Mental Health Issues Concerning Refugees

Refugees are at a higher risk for mental disorders than any other population. The Gale Encyclopedia of Public Health defines refugees as individuals who have been displaced from their home or native countries due to various reasons such as: war, drought, and natural disasters (Nienstedt). Refugees' exposure to war, trauma, violence and extreme torture throughout premigration and during their escape makes them very susceptible to mental health issues. Common mental health problems that affect refugees are post-traumatic stress disorder (PTSD), depression, and anxiety. There are very few programs in place to aid refugees with mental health disorders. The number of health care resources available to refugees is extremely limited, and within this limitation, the inability of medical professionals to appropriately treat immigrant trauma victims is becoming an increasing issue worldwide. The lack of resources and efforts to treat refugees and their mental health issues are the main contributing factor to high mortality rates due to suicide.

Refugees are prone to a variety of different mental disorders. Laurence J. Kirmayer, MD, in an article from The US National Library of Medicine National Institutes of Health, concludes that based on testing and analysis, refugees are at an extremely higher risk for psychiatric disorders than any other population worldwide. This increased risk stems from exposure to war, violence, torture, and forced banishment. Trauma as a result of torture is the leading cause of mental health disorders for refugees (Kirmayer et al.). Many other significant factors are contributing to mental health disorders that are often not considered. The Gale Encyclopedia of Public Health reveals that women are often victims of rape along with being victims of patriarchal and abusive gender-power schemas within many refugee camps. Sexual assault is a common occurrence in refugee camps and can cause detrimental issues concerning mental conditions (e.g., post-traumatic stress disorder, stress, and anxiety) (Nienstedt). Writing for the Journal of Traumatic Stress, authors Joanne Haldane and Angela Nickerson from The University of New South Wales School of Psychology underscore the seriousness of this issue by revealing evidence which reinforces that interpersonal trauma, such as torture and sexual assault, is associated with a heightened risk for the development of psychological disorders among refugees (457). Haldane and Nickerson also write that there is a significant relationship between women who have endured interpersonal trauma and mental disorders such as PTSD and anxiety (460). Sexual assault can be an underlying cause of multiple different mental disorders present in female refugees brought upon by traumatic events. Immigrants experience horrifying and violent situations that can become burned into memory and create life-long problems.

Fortunately, there are small strides towards a solution to the mental health crisis concerning refugees throughout the world, but much more still needs to be done. Nienstadt reports that refugees living in overfilled immigration camps receive emergency medical health care at best, meaning refugees are most likely not treated by physicians, but emergency medical professionals who do not address the full extent of refugees' medical conditions. They also face many difficulties with health care resources outside immigration camps due to language barriers, financial issues, etc. (Nienstedt). The mental health crisis affecting refugees affects populations internationally. Immigrants in refugee camps are almost all completely dependent on international aid and charity, which is far too much for any host nation to handle. In an effort to solve this international financial issue, organizations such as The World Health Organization (WHO), the International Red Cross and Red Crescent Societies, the Disaster Mental Health Institute and the University of South Dakota have come together to form The Rapid Assessment of Mental Health Needs of Refugees, Displaced and Other Populations Affected by Conflict and Post-Conflict Situations Available Resources (RAMH). RAMH is considered a diagnostic tool that helps medical professionals and other personnel working in refugee support roles more effectively assess the mental health needs of refugees and other displaced persons (Nienstedt). RAMH is a solution to this financial problem because although there are huge costs to creating and maintaining international refugee programs, the loss of life due to suicide and medical consequences for refugees who are not receiving adequate mental health care cost nations even more money (Nienstedt). Writing for the World Health Organization, Mary Petevi, Dr. Jean Pierre Revel and Dr. Gerard A. Jacobs explain that, based on the results of the RAMH diagnostic tool, immediate and longer-term community based mental health programs can be formed for refugees suffering from a mental illness. Medical professionals closely involved in the analysis of the results will undergo proper training to expand their knowledge on mental health (8). The potential programs created based off of the RAMH results will hopefully increase the condition of immigrants' mental health and help them adjust to postmigration life. These programs are a small step in solving the extreme mental health crisis, but there is still a large amount of work that needs to be done to resolve this issue and treat mental illnesses in victims of immigration. Along with prevention programs, there needs to be better access to health care and well-trained physicians.

Mental health care is a specific, limited branch of health care and when granted, it is usually inappropriately given. The inability of medical professionals to appropriately diagnose and treat mental disorders is contributing to a large number of patients presenting. A significant problem associated with the quality of care given to refugees is the frequently present language barrier. Most immigrants do not fluently speak the language of the country they are migrating to which presents itself as a problem when trying to receive any health care. In a 2016 Health Evidence Synthesis Report, authors Stefan Priebe, Domenico Giacco, and Rawda El-Nagib, who are part of the World Health Organization, reveal that a mental health diagnosis was not made in more than half of all initial assessments of asylum seekers (11). This lack of diagnoses results from the inability to understand a patient's symptoms and concerns through an interpreter, who can only hear a patient's words, instead of understanding what they're feeling, which can lead to a false diagnosis. This poor language efficiency can negatively influence the effectiveness of psychological treatments (12). The treatments given to refugees can be inaccurate or unnecessary, but the language barriers do not allow medical professionals to accurately understand their patient's symptoms to make a correct diagnosis. Although there is an abundance of information available on the issues associated with the language barriers, there is little information on solutions being created to fix these issues.

