Mental Health Screening

Abstract

There has been a longstanding discussion amongst scholars about the role and use of early mental health screening to detect common mental disorders in refugees. While the Office of Refugee Resettlement requires a health screening of refugees resettled in the United States, guidelines for mental health are less clear. The complex interaction of refugee trauma, the impact of acculturative stress, and refugee cultural frameworks has made screening and diagnosis difficult. This chapter presents a set of considerations for screening refugees and an overview of the most useful and effective tools for screening. Considerations explored in the chapter include managing communication issues, language and cultural barriers and descriptions of symptoms that do not fit easily into a Western medical context. The chapter also gives practical information and suggestions that will aid providers in the screening process including how to engage and more effectively screen refugee patients. Although there is limited empirical research of screening tools for refugees, the chapter reviews the use of the Vietnamese Depression Scale (VDS), the Harvard Trauma Questionnaire (HTQ), the 15-item Health Leaflet (HL), the Posttraumatic Symptom Scale-Self Report (PSS-SR), and the Hopkins Symptom Checklist-25 (HSCL-25). The chapter concludes with a more extensive review of the development and use of the Refugee Health Screener-15 (RHS-15).

Appendix 1

Mental Health SCREENING of Refugees

Sample Screening Questions

Diagnostic criteria	Suggested questions
Hypervigilance	Do you feel you are waiting for something bad to happen?
Intense fear	Do you feel that your body is out of your control?
General anxiety	What do you worry about? Or are you always thinking?
Heart palpitations	Does your heart ever suddenly beat quickly?
Distressing recollections flashbacks	Do you sometimes remember bad things that happened in the past?
Isolation/detachment	Who do you spend time with? How do you spend your time?
Nightmares/sleep disturbance	When do you fall asleep and when do you wake?
	What keeps you awake or wakes you?
Dissociative periods	Does your mind sometimes go far away?
Startle	Do you jump at loud noises?
Avoidance	Do you visit friends or neighbors? What do you do when you are not at work or school?
Lack of concentration	Do you have trouble learning new things?
Poor memory	Do you forget things?
Anger	Do you get angry?
Lack of affect	Do you feel you do not care about anything?
Depression	Do you get sad? How often do you cry?
Poor future imagining	Can you imagine a happy future in America?
Loss of appetite	How many times in a day do you eat?

Tips for Effective Screening

Reminders	Cautions
To Dos
Establish connection/safety	Do not assume that you understand
Check understanding with directed questions	Avoid medical jargon and acronyms
Learn something of the social/political context of events faced by the refugee groups in your area	Be aware of ethnic rivals and relationships in your area
Normalize the trauma response and educate in simple terms	Talk in symptoms, not diagnosis
Know and follow interpreter use protocol!!	DO NOT use interpreters to diagnose
Use trained interpreters	Use simple non-colloquial language. Avoid technical medical language
Ask the refugee what is their first language and what is their level of literacy in that language	Clarify understanding by asking specific questions that cannot be answered with yes/no
Ask the refugee what they think is the problem	Do not assume that the refugee understands the purpose of the appointment