Refugee Mental Health and Healing: Understanding the Impact of Policies of Rapid Economic Self-sufficiency and the Importance of Meaningful Work

  • Julia Meredith Hess
  • Brian L. Isakson
  • Suha Amer
  • Eric Ndaheba
  • Brandon Baca
  • Jessica R. GoodkindEmail author


Although refugees who are accepted for resettlement in a third country are guaranteed certain rights and experience safety from war and persecution, they face many mental health challenges. Using qualitative methods and constructivist grounded theory, we explored culturally specific perspectives on trauma and recovery among Burundian, Congolese, and Iraqi refugees resettled in the USA. Eighteen semi-structured interviews provided extensive data on the meaning of productivity and work, the ways in which they index normalcy and self-sufficiency, and how they create security that facilitates the healing process. Our inductive analyses revealed that participants emphasized the relationship between productivity and healing when they described recovery from trauma. Participants also discussed individual and structural facilitators and barriers to work. Finally, prominent themes emerged around gendered roles and expectations and the ways these function in refugee resettlement contexts that are shaped by policies that demand rapid economic self-sufficiency. Taken together, these findings suggest that policies that promote underemployment and foreclose opportunities for education and professional development may contribute negatively to refugee mental health, as well as keep refugees in poverty.


Healing Health Policy Recovery Refugees Work 



We wish to acknowledge the contributions of our community advisory council members (Jerome Ndabirorere, Freedance Nibakiza, Mohammed Alkwaz, Sulaf Alkawaz, Seyyed Qasim Sadat, Sadiqa Sadat, Hala Al-kurdi, Muslim Al-kurdi, Jean Paul Ninziza, Nina Nahimana, Marshall Jenson, Kiri Mathsen, Kresta Opperman, Ngerina Nyankundwakazi, Danielle Parker, Mandy Ortaa, and Azhar N. Al-Jarry), interviewers/interpreters (Ebtisam Ali, Ahmed Mashhadi, Cynthia Mfurakazi, Martin Ndayisenga, Sanaa Yaqoob), and all of the research participants.

Funding Information

This study was funded by a grant to the senior corresponding author from the National Institute on Minority Health & Health Disparities (R01MD007712).


