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Addressing the Invisible Affliction: An Assessment of Behavioral Health Services for Newly Resettled Refugees in the United States

  • Amir A. AfkhamiEmail author
  • Katy Gorentz
Article

Abstract

The behavioral health needs of refugees in the USA remain insufficiently studied due to a lack of data on their assessment, referral, and treatment during the resettlement process. This study examines the current behavioral health service provisions for this population through individual interviews of refugee resettlement agency staff in the District of Columbia, Maryland, Virginia, and a nationwide survey of state refugee health coordinators. The results reveal shortfalls in behavioral health screening, clinical resources, and other federally mandated services along with linguistic and cultural obstacles facing refugees with potential behavioral health needs. This study offers actionable policy and procedural recommendations on the federal, state, and local levels to address these shortfalls. This includes increasing funding for healthcare entitlement programs and refugee resettlement agencies, improving screening procedures and treatment protocols, expanding federal and state oversight of mandated behavioral health services, and establishing community-partnered programs to reduce cultural and stigma-related barriers to behavior health care.

Keywords

Refugee health Behavioral health Psychiatry PTSD Resettlement Depression Integration 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors. GWU IRB#: 101610, determined research not involving human subjects.

Informed Consent

Informed consent was obtained on all questionnaires.

References

  1. Afkhami, A. A. (2016). Can academic medicine lead the way in the refugee crisis? Academic Medicine, 91(12), 1595–1597.CrossRefGoogle Scholar
  2. Asgary, R., & Segar, N. (2011). Barriers to health care access among refugee asylum seekers. Journal of Health Care for the Poor and Underserved, 22(2), 506–522.CrossRefGoogle Scholar
  3. Bartolomei, J., Baeriswyl-Cottin, R., Framorando, D., Kasina, F., Premand, N., Eytan, A., & Khazaal, Y. (2016). What are the barriers to access to mental healthcare and the primary needs of asylum seekers? A survey of mental health caregivers and primary care workers. BMC Psychiatry, 16(1), 336.CrossRefGoogle Scholar
  4. Bogic, M., Ajdukovic, D., Bremner, S., Franciskovic, T., Galeazzi, G. M., Kucukalic, A., Lecic-Tosevski, D., Nexhmedin, M., Popovski, M., Schutzwohl, M., Wang, D., & Priebe, S. (2012). Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK. The British Journal of Psychiatry, 200(3), 216–223.CrossRefGoogle Scholar
  5. Centers for Disease Control and Prevention [CDC]. (2014). Guidelines for the U.S. domestic medical examination of newly arriving refugees. http://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/domestic-guidelines.html. Accessed 25 June 2018.
  6. Centers for Medicare and Medicaid Services [CMS]. (2018). Translation and Interpretation Services. https://www.medicaid.gov/medicaid/finance/admin-claiming/translation/index.html. Accessed 25 June 2018.
  7. Derr, A. S. (2016). Mental health service use among immigrants in the United States: a systematic review. Psychiatric Services, 67(3), 265–274.CrossRefGoogle Scholar
  8. Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in Western countries: a systematic review. Lancet, 365(9467), 1309–1314.CrossRefGoogle Scholar
  9. Fellmeth, G., Plugge, E., Fazel, M., Charunwattana, P., Nosten, F., Fitzpatrick, R., Simpson, J. A., & McGready, R. (2018). Validation of the Refugee Health Screener-15 for the assessment of perinatal depression among Karen and Burmese women on the Thai-Myanmar border. PLoS One, 13(5), e0197403.  https://doi.org/10.1371/journal.pone.0197403.CrossRefGoogle Scholar
  10. Goffman, E. (1963). Stigma; notes on the management of spoiled identity. Englewood Cliffs: Prentice-Hall.Google Scholar
  11. Goodman, R. (2006). The strengths and difficulties questionnaire: a research note. The Journal of Child Psychology and Psychiatry, 38(5), 581–586.CrossRefGoogle Scholar
  12. Hall, R. C. W., & Wise, M. G. (1995). The clinical and financial burden of mood disorders. Psychosomatics, 36(2), S11–S18.CrossRefGoogle Scholar
  13. Kaleem, J. (2015) More than half of Americans have unfavorable view of Islam, poll finds. Huffington Post. http://www.huffingtonpost.com/2015/04/10/americansislam-poll_n_7036574.html. Accessed 1 June, 2018.
  14. Kearns, M. C., Ressler, K. J., Zatzick, D., & Rothbaum, B. O. (2012). Early interventions for PTSD: a review. Depression and Anxiety, 29(10), 833–842.CrossRefGoogle Scholar
  15. Keller, A., Joscelyne, A., Granski, M., & Rosenfeld, B. (2017). Pre-migration trauma exposure and mental health functioning among Central American migrants arriving at the US border. PLoS One, 12(1), e0168692.CrossRefGoogle Scholar
  16. Médecins Sans Frontières. (2017). Forced to flee Central America’s northern triangle: a neglected humanitarian crisis. https://www.msf.org/sites/msf.org/files/msf_forced-to-flee-central-americas-northern-triangle_e.pdf. Accessed 25 June 2018.
  17. Mollica, R. F., McInnes, K., Poole, C., & Tor, S. (1998). Dose-effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence. British Journal of Psychiatry, 173(DEC.), 482–488.CrossRefGoogle Scholar
