How Mental Health Service Delivery Models Address The Needs of Refugees

Refugees have higher rates of western defined mental health disorders, yet it has been documented there is underutilization of Western mental health services by refugees. A more holistic ecological approach is needed to serve refugees best over a conventional Western biomedical model. This systematic review was designed to explore the research question: How are mental health service delivery models addressing the bio-psycho-social-spiritual needs of refugees. The study was set up using peer-reviewed articles and dissertations after 2000. The databases, SocINDEX, Academic Search Premier, and ProQuest Dissertations & Theses were systematically searched using the terms; “mental health service delivery models” AND “refugees.” And terms “mental health models” AND “refugees” AND “mental health.” Out of these searches, 14 articles met inclusion criteria and were included in the review. One theme emerged on meeting the biological needs; 1. importance of blending both the western medical model and traditional healing practices as part of mental health treatment. For psychological needs three themes emerged; 1. the importance of building trust, 2. group work is being utilized across different mental health service delivery models for both adults and children, 3. non-verbal therapeutic interventions are being used across mental health service delivery models for both adults and children. One theme emerged for meeting social needs; 1. a psycho-social approach is needed. Lastly, one theme emerged for meeting spiritual needs; 1. to help address the spiritual needs of refugees it is important to collaborate with community religious leaders. Overall there is currently limited research on this topic. Of the articles, little was discussed on meeting the biological and spiritual needs as part of treatment. Moving forward, mental health service delivery models should consider meeting all domains of a refugee’s life rather than only addressing psychological distress. Understanding help-seeking behavior, traditional ways of SERVICE DELIVERY MODELS FOR REFUGEES 2 healing, and cultural understanding of mental health, as well as providing service to address the many unmet social needs of refugees, may lead to better mental health outcomes and service utilization. Future research should focus on the study of culturally appropriate evidence-based practices for refugee populations

How Mental Health Service Delivery Models Address The Needs of Refugees

Refugees have higher rates of western defined mental health disorders, yet it has been documented there is underutilization of Western mental health services by refugees. A more holistic ecological approach is needed to serve refugees best over a conventional Western biomedical model. This systematic review was designed to explore the research question: How are mental health service delivery models addressing the bio-psycho-social-spiritual needs of refugees. The study was set up using peer-reviewed articles and dissertations after 2000. The databases, SocINDEX, Academic Search Premier, and ProQuest Dissertations & Theses were systematically searched using the terms; “mental health service delivery models” AND “refugees.” And terms “mental health models” AND “refugees” AND “mental health.” Out of these searches, 14 articles met inclusion criteria and were included in the review. One theme emerged on meeting the biological needs; 1. importance of blending both the western medical model and traditional healing practices as part of mental health treatment. For psychological needs three themes emerged; 1. the importance of building trust, 2. group work is being utilized across different mental health service delivery models for both adults and children, 3. non-verbal therapeutic interventions are being used across mental health service delivery models for both adults and children. One theme emerged for meeting social needs; 1. a psycho-social approach is needed. Lastly, one theme emerged for meeting spiritual needs; 1. to help address the spiritual needs of refugees it is important to collaborate with community religious leaders. Overall there is currently limited research on this topic. Of the articles, little was discussed on meeting the biological and spiritual needs as part of treatment. Moving forward, mental health service delivery models should consider meeting all domains of a refugee’s life rather than only addressing psychological distress. Understanding help-seeking behavior, traditional ways of SERVICE DELIVERY MODELS FOR REFUGEES 2 healing, and cultural understanding of mental health, as well as providing service to address the many unmet social needs of refugees, may lead to better mental health outcomes and service utilization. Future research should focus on the study of culturally appropriate evidence-based practices for refugee populations

Understanding mental health needs of Southeast Asian refugees: Historical, cultural, and contextual challenges

Research and clinical information pertaining to mental health needs of Asians residing in the United States is limited but growing. There is a tendency to group all persons of Asian descent together and, therefore, the empirical literature does not sufficiently address the mental health needs in specific subgroups. The focus of this article is to understand the mental health needs of one subgroup of Asians-Southeast Asian refugees (SEAR). The main purpose is to review the relevant literature pertaining to Southeast Asian refugees’ experiences and to understand the manifestation of psychiatric disorders by examining historical, cultural, and contextual challenges. Despite the well-documented mental health needs for SEAR, most do not present for mental health services. Therefore, resilience and protective factors are discussed. Research and clinical implications are described and suggestions are offered on how to apply information obtained from Southeast Asian refugees’ experiences to future refugees

Minding the Iraqi refugee: Psychological challenges of Iraqi war refugees and the effectiveness of existing support services in Saskatoon

