By BetterHelp Editorial Team|Updated July 5, 2022
The worldwide population of people living as refugees has risen to 30 million so far in 2022, increasing significantly in recent years. With various global societal, political, and environmental crises, more and more individuals and families are seeking refuge from unrest and danger in their home countries. Accompanying the physical danger people in these populations experience is another less valued but equally important threat of mental health challenges.
Causes of mental health challenges in refugee populations
The mental health challenges people face in these populations are generally related to stressors at each step of the relocation process. Historically, the experience of refugees has been divided into four stages – pre-migration, migration, post-migration, and resettlement – each with independent stressors on mental and physical health.
Pre-Migration
The pre-migration period, sometimes called “pre-flight,” refers to the period of life before moving to a new area or country. The challenges faced in this stage include the trauma or adversity the person or family is fleeing from, including persecution, violence, or other physical and mental exposure to traumatic experiences.
Migration
The time spent traveling from a country or locale of origin to a new home is often called the migration or flight period. It usually involves uncertainty, familial separation, time spent in detention centers, and insufficient access to necessary services and care. These stressors can individually affect mental well-being, but with the challenge of facing several at one time, there is an even greater risk of damage to mental health.
Post-migration
Before the stage of resettlement, many people in these situations go through a period called post-migration, the time spent in a new location before permanent or long-term settlement. Again, individuals and families in this stage face issues like family separation, inadequate living conditions, or time at detention centers. The post-migration period also often includes other inaccessibility or barriers to necessary care and services, furthering the challenges that increase the risk of mental health conditions.
Resettlement
As individuals and families adjust to their new home or living arrangements, the resettlement phase generates additional stressors and mental health challenges. In particular, families and individuals often experience stressors like employment concerns, poor living conditions, and lack of access to psychological and physical care and services. Refugees also often experience additional challenges from cultural changes, language barriers, prejudice from their new communities, isolation, and more. The transition to a new place is typically filled with stressors that can have additional detrimental effects on mental health in the long term, especially since these issues do not go away overnight, but are long-lasting and continuous, often existing for as long as they stay in the new location.
Mental health challenges facing refugees and people experiencing forced displacement
As a result of the stressors listed above, people experiencing displacement have higher risks of certain mental health conditions, specifically post-traumatic stress disorder, anxiety, depression, and panic disorders. According to the Refugee Health Technical Assistance Center, studies have found post-traumatic stress disorder and depression rates among refugees that vary in range, depending on the population, experiences, and age group. Some studies show PTSD at rates of 10-40% in adults and 50-90% in children, and depression at 5-15% in adults and 6-40% in children.
The higher rates listed here are notably more expansive than the rates of mental health conditions in the general population, speaking to the reality that the refugee experience is fraught with mental health stressors and unique challenges. Risk factors for these mental health conditions include the trauma experienced, what adversities occurred if services or treatment were accessible at any point, and whether the person or family went through a detention center.
Strategies for managing mental health
The mental health treatment options most often offered to individuals in these situations are chosen based on their severity and the background and experiences of the individual. In the general population, depression, anxiety, and post-traumatic stress disorder are effectively treated through counseling services like therapy, medication, and training with strategies such as mindfulness-based relaxation techniques. Each mental health condition is treated with unique therapeutic modalities, depending on the person and need. For example, PTSD is often treated with a combination of cognitive therapy and exposure therapy.
Refugees may also benefit from virtual counseling, offering a more accessible option for some. Online therapy is proven to be as effective as in-person options in treating various mental health conditions, including some of those experienced by refugee populations.
In populations that have experienced the challenges associated with a traumatic relocation, therapy must be tailored to be culturally informed. The treatment options are usually the same, such as therapy and medication when needed, etc.. Still, community relationships and improving other conditions are equally important to the successful management of these conditions. Because people in these populations cope with the additional issues listed above (unemployment, isolation, inaccessibility to care, and more), building a safe, comfortable living situation is also crucial for success in mental health treatment.
Barriers to mental health treatment
Along with the adversities faced during the resettlement process, certain barriers to mental health treatment exist that advance mental health conditions and other challenges. First, a lack of access to mental health services throughout the stages of resettlement, even upon long-term settlement in a new home, is a substantial roadblock for families and individuals seeking resources or treatment. When services exist or are offered, they are not always accessible due to language or cultural barriers, lack of continuity or stability, or financial inaccessibility.
As noted by the Refugee Health Technical Assistance Center, policies have traditionally only emphasized the physical wellness of these populations and host populations, i.e., avoiding infectious diseases, rather than addressing the vital needs of mental well-being. As research and public understanding of mental health have expanded, we are seeing policies addressing these concerns and hopefully continue to see more.
How to address and support mental health in refugees
Non-refugees are responsible for supporting mental health in refugee populations through policy change, community, and individual interactions. The World Health Organization (WHO) shares a helpful outline for policy changes and community leaders’ suggestions on their site.
In terms of addressing mental health through programs, it is suggested that services are accessible and inclusive to a variety of populations and are focused on offering a culturally informed approach. These mental health programs should also be added to other health services. In other words, mental health should be treated as part of overall health and included in the healthcare options and education that refugee families and individuals receive upon relocation. Part of this integration should include timely and efficient action on treatment and diagnosis and ensure that care continues to be accessible without large gaps in treatment.
Services must be effectively communicated. They should offer information on mental health care options and how they can be sought, display opportunities for financial support, and reach out to high-risk communities. All should be done in accessible language(s) with the help of an interpreter when needed.
In addition to policy and programs, focusing on fostering social wellness and providing opportunities for community events and connection, especially with peers from the same cultural background, are also important for mental health.
Advocating for eliminating policies known to be detrimental (for example, family separation) is a productive and essential action for non-refugee individuals and communities to take in support of mental health. Similar advocacy in day-to-day situations is equally valuable. That includes speaking up against prejudice and ensuring equity in access to services and employment.
The important role of therapy
As refugees face many unique and potentially serious mental health challenges associated with forging a new life in a new and unfamiliar place, therapy can play a hugely important role in facilitating overall refugee health and well-being.
Online therapy may offer support if you or your loved one is experiencing a mental health condition or poor feelings of mental wellness. Found to be an effective alternative to in-person therapy, virtual counseling is an accessible and practical option for people of different backgrounds and experiences. Online counseling can help you navigate traumatic experiences and mental health conditions and even support reaching goals in your career, social or family life, and other relationships, including your relationship with yourself.
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