Abstract
Although there are growing numbers of forced migrants in the United States (US), a gap exists in our understanding of their mental health needs, and of how best to build on existing services to provide migrants with good care. To address these gaps, we undertook a qualitative needs assessment exploring (1) perceived mental health needs of forced migrants, (2) barriers to accessing services and achieving positive health outcomes, and (3) effective models and possibilities for improving services across disciplines within healthcare and social service settings. We conducted three focus groups separately engaging 20 (18 women, 2 men) key informants with expert insights into forced migrant health services (researchers, health/mental healthcare providers, lawyers, policy makers, representatives from local social service and government agencies, and advocates) and 9 (3 women, 6 men) forced migrants. We analyzed responses for each group of participants using an iterative thematic analysis process. Results indicated significant overlap in key informant and forced migrant perceptions across multiple themes: mental health–related stressors of migration, changes in mental health status and health concerns once in the US, ways forced migrants cope with health and mental health concerns, ideals for good health, barriers to accessing mental healthcare, limitations of existing services, and characteristics of good health models. Our results point to the need for more accessible, collaborative, and trauma-informed and culturally informed mental healthcare approaches. Based on our findings, we recommend possible components of an effective interdisciplinary, collaborative care model for forced migrants.
Public Policy Relevance
The growing forced migrant population in the US may face significant mental health needs as a result of the traumas of their migration journey. Drawing on the perspectives of both migrants and mental health service experts, this study helps to illuminate strengths and limitations of existing services available to forced migrants, and points to key elements of a collaborative care model that could more efficiently and effectively address mental health concerns and decrease disparities.
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References
Afkhami, A. A., & Gorentz, K. (2019). Addressing the invisible affliction: An assessment of behavioral health services for newly resettled refugees in the US. Journal of International Migration and Integration, 20(1), 247–259. https://doi.org/10.1007/s12134-018-0603-z
Al-Obaidi, A. K., West, B., Fox, A., & Savin, D. (2015). Incorporating preliminary mental health assessment in the initial healthcare for refugees in New Jersey. Community Mental Health Journal, 51(5), 567–574. https://doi.org/10.1007/s10597-015-9862-8
Birman, D., Beehler, S., Harris, E. M., Everson, M. L., Batia, K., Liautaud, J., … Cappella, E. (2008). International Family, Adult, and Child Enhancement Services (FACES): A community-based comprehensive services model for refugee children in resettlement. American Journal of Orthopsychiatry, 78(1)https://doi.org/10.1037/0002-9432.78.1.121
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Brun, C & Rapp, R. C. (2001). Strengths-based case management: Individuals’ perspectives on strengths and the case manager relationship. Social Work 46 (3), 278–288. https://doi.org/10.1093/sw/46.3.278
Capps, R., & Fix, M. (2015). Ten facts about U.S. refugee resettlement. Migration Policy Institute. https://www.migrationpolicy.org/research/ten-facts-about-us-refugee-resettlement
Carswell, K., Blackburn, P., & Barker, C. (2011). The relationship between trauma, post-migration problems and the psychological well-being of refugees and asylum seekers. International Journal of Social Psychiatry, 57(2), 107–119. https://doi.org/10.1177/0020764009105699
Center for Victims of Torture. (2015, September). U.S. home to far more refugee torture survivors than previously believed. Retrieved from https://www.cvt.org/sites/default/files/Release_TortureSurvivorNumber_09292015_FINAL.pdf. Accessed 30 Jan 2020.
Center for Victims of Torture. (2019). Where we work: US. Retrieved from https://www.cvt.org/where-we-work. Accessed 30 Jan 2020.
Chung, R. C.-Y., Bemak, F., & Grabosky, T. K. (2011). Multicultural-Social Justice Leadership Strategies: Counseling and Advocacy with Immigrants. Journal for Social Action in Counseling & Psychology, 3(1), 86–102. https://doi.org/10.33043/JSACP.3.1.86-102
Codell, J. D., Hill, R. D., Woltz, D. J., & Gore, P. A. J. (2011). Predicting meaningful employment for refugees: The influence of personal characteristics and developmental factors on employment status and hourly wages. International Journal for the Advancement of Counselling, 33(3), 216–224. https://doi.org/10.1007/s10447-011-9125-5
Esala, J. J., Vukovich, M. M., Hanbury, A., Kashyap, S., & Joscelyne, A. (2018). Collaborative care for refugees and torture survivors: Key findings from the literature. Traumatology, 24(3), 168–185.
