Refugee Mental Health

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Refugee Mental Health

• For further information contact
• CAPT John J. Tuskan, Jr., USPHS
• Refugee Mental Health Program, Center for Mental
  Health Services, SAMHSA
• Tel [phone]
• E-mail jtuskan_at_samhsa.gov

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Who Is a Refugee?

• A person who has fled his or her country of
  origin because of a well-founded fear of
  persecution based on race, religion, nationality,
  political opinion or membership in a particular
  social group.
• Excludes people who left their homes only to seek
  a more prosperous life. Such people are commonly
  called economic migrants
• People fleeing civil wars and natural disasters
  also may not be eligible for refugee resettlement
  under U.S. Law, though they may come under the
  protection of the united nations high
  commissioner for refugees (UNHCR)

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Definition of a RefugeeThe 1951 Convention and
1967 Protocol Relating to the Status of Refugees

• Article 1 -- Definition of the term Refugee
• A(2) Any person who. . . owing to well-founded
  fear of being persecuted for reasons of race,
  religion, nationality, or political opinion, is
  outside the country of his nationality and is
  unable or, owing to such fear or for reasons
  other than personal convenience, is unwilling to
  avail himself of the protection of that country
  or who, not having a nationality and being
  outside the country of his former habitual
  residence, is unable or, owing to such fear of
  for reasons other than personal convenience, is
  unwilling to return to it. (as amended y Article
  1(2) of the 1967 UNHCR Protocol relating to the
  status of refugees)

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Review of the Last Decade the International
Perspective

• 35 million people forced from their homes by
  violence and repression
• 21 million internally displaced
• 14 million refugees
• The number of countries producing massively
  uprooted populations doubled
• 13 million refugees voluntarily repatriated

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Countries of Origin(Courtesy of the UNHCR)
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Top Ten Places of Refugee Origin (Courtesy of the
UNHCR)
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Countries of Resettlement (Courtesy of the UNHCR)
2,000,000 Refugees in U.S. since 198072,515
admitted to US in FY 2000 out of authorized
level of 90,000)
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Top Ten Places for Hosting Refugees (Courtesy of
the UNHCR)
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How Refugees Come to the U.S.Courtesy Will
Coley, Jesuit Refugee Services (JRS)
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Approximately 75 of the worlds refugees are
women and children
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Approximately 65 of the worlds refugees are
African
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Approximately 60 of the worlds refugees are
Muslim

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Aspects of Migration Refugees Immigrants

• Push-Pull
• Choice
• Plan-Process
• Cannot go back
• Transition time

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Refugee Journey Traumatic Stress

• Pre-departure
• Migration/flight
• First country of asylum/refugee camp
• Asylum process (Detention)
• Resettlement
• Repatriation

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The Refugee Experience

• World-shattering and world-shaping experience
• Raises questions of ultimate meaning and purpose
• Raises questions of values good vs. evil, God
  and man
• Raises questions about nature of reality

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What is Refugee Mental Health?

• Human rights perspective
• Primary prevention
• Well-being of a population
• Ecological approach
• Secondary prevention
• Suffering
• Psychosocial adjustment
• Community mental health

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What is Refugee Mental Health?

• Individual mental health
• Tertiary prevention
• Case identification
• Clinical interventions

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Vulnerable Refugee Subgroups

• Children/youth
• e.g., cognitive physical limitations,
  intergenerational conflict
• Women
• e.g., changing roles

• Elderly
• e.g., loss of prestige, reluctant to acculturate
• Torture Survivors
• e.g., neurological damage

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Refugee Trauma Pyramid
Adapted from The Harvard Program in Refugee
Trauma
Serious Mental Illness
(1-25)
Physical handicaps
Severe functional impairments
Family problems
Despair / Hopelessness
Lack of Trust
Social justice/Revenge
Physical and Mental Exhaustion
100 General Population
Suffering
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Refugee Public Health Requirements
Durable Solutions
7
Maintenance Rehab/Ed
6
Primary Care Case Management
5
Preventive Medicine Health/Nutritional
Assessment Immunizations
4
Environmental Health Sanitation
3
Logistics Food Shelter
2
1
Protection Security
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Most Essential Need of Providers

• An appreciation of the legal, physical,
  intellectual, spiritual, and emotional
  implications of being a refugee.

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Positive Psychosocial Adaptation Variables

• integrated MH services
• peer support initiatives
• use of para-professionals from community
• education and outreach

• supportive relationships
• access to services
• migration to similar culture
• social support network
• access to opportunities

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Negative Psychosocial Adjustment Variables

• downward social drift
• overemphasis on mental health
• stigmatizing
• individual focus at the exclusion of the family
  and community

• no community support
• exposure to repeated stresses
• social cultural isolation
• limited or no English language
• no support network