This thesis explores the psychological challenges experienced by Iraqi war refugees living in Saskatoon, the effect of war trauma and forced displacement on their mental health, and examines the adequacy of existing mental health services in meeting their needs. Qualitative data collected from refugees, settlement workers, and mental health professionals in Saskatoon were used to provide an in-depth, person-centered understanding of the refugees’ experiences and the way existing services succeed or fail to correspond to their experiences. Convenience and snowball sampling were used to recruit participants. Life history and semi-structured interviews were conducted with 10 Iraqi refugees; semi-structured interviews were also conducted with 10 settlement workers and four mental health care providers. Additionally, one focus group interview was conducted with the settlement workers. The study was designed from a phenomenological point of view, and thematic analysis was used to analyze the data. The findings revealed that Iraqi refugees face many difficulties during different migration stages, which can include: traumatic experiences, loss and grief, and religious intolerance in Iraq; continuous fear for safety, separation from family members, uncertainty about the future in the transition country; and unmet expectations, racism and discrimination, difficulties entering the workforce, family conflicts, and loneliness in Canada. The data further identifies many gaps in the current mental health services provided to refugees in Saskatoon, such as difficulties of navigating the system, a lack of connection between different settlement agencies and the health region, and a lack of specialized training for service providers. Additionally, the interviews highlighted an underutilization of mental health services, which can be explained by stigmas around mental health, having other priorities, cultural differences in understanding mental illness, and a lack of culturally competent services. It is concluded that current mental health services in Saskatoon do not correspond to the mental health needs of Iraqi war refugees. Based on these findings, recommendations are provided for improvement of mental health services in Saskatoon, with primary focus in three areas: raising awareness, professional training, and developing culturally competent mental health services. A deeper understanding of the difficulties that Iraqi refugees have experienced, their psychological needs, and currently available mental health services is a prerequisite for improving the existing services and the refugees’ experience as Canada continues to open its doors to war refugees from the Middle East

THE SYRIAN REFUGEES’ NEED FOR TRAUMA-BASED SERVICES, A SURVEY OF MENTAL HEALTH PROFESSIONALS

Background: Trauma Aid UK (previously HAP UK &Ireland) conducted three EMDR trainings in Turkey: the first was in Istanbul on 28th November 2013. Aim: The purpose of this study is to assess the needs of the Syrian Refugees for trauma services training and provision as assesses by mental health professionals who work with them. Subjects and methods: Amongst the 62 participants of two Istanbul EMDR trainings organised by HAP, 53% were Syrian. We felt it is a unique opportunity to assess the needs of Syrian refugees they are working with. We asked all the participants who are all mental health professionals to complete an Arabic translation of \u27The Need for Trauma-based Services Questionnaire\u27 in these trainings. The rest of the participants on the course were from Iraq (18%), Jordan (16%), Egypt (7%) and others from Palestine, Sudan & Libya (6%). All participants completed questionnaires. Results: The results of comparing the needs reported by Syrian mental health professionals showed higher prevalence of PTSD seen by the Syrian mental health professionals (72% compared with 56% in the clients seen by the rest of participants). Also, the Syrian mental health professionals could only meet 34% (SD=17.1) of the needs of their client who suffer from PTSD. The unmet need for trauma therapy was reported as 100% by these professionals. Conclusions: This study highlighted the high need for trauma mental health services of the Syrian refugees as reported by mental health professionals working in the neighbouring countries. The needs of the Syrian refugees, arriving to the UK because of the very difficult situations, these refugees are coming from, may be met with EMDR therapy. EMDR can be used to help these refugees to be a productive part of the British society

Meeting the Mental Health Needs of Syrian Refugees in Turkey

Movements such as the Arab Spring (as described by popular media) and recent regional conflicts have forced people to leave their homes and flee to other countries or regions. Syrian refugees are currently the second largest refugee group worldwide, with half of them resettled in Turkey. Turkish government and non-governmental civil organizations have mobilized efforts to address the immediate survival needs of these refugees such as food, shelter and other provisions. Despite efforts to manage the complexity of mental health and social service needs of forcibly displaced people, counseling services are still lacking. This expository article addresses the mental health needs of Syrian refugees and provides implications for counseling professionals working with displaced people from a crisis intervention approach built on principles and perspectives of humanistic mental health. In addition, programs of support, such as the Mental Health Facilitator program, are discussed

