristy, The Canadian Press, Nov. 25, 2015, retrieve from: https://www.thestar.com/news/canada/2015/11/25/refugees-at-high-risk-for-mental-health-issues-experts-say.html
Pernice, R. & Brook, J. (1996) Refugees' and immigrants' mental health: association of demographic and post-migration factors. Journal of Social Psychology, 136, 511–519.
Tribe, R. & de Silva, P. (1999) Psychological intervention with displaced widows in Sri Lanka. International Review of Psychiatry, 11, 186–192.
Tribe, Rachel; Mental health of refugees and asylum-seekers, Advances in Psychiatric Treatment Jul 2002, 8 (4) 240-247;