  1. Agamben, G. (1998). Homo Sacer: sovereign power and bare life. Palo Alto: Stanford University Press.Google Scholar
  2. Goodkind, J. (2005). Effectiveness of a community-based advocacy and learning program for Hmong refugees. American Journal of Community Psychology, 36(3/4), 387–408.
  3. Goodkind, J. (2006). Promoting Hmong refugee’s well-being through mutual learning: Valuingknowledge, culture, and experience. American Journal of Community Psychology, 37(1/2), 77–93. doi:
  4. Goodkind, J., Amer, S., Christian, C., Hess, J.M., Bybee, D., Isakson, B., et al. (2017). Challenges and innovations in a community-based participatory randomized controlled trial. Health Education & Behavior, 44(1), 123–130.
  5. Goodkind, Jessica, Hess, J. M., Isakson, B., LaNoue, M., Githinji, A., Roche, N., Vadnais, K., & Parker, D. P. (2014). Reducing refugee mental health disparities: A community-based intervention to address post-migration stressors with African adults. Psychological Services, 11(3), 333–46.
  6. Brown, A., & Sribner, T. (2014). Unfulfilled promises, future possibilities: the refugee resettlement system in the United States. Journal on Migration and Human Security, 2(2), 101–120.CrossRefGoogle Scholar
  7. Charmaz, K. (2014). Constructing grounded theory (2nd ed.). Thousand Oaks: SAGE Publications.Google Scholar
  8. Dawood, N. (2011). From persecution to poverty: the costs of the U.S. Refugee Resettlement Program’s narrow emphasis on early employment. Berkeley Public Policy Journal, January 2011. Accessed 11 Oct 2018.
  9. Droždek, B., Wilson, J. P., & Turkovic, S. (2012). Assessment of PTSD in non-Western cultures: the need for new contextual and complex perspectives. In J. G. Beck, D. M. Sloan, J. G. Beck, & D. M. Sloan (Eds.), The Oxford handbook of traumatic stress disorders (pp. 302–314). New York: Oxford University Press. Scholar
  10. Fassin, D., & Rechtman, R. (2009). The empire of trauma: an inquiry into the condition of victimhood. Princeton: Princeton University Press.Google Scholar
  11. Haines, D. W. (2010). Safe haven?: a history of refugees in America. Sterling: Kumarian Press.Google Scholar
  12. Herman, J. (1992). Trauma and recovery: the aftermath of violence—from domestic abuse to political terror. New York: HarperCollins.Google Scholar
  13. Hess, J. M., Isakson, B., Githinji, A., Roche N., Vadnais, K., Parker, D. P., et al. (2014). Reducing mental health disparities through transformative learning: A social change model with refugees and students. Psychological Services 11(3), 347–356Google Scholar
  14. Kirmayer, L. (2004). The cultural diversity of healing: meaning, metaphor and mechanism. British Medical Bulletin, 2004(69), 33–48. Scholar
  15. Kleinman, A., Das, V., & Lock, M. (1997). Social suffering. Berkeley: University of California Press.Google Scholar
  16. Malkki, L. (1992). National geographic: the rooting of peoples and the territorialization of national identity among scholars and refugees. Cultural Anthropology, 7(1), 24–44.CrossRefGoogle Scholar
  17. Marsella, A. (2010). Ethnocultural aspects of PTSD: an overview of concepts, issues and treatments. Traumatology, 16(4), 17–26.CrossRefGoogle Scholar
  18. Miller, K. E. (1999). Rethinking a familiar model: psychotherapy and the mental health of refugees. Journal of Contemporary Psychotherapy, 29(4), 283–306.CrossRefGoogle Scholar
  19. Miller, K. E., Omidian, P., Quraishy, A., et al. (2006). The Afghan symptom checklist: a culturally grounded approach to mental health assessment in a conflict zone. The American Journal of Orthopsychiatry, 76(4), 423–433.CrossRefGoogle Scholar
  20. Mollica, R. F. (2006). Healing invisible wounds: paths to recovery in a violent world. Nashville: Vanderbilt University Press.Google Scholar
  21. Owens, P. (2009). Reclaiming ‘Bare Life’?: against Agamben on refugees. International Relations, 23(4), 567–582.CrossRefGoogle Scholar
  22. Silove, D. (1999). The psychosocial effects of torture, mass human rights violations, and refugee trauma: toward an integrated conceptual framework. Journal of Nervous and Mental Disease, 187(4), 200–207.CrossRefGoogle Scholar
  23. Summerfield, D. (1999). A critique of seven assumptions behind psychological trauma programs in war-affected areas. Social Science and Medicine, 48, 1449–1462.CrossRefGoogle Scholar
  24. Terheggen, M., Stroebe, M., & Kleber, R. J. (2001). Western conceptualizations and eastern experience: a cross-cultural study of traumatic stress reactions among Tibetan refugees in India. Journal of Traumatic Stress, 14(2), 391–403.CrossRefGoogle Scholar
  25. UN General Assembly (1951). Convention relating to the status of refugees, 28 July 1951, United Nations, Treaty Series, vol. 189, p. 137. Available at: (accessed 21 March 2016).
  26. United Nations High Commissioner for Refugees (UNHCR) (2016). Global trends: forced displacement in 2015. Accessed on February 8, 2017.
  27. US Government Accountability Office (2012). Refugee resettlement: greater consultation with community stakeholders could strengthen program. Washington, DC.Google Scholar
  28. US Senate Committee on Foreign Relations (2010). Abandoned on arrival: implications for refugees and local communities burdened by a U.S. refugee system that is not working. Washington, DC: US Printing Office.Google Scholar
  29. Wilson, J. P., & Tang, C. S. K. (2007). Cross-cultural assessment of psychological trauma and PTSD. New York: Springer Publishing.CrossRefGoogle Scholar
  30. Yakushko, O., Backhaus, A., Watson, M., Ngaruiya, K., & Gonzalez, J. (2008). Career development concerns of recent immigrants and refugees. Journal of Career Development, 34(4), 362–396. Accessed 30 January 2017.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of New MexicoAlbuquerqueUSA
  2. 2.Department of Psychiatry and Behavioral SciencesUniversity of New MexicoAlbuquerqueUSA
  3. 3.Department of Sociology MSC05 3080University of New MexicoAlbuquerqueUSA

Personalised recommendations