Understanding the mental health of refugees: Trauma, stress, and the cultural context

At the end of 2016, there were a record-high 65.6 million people forcibly displaced according to the United Nations High Commissioner for Refugees (1). With 300,000 new people displaced in 2016, there were 20 people newly displaced every minute of 2016. Most refugees flee their homes with little time to prepare (2) and, in turn, frequently are ill-equipped with the financial, linguistic, and other resources needed to address the challenges of the journey that lies ahead. The nature of the pre-migration and flight experiences for refugees, which are frequently marked by fear, forced departure, and experiences of torture and trauma, distinguishes them from other voluntary migrants. Since 1975 approximately three million individuals have been resettled in the USA (approximately 2 million adults and 1 million children) (3); this represents a significant population to respond to clinically. Importantly, status as a forcibly displaced person seeking refuge is not in itself a psychiatric condition – refugee status is a sociopolitical phenomenon with common downstream psychosocial effects (4). As refugees resettle in third party countries, often after prolonged stays in refugee camps in a country or countries outside of their home, many experience mental health problems associated with past trauma, ongoing stress, or both. In order to effectively serve resettled refugee and migrant communities, mental health professionals including, researchers, clinicians, educators, and policy makers need to understand the impact of the refugee experience and cultural contexts on psychosocial functioning. This chapter will review the unique mental health challenges and culturally-responsive assessments and treatments targeting some of the world’s most vulnerable and resilient populations