Skip to main content

Advertisement

Log in

Characteristics of Successful and Unsuccessful Mental Health Referrals of Refugees

  • Original Article
  • Published:
Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

In this community based participatory research study, we explored key characteristics of mental health referrals of refugees using stories of providers collected through an on-line survey. Ten coders sorted 60 stories of successful referrals and 34 stories of unsuccessful referrals into domains using the critical incident technique. Principal components analysis yielded categories of successful referrals that included: active care coordination, establishing trust, proactive resolution of barriers, and culturally responsive care. Unsuccessful referrals were characterized by cultural barriers, lack of care coordination, refusal to see refugees, and system and language barriers. Recommendations for training and policy are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Anderson, L., & Wilson, S. (1997). Critical incident technique. In D. Whetzel & G. R. Wheaton (Eds.), Applied measurement methods in industrial psychology (pp. 89–112). Palo Alto, CA: Davies Black Publishing.

    Google Scholar 

  • Apostoleris, N. H. (2000). Integrating psychological services into primary care in an underserved community: Examining the referral process for on-site mental health services. Presented at the Northeast Regional Conference of the Society of Teachers of Family Medicine, Philadelphia.

  • Bjarnadottir, A., & Campbell, J. P. (2001). Development of a model of individual performance in customer service. Ergometrika, 2, 2–25.

    Google Scholar 

  • Blount, A. (2003). Integrated primary care: Organizing the evidence. Families, Systems, & Health, 21(2), 121–133. doi:10.1037/1091-7527.21.2.121.

    Article  Google Scholar 

  • Borman, W. C., & Brush, D. H. (1993). More progress toward a taxonomy of managerial performance requirements. Human Performance, 6(1), 1–21. doi:10.1207/s15327043hup0601_1.

    Article  Google Scholar 

  • Bownas, D. A., & Berdain, H. J. (1988). Critical incident technique. In G. Sidney (Ed.), The job analysis handbook for business, industry, and government (pp. 1120–1137). New York: Wiley.

    Google Scholar 

  • Carlsson, J. M., Olsen, D. R., Mortensen, E. L., & Kastrup, M. (2006). Mental health and health-related quality of life: A 10-year follow-up of tortured refugees. The Journal of Nervous and Mental Disease, 194(10), 725–731. doi:10.1097/01.nmd.0000243079.52138.b7.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control. (2012). Guidelines for mental health screening during the domestic medical examination for newly arrived refugees. Retrieved from: http://www.cdc.gov/immigrantrefugeehealth/guidelines.html.

  • Davison, M. L. (1992). Multidimensional scaling. Malabar, FL: Krieger.

    Google Scholar 

  • de Anstiss, H., Ziaian, T., Procter, N., Warland, J., & Baghurst, P. (2009). Help-seeking for mental health problems in young refugees: A review of the literature with implications for policy, practice, and research. Transcultural Psychiatry, 46(4), 584–607. doi:10.1177/1363461509351363.

    Article  PubMed  Google Scholar 

  • Edward, J., & Hines-Martin, V. (2014). Exploring the providers perspective of health and social service availability for immigrants and refugees in a southern urban community. Journal of Immigrant and Minority Health,. doi:10.1007/s10903-104-0098-1.

    Google Scholar 

  • Eiseman, D. P., Keller, A. S., & Kim, G. (2000). Survivors of torture in a general medical setting: How often have patients been tortured, and how often is it missed? Western Journal of Medicine, 172, 301–304. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070871/.

  • Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7,000 refugees resettled in Western countries: A systematic review. The Lancet, 365(9467), 1309–1314. doi:10.1016/S0140-6736(05)67655-6.

    Article  Google Scholar 

  • Ferguson W. J. & Candib L. M. (2002). Culture, language, and the doctor–patient relationship. Family Medicine, 34, 353–61. http://works.bepress.com/lucy_candib/26.

  • Flanagan, J. C. (1954). The critical incident technique. Psychological Bulletin, 51(4), 327–358. doi:10.1037/h0061470.

    Article  CAS  PubMed  Google Scholar 

  • Flynn, P. M., Ridgeway, J. L., Wieland, M. L., Williams, M. D., Haas, L. R., Kremers, W. K., et al. (2013). Primary care utilization and mental health diagnoses among adult patients requiring interpreters: A retrospective cohort study. Journal of General Internal Medicine, 28(3), 386–391. doi:10.1007/211606-012-2159-5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gremler, D. D. (2004). The critical incident technique in service research. Journal of service research, 7(1), 65–89. doi:10.1177/1094670504266138.

    Article  Google Scholar 

  • Jaranson, J. M., Butcher, J., Halcon, L., Johnson, D. R., Robertson, C., Savik, K., et al. (2004). Somali and Oromo refugees: Correlates of torture and trauma history. American Journal of Public Health, 94, 591–598. doi:10.2105/AJPH.94.4.591.