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. https://doi.org/10.1016/S0140-6736(05)61027-6
Forte, A., Trobia, F., Gualtieri, F., Lamis, D. A., Cardamone, G., Giallonardo, V., … Pompili, M. (2018). Suicide risk among immigrants and ethnic minorities: A literature overview. International Journal of Environmental Research and Public Health, 15(7). https://doi.org/10.3390/ijerph15071438
Gilbody, S., Bower, P., Fletcher, J., Richards, D., & Sutton, A. J. (2006). Collaborative care for depression: A cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine, 166(21), 2314–2321. https://doi.org/10.1001/archinte.166.21.2314
Goździak, E. M. (2004). Training refugee mental health providers: Ethnography as a bridge to multicultural practice. Human Organization, 63(2), 203–210. https://doi.org/10.17730/humo.63.2.mh8fl2hl8d1f2qnf
Herati, H., & Meyer, S. B. (2020). Mental health interventions for immigrant-refugee children and youth living in Canada: A scoping review and way forward. Journal of Mental Health, 11, 1–14. https://doi.org/10.1080/09638237.2020.1818710
Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., Jr., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60(3), 353–366. https://doi.org/10.1037/a0032595
Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal, 3, 80–100. https://doi.org/10.2174/1874924001003010080
Hynie, M. (2018). The social determinants of refugee mental health in the post-migration context: A critical review. Canadian Journal of Psychiatry, 63(5), 297–303. https://doi.org/10.1177/0706743717746666
Johnson, R. L., Roter, D., Powe, N. R., & Cooper, L. A. (2004). Patient race/ethnicity and quality of patient-physician communication during medical visits. American Journal of Public Health, 94(12), 2084–2090. https://doi.org/10.2105/AJPH.94.12.2084
Kaltman, S., Pauk, J., & Alter, C. L. (2011). Meeting the mental health needs of low-income immigrants in primary care: A community adaptation of an evidence-based model. American Journal of Orthopsychiatry, 81(4), 543–551. https://doi.org/10.1111/j.1939-0025.2011.01125.x
Kirmayer, L. J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A. G., Guzder, J., … Pottie, K. (2011). Common mental health problems in immigrants and refugees: General approach in primary care. Canadian Medical Association Journal, 183(12), 959–967https://doi.org/10.1503/cmaj.090292
Krause, S., Block, A. M., Aizenman, L., Salib, Y., & Greeno, C. (2021). Yoga as medicine: Understanding Bhutanese refugee perspectives on health and healthcare. Social Work in Health Care, 15, 1–15. https://doi.org/10.1080/00981389.2021.1894306
Laban, C. J. (2010). Impact of a long asylum procedure on health in Iraqi asylum seekers in the Netherlands: An epidemiological study. Vrije Universiteit Amsterdam. https://doi.org/10.1016/s0924-9338(09)70304-9
Laban, C. J., Gernaat, H. B. P. E., Komproe, I. H., Schreuders, B. A., & De Jong, J. T. V. M. (2004). Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in The Netherlands. Journal of Nervous and Mental Disease, 192(12), 843–851. https://doi.org/10.1097/01.nmd.0000146739.26187.15
Laban, C. J., Gernaat, H. B. P. E., Komproe, I. H., Van Der Tweel, I., & De Jong, J. T. V. M. (2005). Post migration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands. Journal of Nervous and Mental Disease, 193(12), 825–832. https://doi.org/10.1097/01.nmd.0000188977.44657.1d
Longacre, M., Silver-Highfield, E., Lama, P., & Grodin, M. (2012). Complementary and alternative medicine in the treatment of refugees and survivors of torture: A review and proposal for action. Torture, 22(1), 38–57. https://pubmed.ncbi.nlm.nih.gov/23086004/
MacKenzie1, L., & Hatala, A. (2019). Addressing culture within healthcare settings: The limits of cultural competence and the power of humility. Canadian Medical Education Journal, 10(1), e124–e127. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6445323/
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. https://doi.org/10.1111/j.1939-0025.2010.01062.x
Nadeau, L., & Measham, T. (2005). Immigrants and mental health services: Increasing collaboration with other service providers. The Canadian Child and Adolescent Psychiatry Review = La Revue Canadienne de Psychiatrie de l’enfant et de l’adolescent, 14(3), 73–736.