Failures of US Foreign Aid: Jordan and its Unique History of Refugee Absorption

The United States began giving aid to Jordan as a geopolitical strategy in 1951 to assists with Jordan’s absorption of Palestinian refugees after the creation of Israel in 1948. Since 1951, the United States has given nearly $15.833 billion in support. Foreign aid to Jordan began, and has been perpetuated, in order to keep the country economically stable. Jordan’s total population is 55–57% refugees. Most of these refugees require financial, health, and housing assistance, and they suffer from untreated mental health conditions. US foreign aid policy needs to have programming to treat the mental health trauma that refugees experience. Research needs to be done on the connection between this trauma and social, political, and economic problems that affect Jordan in relation to refugees. Implementing programs to treat mental illness through aid will allow US foreign aid in Jordan to be more effective in assisting the socio-economic growth of refugees and entire country as a whole

Assessing trauma in a transcultural context: Challenges in mental health care with immigrants and refugees

The growing numbers of refugees and immigrants from conflict-prone areas settling throughout the world bring several challenges for those working in the mental health care system. Immigrants and refugees of all ages arrive with complex and nuanced mental health histories of war, torture, and strenuous migration journeys. Many of the challenges of addressing the health care needs for this growing population of immigrants and refugees are often unfamiliar, and thus practices to address these challenges are not yet routine for care providers and health care organizations. In particular, complex trauma can make mental health assessments difficult for health care organizations or care providers with limited experience and training in transcultural or trauma-informed care. Using a transcultural approach can improve assessment and screening processes, leading to more effective and high-quality care for immigrant and refugee families experiencing mental health disorders. This paper presents findings from an assessment of current mental health services focusing on current practices and experiences with immigrant and refugee patients and families. The difficulties in developing shared understandings about mental health can hinder the therapeutic process; therefore, it is imperative to ensure an effective assessment right from the beginning, yet there is limited use of existing cultural formulation tools from the DSM-IV or DSM-5. The paper outlines current practices, approaches, challenges, and recommendations shared by mental health care providers and program leaders in addressing the mental health care needs of immigrants and refugees. The results from this study demonstrate that there are many challenges and inconsistencies in providing transcultural, trauma-informed care. Respondents emphasized the need for a thorough yet flexible and adaptive approach that allows for an exploration of differences in cultural interpretations of mental health. Our study concluded that ensuring a mindful, reflexive, transcultural, and trauma-informed health care workforce, and a learning environment to support staff with education, resources, and tools will improve the health care experiences of immigrants and refugees in the mental health care system

Investigating the mental health needs of Zimbabwean refugees in Durban, South Africa : a thematic analysis.

Masters of Social Science in Counselling Psychology. University of KwaZulu-Natal. Durban, 2017.This study endeavoured to investigate the mental health needs of refugees to help establish the real cause of prevailing problems they experience in their host country, South Africa, so that deficits, gaps and needs in current intervention programs and services can be addressed to aid this population. The research questions aimed to investigate the psychological, emotional, social and environmental difficulties that refugees face on a daily basis which could contribute to their mental health needs. How refugees manage these difficulties was also investigated. A qualitative research design was used, with Braun and Clarke’s six-phased thematic analysis process used as the methodology of choice. Ten refugees from Zimbabwe living in Durban, South Africa, were purposively selected and semi-structured interviews were conducted to provide the required data. Thematic analysis was conducted and resulted in the identification of five themes: inaccessibility, basic needs, being a foreigner, emotional well-being, and internal and external coping strategies. The findings of this study show that refugees living in Durban present with mental health needs as they encounter various difficulties across the psychological, emotional, social and environmental domains. The primary difficulties identified by the refugees were difficulty with accessing employment and maintaining a secure income, as well as difficulty being a foreigner and not being accepted by the locals in Durban. The primary coping strategies identified by the refugees with these difficulties were their spiritual faith and social support. Limitations to the study included minimal time that the researchers could have with the refugees as only one interview could be conducted with each participant, and due to the sensitive experiences refugees might encounter, the possibility that some participants only share general and superficial concerns is possible

Telepsychiatry And Mental Health Care For Syrian Refugees In Turkey

The Syrian conflict is now in its fourth year and has produced one of the largest humanitarian disasters since the Cold War. Violent fighting and aerial bombings in many of the country’s major cities have resulted in massive numbers of internally and externally displaced Syrians, many psychologically traumatized and in need of expert mental health attention. The influx of refugees into Syria’s neighboring countries of Lebanon, Jordan and Turkey has stressed already strained health systems. The ability to deliver mental health care is inextricably linked to the existing health care infrastructure—a dynamic and often unstable institution as refugees migrate from one region to another and as local government and social factors influence refugees’ access to services. This thesis attempts to provide a framework for understanding the challenges to providing mental health care for Syrian refugees. Telepsychiatry is proposed as a potential modality to help bridge the mental health needs gap. Emphasis will be placed on the southern Turkish province of Kilis, were we carried out a pilot telepsychiatry assessment (PASSPORT study) discussed later in the thesis