    Article  PubMed  PubMed Central  Google Scholar 

  • Johnson, H., & Thompson, A. (2008). The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clinical Psychology Review, 28(1), 36–47. doi:10.1016/j.cpr.2007.01.017.

    Article  PubMed  Google Scholar 

  • Lee, E. (2012). A working model of cross-cultural clinical practice (CCCP). Clinical Social Work Journal, 40(1), 23–36. doi:10.1007/s10015-011-0310-3.

    Article  Google Scholar 

  • Lee, S., & Matejkowski, J. (2012). Mental health service utilization among noncitizens in the United States: findings from the National Latino and Asian American Study. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 406–418. doi:10.1007/s10488-011-0366-8.

    Article  PubMed  Google Scholar 

  • Marshal, G., Schell, T., Elliot, M., Berthold, S., & Chun, C. A. (2005). Mental health of Cambodian refugees two decades after resettlement in the United States. Journal of the American Medical Association, 294(5), 571–591. doi:10.1001/jama.294.5.571.

    Article  Google Scholar 

  • McMurray, J., Breward, K., Breward, M., Alder, R., & Arya, N. (2014). Integrated primary care improves access to healthcare for newly arrived refugees in Canada. Journal of Immigrant and Minority Health, 16(4), 576–585.

    Article  PubMed  Google Scholar 

  • Meredith, L. S., Eisenman, D. P., Green, B. L., Basurto-Dávila, R., Cassells, A., & Tobin, J. (2009). System factors affect the recognition and management of post-traumatic stress disorder by primary care clinicians. Medical Care, 47(6), 686–694.

    Article  PubMed  PubMed Central  Google Scholar 

  • Miles, S. H. (2008). Doctors’ complicity with torture. BMJ,. doi:10.1136/bmj.a1088.

    PubMed  Google Scholar 

  • Miller, K. E., & Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks. Social Science and Medicine, 70(1), 7–16. doi:10.1016/j.socscimed.2009.09.029.

    Article  PubMed  Google Scholar 

  • Minkler, M., & Wallerstein, N. (Eds.). (2010). Community-based participatory research for health: From process to outcomes. San Francisco: Wiley.

  • 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), 529–536. doi:10.1007/s10900-009-9175-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Office of Refugee Resettlement. (2012). Oversees refugee arrival data. Retrieved from http://www.acf.hhs.gov/programs/orr/resource/refugee-arrival-data.

  • Olson, A. M. (2000). A theory and taxonomy of individual team member performance (Doctoral dissertation, University of Minnesota).

  • Overall, J. E., & Klett, C. J. (1972). Applied multivariate analysis. New York: McGraw-Hill.

    Google Scholar 

  • Palinkas, L., Horwitz, S., Chamberlain, P., Hurlburt, M., & Landsverk, J. (2011). Mixed-methods designs in mental health services research: A review. Psychiatric Services, 62(3), 255–263. doi:10.1176/appi.ps.62.3.255.

    Article  PubMed  Google Scholar 

  • Porter, M., & Haslam, N. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. JAMA, 294, 602–609. doi:10.1001/jama.294.5.602.

    Article  CAS  PubMed  Google Scholar 

  • Roberts, A. L., Gilman, S. E., Breslau, J., Breslau, N., & Koenen, K. C. (2011). Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychological medicine, 41(1), 71–83. doi:10.1017/S0033291710000401.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rosenberg, E., Leanza, Y., & Seller, R. (2007). Doctor–patient communication in primary care with an interpreter: physician perceptions of professional and family interpreters. Patient Education and Counseling, 67, 286–292. doi:10.1016/j.pec.2007.03.011.

    Article  PubMed  Google Scholar 

  • Saechao, F., Sharrock, S., Reicherter, D., Livingston, J. D., Aylward, A., Whisnant, J., et al. (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. doi:10.1007/s10597-011-9419-4.

    Article  PubMed  Google Scholar 

  • Sandhu, S., Bjerre, N. V., Dauvrin, M., Dias, S., Gaddini, A., Greacen, T., et al. (2013). Experiences with treating immigrants: A qualitative study in mental health services across 16 European countries. Social Psychiatry and Psychiatric Epidemiology, 48(1), 105–116. doi:10.1007/s00127-012-0528-3.

    Article  PubMed  Google Scholar 

  • Satcher, D. (2000). Mental health: A report of the surgeon general-executive summary. Professional Psychology: Research and Practice, 31(1), 5. doi:10.1037/0735-7028.31.1.5.

    Article  Google Scholar 

  • Schweitzer, R. D., Brough, M., Vromans, L., & Asic-Kobe, M. (2011). Mental health of newly arrived Burmese refugees in Australia: Contributions of pre-migration and post-migration experience. Australian and New Zealand Journal of Psychiatry, 45(4), 299–307. doi:10.3109/00048674.2010.543412.