Pottie, K., Greenaway, C., Feightner, J., Welch, V., Swinkels, H., Rashid, M., … Canadian Collaboration for Immigrant and Refugee Health. (2011). Evidence-based clinical guidelines for immigrants and refugees. CMAJ, 183(12), 824–925. DOIhttps://doi.org/10.1503/cmaj.090313
Rosenberg, E., Richard, C., Lussier, M. T., & Abdool, S. N. (2006). Intercultural communication competence in family medicine: Lessons from the field. Patient Education and Counseling, 61(2), 236–245. https://doi.org/10.1016/j.pec.2005.04.002
Rousseau, C., & Frounfelker, R. L. (2019). Mental health needs and services for migrants: An overview for primary care providers. Journal of Travel Medicine, 26(2), 1–8. https://doi.org/10.1093/jtm/tay150
Rousseau, C., Measham, T., & Nadeau, L. (2013). Addressing trauma in collaborative mental health care for refugee children. Clinical Child Psychology and Psychiatry, 18(1), 121–136. https://doi.org/10.1177/1359104512444117
Salami, B., Salma, J., & Hegadoren, K. (2019). Access and utilization of mental health services for immigrants and refugees: Perspectives of immigrant service providers. International Journal of Mental Health Nursing, 28(1), 152–161. https://doi.org/10.1111/inm.12512 Epub 2018 Jul 9 PMID: 29984880.
SAMHSA (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Rockville, MD: U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration, Office of Policy, Planning and Innovation
SAMHSA (2014). Treatment Improvement Protocol: Trauma-Informed Care in Behavioral Health Services. Rockville, MD: U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration, Office of Policy, Planning and Innovation
Shannon, P. J., Vinson, G. A., Horn, T. L., & Lennon, E. (2018). Defining effective care coordination for mental health referrals of refugee populations in the USnite. Ethnicity and Health. https://doi.org/10.1080/13557858.2018.1547369
Slobodin, O., & De Jong, J. T. V. M. (2015). Mental health interventions for traumatized asylum seekers and refugees: What do we know about their efficacy? International Journal of Social Psychiatry, 61(1), 17–26. https://doi.org/10.1177/0020764014535752
Song, S. J., Kaplan, C., Tol, W. A., Subica, A., & de Jong, J. (2015). Psychological distress in torture survivors: Pre- and post-migration risk factors in a US sample. Social Psychiatry and Psychiatric Epidemiology, 50(4), 549–560. https://doi.org/10.1007/s00127-014-0982-1
Suphanchaimat, R., Kantamaturapoj, K., Putthasri, W., & Prakongsai, P. (2015). Challenges in the provision of healthcare services for migrants: A systematic review through providers’ lens. BMC Health Services Research, 15(1), 1–14. https://doi.org/10.1186/s12913-015-1065-z
Tatian, P.A., McTarnaghan, S., Arena, O. & Su, Y. (2018). State of immigrants in the district of Columbia. Urban Institute. https://www.urban.org/research/publication/state-immigrants-district-columbia
Torres Stone, R. A., Cardemil, E. V., Keefe, K., Bik, P., Dyer, Z., & Clark, K. E. (2020). A community mental health needs assessment of a racially and ethnically diverse population in New England: Narratives from community stakeholders. Community Mental Health Journal, 56, 947–958. https://doi.org/10.1007/s10597-020-00562-2.
Waslin, M. (2016). Six facts you should know about refugees. Immigration Impact. Retrieved from immigrationimpact. com/2016/06/16/six-facts-on-refugees/#.XUdWTW9Kg2w
Acknowledgements
We would like to thank Dr. Ranit Mishori for her professional guidance on this project and continued support.
Funding
This research was funded by a Collaborative Seed Grant from Georgetown University Medical Center’s Global Health Initiative.
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Sheth, N., Patel, S., O’Connor, S. et al. Working Towards Collaborative, Migrant-Centered, and Trauma-Informed Care: a Mental Health Needs Assessment for Forced Migrant Communities in the DC Metropolitan Area of the United States. Int. Migration & Integration 23, 1711–1737 (2022). https://doi.org/10.1007/s12134-021-00884-4
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DOI: https://doi.org/10.1007/s12134-021-00884-4