Review
Refugee mental health: Culturally relevant considerations

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Abstract

In recent years, multiple global crises have contributed to increasing human displacement. Currently, there are approximately 84 million displaced people around the world. Many suffer from mental health problems. However, the mental health service delivery system is not fully prepared to meet the complex needs of refugees. Refugees experience multiple barriers, both individual and systemic, to accessing and engaging in mental health treatment. The following article provides an overview of some of the challenges faced by refugees worldwide and avenues forward. The authors also examine contextual factors that impact refugee resettlement and discuss barriers to culturally responsive, trauma-informed, and ethical care. Finally, the authors review advocacy efforts and discuss future directions to improve refugee mental health care delivery.

Introduction

Human displacement has become common in recent years due to political and religious conflict, climate change, human rights violations, pandemics, and economic factors. In 2021, the United Nations Refugee Agency (UNHCR) reported that an unprecedented 84 million people were forcibly displaced [1]. The majority of refugees moving across borders hailed from Syria, Venezuela, Afghanistan, South Sudan, and Myanmar. Some of the countries receiving most refugees were Turkey, Jordan, Uganda, Pakistan, and Lebanon [1]. Experts predict that forced migration will continue to increase, bringing numerous challenges, including mental health problems, in this population [2]. As such, improving knowledge of and skills for trauma-informed and culturally-responsive interventions and best practices is key to ensuring the well-being of refugees.

Current estimates of mental health problems among refugees are high. Posttraumatic stress disorder (PTSD) and depression, problems that tend to persist many years after refugees’ initial displacement, are especially prevalent [3]. Refugees experience multiple barriers to receiving health care such as legal and language barriers, discrimination, acculturation difficulties, lack of health insurance, mental health stigma, limited understanding of how to access care, and economic challenges [4∗, 5, 6]. These problems are compounded by mental health providers with limited cultural responsiveness, cultural humility, and specialized training [7]. Other complicating factors are the use of assessment tools that are not culturally appropriate, and systemic barriers such as discriminatory immigration practices [8], and an increased health vulnerability during disasters, such as the COVID-19 pandemic [9].

The following article provides an overview of common mental health problems and service access challenges that refugees face worldwide. The authors also examine contextual factors that impact refugee resettlement and barriers to providing culturally responsive and ethical care. Finally, the authors review advocacy efforts and discuss future directions to improve refugee mental health care.

Section snippets

Patterns of mental health problems among refugees

Refugees are exposed to extreme life conditions that affect their mental health and wellbeing. They face stressors and traumas at different phases of displacement: pre-migration (i.e., war, famine, torture, job and property loss, rape), during transit (i.e., family separation, physical and sexual assault, extortion, lack of access to services for basic needs), and post-migration (i.e., discrimination, acculturation shock, separation from family, detention, poor living conditions, barriers to

What is traumatic? Displacement stages and trauma

Refugees often experience multiple traumas before migration, during transit, and post-resettlement. These experiences are complex due to individual factors, social considerations, and political contexts [12], and they can have severe and long-term mental health consequences. It is important to understand mental health needs at each of the migration stages to provide adequate trauma treatment [11,12].

Before fleeing their countries, refugees may experience multiple traumas such as war, torture,

Culturally-responsive care and trauma-informed treatment

Providing treatment that is culturally-responsive and trauma-informed is essential due to refugees’ specific challenges, such as numerous barriers to receiving care, including language and legal barriers, acculturation factors, lack of information on how to access care, lack of health insurance, and mental health stigma [15,16]. Cultural adaptations of Western evidence-based mental health treatments are believed to make interventions more acceptable to and appropriate for refugees [17]. This

The impact of COVID-19 on refugee mental health

The COVID-19 pandemic presented a host of new challenges and exacerbated existing disparities in an already vulnerable population. Immigrants and refugees face substantial barriers to healthcare, including transportation difficulties, limited insurance coverage, an underpowered workforce of linguistically and culturally aligned providers, and fears about deportation [27]. The pandemic exposed and multiplied these barriers: accessing care became more difficult due to systems overburdened with

New technologies and refugees

While the pandemic accelerated advances in digital technology that facilitated online connections in lieu of in-person gatherings [36], refugees and immigrants may have been less likely to utilize and benefit from virtual platforms compared to individuals outside of this vulnerable population. Structural barriers including low technological literacy, limited access to technological devices and the internet, and scant availability of video and telephone interpreters have been found to interfere

Advocacy in refugee mental health care

Digital mental health innovations alone cannot compensate for the systemic racism and discrimination refugees often face in their host countries. Immigration policies, rooted in decades of systematized racism, have long been a source of trauma for refugees and immigrants coming to the U.S [8]. A rising number of asylum-seekers have been unethically detained, often for lengthy periods of time, suffering human rights violations and associated mental health problems [44]. Migrant children in

Conclusion

As disasters continue to accelerate worldwide, so does the number of people forced to leave their homes and seek refuge elsewhere. The psychological trauma refugees and immigrants endure at every stage of the migration process is well-documented, and its impacts are undeniable, affecting even the most resilient. Refugees and immigrants are not guaranteed safety – physical, emotional, or mental – in their host countries, where they face institutionalized racism, numerous barriers to engaging in

Conflict of interest statement

Nothing declared.

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