    Article  PubMed  Google Scholar 

  • Shannon, P. J. (2014). Refugees’ advice to physicians: How to ask about mental health. Family Practice, 31(4), 462–466. doi:10.1093/fampra/cmu017.

    Article  PubMed  Google Scholar 

  • Shannon, P. J., Wieling, E., Simmelink-McCleary, J., & Becher, E. (2014). Beyond stigma: Barriers to discussing mental health in refugee populations. Journal of Loss and Trauma. doi:10.1080/15325024.2014.934629.

  • 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. Retrieved from http://journals.lww.com/jonmd/Abstract/1999/04000/The_Psychosocial_Effects_of_Torture,_Mass_Human.2.aspx.

  • 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. JAMA, 302(5), 537–549. doi:10.1001/jama.2009.1132.

    Article  CAS  PubMed  Google Scholar 

  • Sue, D. W., & Sue, D. (2012). Counseling the culturally diverse: Theory and practice. New York: Wiley.

    Google Scholar 

  • Summerfield, D. (2012). Afterword: Against global mental health. Transcultural Psychiatry, 49(3–4), 519–530. doi:10.1177/1363461512454701.

    Article  PubMed  Google Scholar 

  • Thapa, S. B., Van Ommeren, M., Sharma, B., de Jong, J. T., & Hauff, E. (2003). Psychiatric disability among tortured Bhutanese refugees in Nepal. American Journal of Psychiatry, 160(11), 2032–2037. doi:10.1176/appi.ajp.160.11.2032.

    Article  PubMed  Google Scholar 

  • The Refugee Act of 1980. Pub. L. No. 96-212, § 201 Stat. 102 (1980). http://www.gpo.gov/fdsys/pkg/STATUTE-94/pdf/STATUTE-94-Pg102.pdf.

  • Tol, W. A., Kohrt, B. A., Jordans, M. J., Thapa, S. B., Pettigrew, J., Upadhaya, N., et al. (2010). Political violence and mental health: A multi-disciplinary review of the literature on Nepal. Social Science and Medicine, 70(1), 35–44. doi:10.1016/j.socscimed.2009.09.037.

    Article  PubMed  Google Scholar 

  • United Nations High Commissioner for Refugees. (2012). Statistical yearbook (12th ed.). Retrieved from http://www.unhcr.org/52a7213b9.html.

  • Van Ommeren, M., Sharma, B., Sharma, G. K., Komproe, I., Cardeña, E., & de Jong, J. T. (2002). The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: Examination of comorbidity with anxiety and depression. Journal of Traumatic Stress, 15(5), 415–421. doi:10.1023/A:1020141510005.

    Article  PubMed  Google Scholar 

  • Van Rooyen, K., & Nqweni, Z. C. (2012). Culture and posttraumatic stress disorder (PTSD): A proposed conceptual framework. South African Journal of Psychology, 42(1), 51–60. doi:10.1177/008124631204200106.

    Article  Google Scholar 

  • Vinson, G.A. (2012). Brief ethnographic interviewing manual Appendix I: Statistical analysis for sort method. Minneapolis, MN: Center for Victims of Torture. Retrieved from http://www.cvt.org/sites/cvt.org/files/attachments/u8/downloads/Brief%20Ethnographic%20Interviewing%20Appendix%20I%20%20Statistical%20Analysis%20for%20Sorth%20Method%20Data.pdf.

  • Willard, C. L., Rabin, M., & Lawless, M. (2013). The prevalence of torture and associated symptoms in United States Iraqi refugees. Journal of Immigrant and Minority Health,. doi:10.1007/s10903-013-9817-5.

    Google Scholar 

  • Williams, M. E., & Thompson, S. C. (2011). The use of community-based interventions in reducing morbidity from the psychological impact of conflict-related trauma among refugee populations: A systematic review of the literature. Journal of Immigrant and Minority Health, 13(4), 780–794.

    Article  PubMed  Google Scholar 

  • Wong, Y. L. R., & Tsang, A. (2004). When Asian immigrant women speak: From mental health to strategies of being. American Journal of Orthopsychiatry, 74(4), 456–466. doi:10.1037/0002-9432.74.4.456.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) Award Number UL1TR000114 to the University of Minnesota Clinical and Translational Science Institute (CTSI). This work was supported by the USDA National Institute of Food and Agriculture, Hatch Project [55-028].

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Patricia J. Shannon.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shannon, P.J., Vinson, G.A., Cook, T.L. et al. Characteristics of Successful and Unsuccessful Mental Health Referrals of Refugees. Adm Policy Ment Health 43, 555–568 (2016). https://doi.org/10.1007/s10488-015-0639-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-015-0639-8

Keywords

Navigation