Many refugees dealing with trauma face barriers to mental health care.

As a young boy living in Zaire at the time, Brittain Bahige saw refugees from the 1994 Rwandan genocide fleeing across a river that forms the border between two states in the central African nation.

“Little did I know it would happen a few years later,” Bahige said.

Bahige’s harrowing refugee 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 Congo in 1997. Until arriving in Baltimore in 2004 through the Refugee Resettlement Program.

Bahige, now 42, said the way he grew up was to “just get it together and tough it out,” and that he took several jobs and community college to adapt that philosophy to life in America. took classes until he went to university. of Wyoming on scholarship. He’s now principal of an elementary school in Gillette, Wyoming, and said his coping strategy, then and now, is to keep himself busy.

“In retrospect, I don’t think I ever dealt with my own trauma,” he said.

Refugees have been arriving in the United States in large numbers this year after resettlement numbers hit a 40-year low under President Donald Trump. These newcomers, like the refugees before them, are 10 times more likely to suffer from post-traumatic stress disorder, depression and anxiety than the general population. Many of them, like the Bahige, fled their homeland because of violence or persecution. They then have to deal with the mental burden of assimilating into a new environment that is as different as Wyoming is from Central Africa.

This worries Bahige for the welfare of the new generation of refugees.

“The nature of the system a person used to live in may be completely different from the new life and system in the world they now live in,” Bahige said.

Although their need for mental health services is greater than the general population, refugees are less likely to receive such care. Part of the shortage stems from social differences. But a larger factor is the overall shortage of mental health providers in the U.S., and the numerous obstacles and barriers to accessing mental health care that immigrants face.

Whether they end up in a rural area like the northern Rocky Mountains or an urban environment like Atlanta, refugees can face months-long waits for care, as well as a lack of medical professionals who understand the people’s culture. They understand who they are serving.

About 3.5 million immigrants have been admitted to the United States since 1975. According to the State Department, annual admissions fell during the Trump administration from about 85,000 in 2016 to 11,814 in 2020.

President Joe Biden has raised the refugee admissions cap to 125,000 for the federal fiscal year 2022, which ends Sept. 30. With less than 18,000 arrivals until the beginning of August, it is unlikely to reach this limit, but the number of people entering increases monthly.

Asylum seekers receive a mental health screening within 90 days of their arrival, along with a general medical evaluation. But the effectiveness of the testing depends largely on the screener’s ability to navigate complex cultural and linguistic issues, said Dr. Ranit Mashuri, a professor of family medicine at Georgetown University and senior medical advisor to Physicians for Human Rights.

Although rates of trauma are high in refugee populations, not all homeless people need mental health services, Mashuri said.

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

“Some people will come in and request services right away, and some won’t need it for a few years until they feel completely safe, and their bodies heal, and the trauma. “The reaction is starting to die down a little bit,” said McKinley Goyner. , mental health navigator for IRC in Missoula, Montana.

Unlike Bahige’s adopted state of Wyoming, which has no refugee resettlement services, IRC Missoula has housed refugees from the Democratic Republic of the Congo, Syria, Myanmar, Iraq, Afghanistan, Eritrea and Ukraine in Montana in recent years. . A major challenge in accessing mental health services in rural areas is that few providers speak the languages โ€‹โ€‹of these countries.

In the Atlanta suburb of Clarkston, which has a large population 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 IRC program at Atlanta and Georgia State University’s Prevention Research Center. Clinicians will assess the mental health needs of refugees as caseworkers help them with housing, employment, education and other issues.

Seeking mental health care from a professional can be an unfamiliar idea for many refugees, said Firdous Ahmed, a former Somali 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 some refugees fear they could face deportation if U.S. authorities find they are struggling with mental health, and some single mothers fear they could be deported for the same reason. will lose their children.

“Some people think that hiring means they’re ‘crazy,'” she said. “Understanding the perspectives of different cultures and how they perceive mental health services.”

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

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

Spending time with someone who shares the same language or figuring out how to use the bus to get to the grocery store is “incredibly healing and gives someone a sense of belonging,” Song said. Gives,โ€ Song said.

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

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

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

The American Psychological Association, however, only conditionally recommends narrative exposure therapy for adult patients with PTSD, suggesting that more research is needed.

But the method worked for Muhammad Alou, a 25-year-old Kurdish immigrant living in Snellville, Georgia, who arrived in the U.S. from Syria in 2016.

Alo was attending Georgia State while working full-time to support himself when the Covid-19 pandemic began. While the downtime during the pandemic gave him time to reflect, he lacked the tools to process his past, which included fleeing Syria and risking violence.

When his busy schedule returned, he found himself unable to cope with his new anxiety and loss of focus. Narrative exposure therapy helped deal with this stress, she said.

Regardless of treatment options, mental health is not necessarily a top priority when a refugee arrives in the United States. “When someone has lived a life of survival, risk is the last thing you’re going to project,” Bahige said.

But Bahige also sees resettlement as an opportunity for refugees to address their mental health needs.

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

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three major operating programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information on health issues to the nation.

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