  18. Morris, M. D., Popper, S. T., Rodwell, T. C., Brodine, S. K., & Brouwer, K. C. (2009). Healthcare barriers of refugees post-resettlement. Journal of Community Health, 34(6), 529–538.CrossRefGoogle Scholar
  19. Murray, K. E., Davidson, G. R., & Schweitzer, R. D. (2010). Review of refugee mental health interventions following resettlement: best practices and recommendations. American Journal of Orthopsychiatry, 80(4), 576–585.CrossRefGoogle Scholar
  20. Nicholson, B. L. (1997). The influence of pre-emigration and post-emigration stressors on mental health: a study of Southeast Asian refugees. Social Work Research, 21(1), 19–31.CrossRefGoogle Scholar
  21. Office of Refugee Resettlement [ORR]. (2012). Domestic medical screening guidelines checklist. http://www.acf.hhs.gov/programs/orr/resource/medical-screening-protocol-for-newly-arriving-refugees. Accessed 25 June 2018.
  22. Office of Refugee Resettlement [ORR]. (2016). FY 2015 Served populations by state and country of origin (refugees only). http://www.acf.hhs.gov/orr/resource/fy-2015-refugees-by-state-and-country-of-origin-all-served-populations. Accessed 25 June 2018.
  23. O’Mahony, J., & Donnelly, T. (2010). Immigrant and refugee women’s post-partum depression help-seeking experiences and access to care: a review and analysis of the literature. Journal of Psychiatric and Mental Health Nursing, 17(10), 917–928.CrossRefGoogle Scholar
  24. Ostrander, J., Loomis, A., & Berthold, S. (2017). Working with refugees in the U.S.: trauma-informed and structurally competent social work approaches. Advances in Social Work, 18(1), 66–79.CrossRefGoogle Scholar
  25. Pathways to Wellness. (2011). Integrating refugee health and well-being creating pathways for refugee survivors to heal. http://refugeehealthta.org/wp-content/uploads/2012/09/RHS15_Packet_PathwaysToWellness-1.pdf. Accessed 25 June 2018.
  26. Saechao, F., Sharrock, S., Reicherter, D., Livingston, J. D., Aylward, A., Whisnant, J., Koopman, C., & Kohli, S. (2012). Stressors and barriers to using mental health services among diverse groups of first-generation immigrants to the United States. Community Mental Health Journal, 48(1), 98–106.CrossRefGoogle Scholar
  27. Scott, K. M., Lim, C., Al-Hamzawi, A., et al. (2016). Association of mental disorders with subsequent chronic physical conditions: world mental health surveys from 17 countries. Journal of the American Medical Association Psychiatry, 73(2), 150–158.Google Scholar
  28. Shannon, P., Im, H., Becher, E., Simmelink, J., Wieling, E., & O'Fallon, A. (2012). Screening for war trauma, torture, and mental health symptoms among newly arrived refugees: a national survey of U.S. refugee health coordinators. Journal of Immigrant and Refugee Studies, 10(4), 380–394.CrossRefGoogle Scholar
  29. Shannon, P., McCleary, J., Wieling, E., Im, H., Becher, E., & O’Fallon, A. (2015a). Exploring mental health screening feasibility and training of refugee health coordinators. Journal of Immigrant and Refugee Studies, 13(1), 80–102.CrossRefGoogle Scholar
  30. Shannon, P., Wieling, E., Simmelink-McCleary, J., & Becher, E. (2015b). Beyond stigma: barriers to discussing mental health in refugee populations. Journal of Loss and Trauma, 20(3), 281–296.CrossRefGoogle Scholar
  31. Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & Van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement. Journal of the American Medical Association, 302(5), 537–549.CrossRefGoogle Scholar
  32. Steel, Z., Silove, D., Brooks, R., Momartin, S., Alzuhairi, B., & Susljik, I. (2006). Impact of immigration detention and temporary protection on the mental health of refugees. British Journal of Psychiatry, 188(1), 58–64.CrossRefGoogle Scholar
  33. Substance Abuse and Mental Health Services Administration [SAMHSA]. (2017). About Section 223. https://www.samhsa.gov/section-223/about. Accessed 25 June 2018.
  34. The Office of the United Nations High Commissioner for Refugees [UNHCR]. (2015). UNHCR mid-year trends 2015. http://www.unhcr.org/56701b969.html. Accessed 25 June 2018.
  35. The Office of the United Nations High Commissioner for Refugees [UNHCR]. (2016). Global trends forced displacement in 2015. http://www.unhcr.org/576408cd7.pdf. Accessed 25 June 2018.
  36. Ullmann, E., Barthel, A., Taché, S., Bornstein, A., Licinio, J., & Bornstein, S. R. (2015). Emotional and psychological trauma in refugees arriving in Germany in 2015. Molecular Psychiatry, 20(12), 1483–1484.CrossRefGoogle Scholar
  37. United States Department of State [DOS], Bureau of Population, Refugees, and Migration. (2013). Refugee Resettlement in the United States. https://2009-2017.state.gov/j/prm/releases/factsheets/2013/203578.htm. Accessed 25 June 2018.
  38. United States Department of State [DOS], Bureau of Population, Refugees, and Migration. (2015). FY15 Refugee admission statistics. https://2009-2017.state.gov/j/prm/releases/statistics/251285.htm. Accessed 25 June 2018.
  39. Worabo, H. (2016). Understanding refugees’ perceptions of health care in the United States. Journal for Nurse Practitioners, 12(7), 487–494.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral SciencesGeorge Washington University School of Medicine and Health SciencesWashington DCUSA
  2. 2.Department of Global HealthMilken Institute School of Public HealthWashington DCUSA

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