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Refugees dealing with trauma face obstacles to mental health care

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As a young child living in what was then Zaire, Bertin Bahij remembers witnessing refugees fleeing the Rwandan genocide in 1994 by crossing the river that forms the borders of the two Central African nations.

“I didn’t know I would be in a few years,” Bahij said.

A refugee’s harrowing journey began when he was kidnapped and forced to become a child soldier when war broke out in his country, which became the Democratic Republic of the Congo in 1997. At the age of 15 he fled to a refugee camp in Mozambique, where he lived for five years. Years until he arrived in Baltimore in 2004 through the refugee resettlement program.

The way he was raised was “just buckle up and hard to get out of,” said Bahij, 42, and he carried that philosophy into adjusting to life in the United States. He worked multiple jobs and took classes at a community college until he attended college from Wyoming on a scholarship. Now an elementary school principal in Gillette, Wyoming, he said his strategy for coping, then and now, is to keep himself busy.

Looking back, he said, “I don’t think I’ve dealt with the trauma at all.”

Refugees are arriving in the United States in greater numbers this year after resettlement numbers hit a 40-year low under President Donald Trump. These newcomers, like those refugees before them, are 10 times more likely than the general population to develop PTSD, depression and anxiety. Many of them, like Bahija, fled their homelands due to violence or persecution. They then have to deal with the mental toll of integrating into completely different new environments like Wyoming from Central Africa.

This made Bahij worried about the welfare of the new generation of refugees.

“The kind of order a person is in may be very different from the order and new life of the world in which he now lives,” Bhaig said.

While their need for mental health services is greater than the needs of the general population, refugees are much less likely to receive such care. Part of the deficiency stems from societal differences. But the biggest factor is the general shortage of mental health providers in the United States, and the myriad obstacles and hurdles to receiving mental health care that refugees face.

Whether they end up in a rural area like the Northern Rockies or in an urban environment like Atlanta, refugees can face long waits for care, as well as a shortage of doctors who understand the culture of the people they serve.

Since 1975, about 3.5 million refugees have been accepted into the United States. Annual admissions fell during the Trump administration from about 85,000 in 2016 to 11,814 in 2020, according to the State Department.

President Joe Biden raised the limit on refugee admissions to 125,000 in the 2022 federal fiscal year, which ends September 30. With fewer than 18,000 people arriving by the beginning of August, this limit is unlikely to be reached, but the number of people admitted is not possible to increase monthly.

“Some people will come and request services right away, others won’t need them for a few years until they feel completely safe, their bodies have adjusted, and the shock response is starting to dissipate a little.”

McKinley Joyner, mental health navigator at IRC in Missoula

Refugees undergo a mental health examination, along with a general medical assessment, within 90 days of their arrival. The effectiveness of this test largely depends on the examiner’s ability to deal with complex cultural and language issues, said Dr. Ranitt Michori, professor of family medicine at Georgetown University and senior medical advisor for Physicians for Human Rights.

Michori said that although trauma rates are higher among refugees, not all displaced people need mental health services.

For refugees dealing with the effects of stress and adversity, resettlement agencies such as the International Rescue Committee offer support.

“Some people will come in and request services right away, others won’t need them for a few years until they feel completely safe, their bodies have adjusted, and the shock response is starting to dissipate a little bit,” McKinley-Joyner said. , a mental health navigator at the IRC in Missoula, Montana.

Unlike Wyoming, which has no refugee resettlement services, the IRC Missoula has placed refugees from the Democratic Republic of the Congo, Syria, Myanmar, Iraq, Afghanistan, Eritrea, and Ukraine in Montana in recent years. One of the main challenges in accessing mental health services in rural areas is the small number of service providers who speak the languages ​​of those countries.

In the Atlanta suburb of Clarkston, which has a large number of refugees from Myanmar, the Democratic Republic of the Congo and Syria, translation services are more available. Five mental health clinicians will work alongside IRC caseworkers under a new program by IRC Atlanta and Georgia State University’s Prevention Research Center. Doctors will assess the mental health needs of refugees as social workers help with housing, employment, education and other issues.

Seeking mental health care from a professional may be an unfamiliar idea for many refugees, said Firdous Ahmed, a former Somali-born refugee mental health physician at the University of Colorado School of Medicine.

For refugees who need mental health care, stigma can be a barrier to treatment. Ahmed said that some refugees fear that if US authorities find out that they suffer from their mental health, they may face deportation, and some single mothers fear they will lose their children for the same reason.

“Some people think that asking for services means they are crazy,” she said. “It is very important to understand the perspective of different cultures and how they view mental health services.”

Long waiting times, lack of cultural and language resources, and societal differences have led some health professionals to suggest alternative ways to address the mental health needs of refugees.

Expanding the scope beyond individual therapy to include peer interventions can rebuild dignity and hope, said Dr. Susan Song, professor of psychiatry at George Washington University.

Spending time with someone who speaks the same language or figuring out how to use the bus to go to the grocery store “is incredibly healing and allows someone to feel a sense of belonging,” Song said.

Some people think that asking for services means they are “crazy”. It is very important to understand the perspective of different cultures and how they view mental health services.”

Ferdous Ahmed, a former refugee mental health physician at the University of Colorado School of Medicine.

In Clarkston, the Prevention Research Center will soon launch an alternative that allows refugees to play a more direct role in caring for the mental health needs of community members. The center plans to train six to eight refugee women as “ordinary therapists” who advise and train other women and mothers using a technique called narrative exposure therapy to treat complex and multiple trauma.

Therapy, in which patients create a chronological narrative of their life with the help of a therapist, focuses on traumatic experiences over a person’s lifetime.

The treatment can be culturally adapted and implemented in underserved communities, said Jonathan Orr, coordinator of the Clinical Mental Health Counseling Program at Georgia State University.

Despite this, the American Psychological Association conditionally recommends only narrative exposure therapy for adult patients with PTSD, and advises that further research is needed.

But the method worked for Muhammad Alo, a 25-year-old Kurdish refugee living in Snellville, Georgia, after arriving in the United States from Syria in 2016.

Allo was attending Georgia State while working full time to support himself when the COVID-19 pandemic began. While the hiatus during the pandemic gave him time to think, he did not have the tools to address his past, which included fleeing Syria and threatening violence.

When his busy schedule came back again, he felt unable to deal with his new anxiety and loss of focus. He said that narrative exposure therapy has helped him deal with this stress.

Regardless of treatment options, mental health is not necessarily the highest priority when a refugee arrives in the United States. “When someone lives a life of survival, vulnerability is the last thing you’ll photograph,” said Bahij.

But Bahij also sees resettlement as an opportunity for refugees to meet their mental health needs.

He said it was important to help refugees “understand that if they take care of their mental health, they can be successful and thrive in all aspects of the life they are trying to create. Changing that mindset can be empowering, and it’s something I’m still learning.”