Another major issue associated with the inappropriate treatment in mental health is the lack of trust most refugees possess for public health organizations. Priebe, Giacco and El-Nagib explain the reasoning behind this lack of trust in a Health Evidence Synthesis Report. Refugees are afraid to trust the medical professionals because of their premigration experiences of prosecution and/or a fear of being reported to authorities (12). This fear and mistrust can lead to patients withholding important information about medical issues and concerns out of fear, which can eventually lead to even worse consequences. On top of physician-patient issues, there are issues involved with physician care that desperately need solutions. Authors Ramin Asgary from the New York University School of Medicine and Clyde L. Smith from Harvard School of Medicine reveal that there are moral and professional obligations to train health professionals in treating trauma victims that the Convention Against Torture has set. However, physician training to treat trauma victims rarely ever occurs. Asgary and Smith estimate that only 6% of all medical students receive an hour or more of formal training regarding torture (3). Most refugees are victims of torture, so the revelation that only six percent of medical professionals have had the proper training to appropriately assess the refugee population is alarming and is a huge factor contributing to the high rates of suicide due to mental health.

Mental health disorders, if not diagnosed and treated correctly, can lead to suicide. High suicide rates make it extremely important for medical professionals dealing with immigrant trauma victims to be adequately trained to assess and handle mental illnesses of all types, but this training is evidently not occurring. An article in The Atlantic written by Danielle Preiss supports this claim by explaining that many Bhutanese refugees that have migrated to the United States have committed suicide due to mental illness. Suicide became so frequent that the Federal Office of Refugee Resettlement (ORR) began to notice this pattern and performed extensive research on the deceased refugees with hopes of discovering the cause of this alarming number. By completing psychological autopsies on the deceased individuals, the ORR discovered that twenty-one percent of them had been struggling with depression. This is close to three times the amount of the regular United States population (Preiss). These numbers are evidence that the mental health issues of refugees are potentially linked to an increased mortality rate. Completion of proper training by mental health care professionals and creation of mental health programs could prevent suicides. This is just a small piece of evidence supporting the fact that something urgently needs to be done to help refugees through their mental health disorders and provide more effective treatments. Suicide should not be taken lightly“something drastically needs to change.

Refugees are prone to mental health disorders more than any other population in the world. Within the research done on this topic, there was little to no mention of any international mental health policies concerning refugees. Various populations of refugees have been studied and, compared to general populations of different countries, refugees are at a much higher risk for a mental disorder. These findings should indicate a need for prevention and adjustment programs to new countries to avoid the onset of mental disorders, yet close to none are. Due to this inadequate amount of effort to prevent mental health disorders in refugees, mortality rates due to suicide have increased. Training programs need to be put in place for medical professionals treating refugees, along with the creation of international policies protecting refugees' right to mental health care resources. These changes would significantly reduce suicide rates. There is not enough being done to decrease suicide rates; there are an estimated sixteen million refugees worldwide, and with the linkage to suicide rates there is the appropriate question of how many more refugee suicides due to depression, post-traumatic stress disorder, or anxiety need to occur in order for someone to stand up and do something about it.

Works Cited

Asgary, Ramin and Clyde L. Smith. Ethical and Professional Considerations Providing

Medical Evaluation and Care to Refugee Asylum Seekers. American Journal of Bioethics, vol. 13, no. 7, July 2013, pp. 3-12. EBSCOhost, doi:10.1080/1526161 .2013.794876

Haldane, Joanne, and Angela Nickerson. The Impact of Interpersonal and Noninterpersonal

Trauma on Psychological Symptoms in Refugees: The Moderating Role of Gender and Trauma Type. Journal of Traumatic Stress, vol. 29 no.5, Oct. 2016, pp. 457-465. EBSCOhost, doi:10.1002/jts.22132

Kirmayer, Laurence J et al. Common mental health problems in immigrants and refugees:

general approach in primary care CMAJ: Canadian Medical Association journal = journal de l'Association medicale canadienne vol. 183,12 (2011): E959-67.

Nienstedt, Andrea. "Refugee Health." Gale Encyclopedia of Public Health, edited by Gale, 1st

edition, 2013. Credo Reference, https://proxy-lhup.klnpa.org/login?url=https:// search.credoreference.com/content/entry/galegph/refugee_health/0?institutionId=8905.

Petevi, Mary, Dr. Jean Pierre Revel, and Dr. Gerard A. Jacobs. "Rapid Assessment of

Mental Health Needs of Refugees Displaced and Other Populations Affected by Conflict and Post-Conflict Situations." https://www.who.int. World Health Organization, n.d. Web.

Preiss, Daniell. Bhutanese Refugees are Killing Themselves at an Astonishing Rate. The

Atlantic, 13 April 2013, www.theatlantic.com/international/archive/2013/04/bhutanese- refugees-are-killing-themselves-at-an-astonishing-rate/274959/

Priebe, S., D. Giacco and R. El-Nagib. Public Health Aspects of Mental Health Among

Migrants and Refugees: A Review of the Evidence on Mental Health Care for Refugees, Asylum Seekers and Irregular Migrants in the WHO European Region. Copenhagen: WHO Regional Office for Europe, 2016. (Health Evidence Network Synthesis Report, No. 47.) https://www.ncbi.nlm.nih.gov/books/NBK391045/

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