Friends of Refugees

A U.S. Refugee Resettlement Program Watchdog Group

Resettlement program still confused about how to screen refugees for mental health symptoms

Posted by Christopher Coen on October 22, 2011

Wouldn’t you think that the US, which has now been resettling large numbers of refugees here from around the world since the end of World War ll, would have figured out how to screen refugees for mental health problems? After all, we screen every refugee for physical health conditions, supposedly within 30 days of their arrival. It turns out that our resettlement program still hasn’t worked out the nuts and bolts of the screening process — let alone treating them for these conditions — though we have long known that many of these people are survivors of torture, abuse, deprivation, dislocation and other hardships associated with the process of becoming refugees. Minnesota Public Radio News has an article discussing the (still disorganized) process of directing refugees to the basic mental health care that many of them so desperately need. An emerging theory is that we should use community health workers to screen refugees.

According to the Minnesota Department of Human Services, our state is home to more than 70,000 refugees.

Refugees arrive here from countries wracked by political violence. Torture is used intentionally in their homelands to silence opposition and transform cultures through fear. So it isn’t surprising that refugees aren’t comfortable speaking about the atrocities they survived.

Resettlement programs seek to integrate refugees into our communities and to help them achieve economic self-sufficiency. But unless we address their traumatic experiences, we condemn many to live in silence with undiagnosed and misunderstood symptoms of major depression and post traumatic stress disorder.

The real tragedy is that their symptoms are treatable.

Refugees arriving in the United States typically receive a health exam to identify physical problems, but they are not screened systematically for mental health problems…

…The Center for Victims of Torture (CVT) often receives referrals of refugees who are torture survivors after an eight- to 10-year period of difficult resettlement due to undiagnosed and untreated mental health symptoms. Those symptoms make it difficult for refugees to learn English, adjust to community life, learn a new culture and support their families.

Health clinics often tell us they know how to treat trauma, but they lack the language and cultural knowledge. Refugee leaders and groups often tell us they have the cultural knowledge but don’t know how to treat trauma…

…more must be done to include mental health screening along with the required medical exam. CVT is currently collaborating with the University of Minnesota, the Minnesota Department of Health and four refugee groups to develop a culturally appropriate mental health questionnaire for refugees coming to our state. Simple questions in the refugee’s language will identify those who might benefit from mental health services, and allow the health care screeners to refer them to the best resource in the community.

One such resource emerging in Minnesota is community health workers. They are bicultural and bilingual health workers who help link vulnerable populations to the health care system and could be used when larger numbers of refugees are screened and identified for mental health concerns Read more here

Apparently no one has thought to ask why refugee resettlement agencies aren’t already screening refugees for major depression, post-traumatic stress disorder (PTSD) and other mental stress related conditions. Why would refugee resettlement case workers, who do nothing but work with refugees every day, not already be educated in recognizing these illnesses? Resettlement agency case workers are supposedly bicultural and bilingual, and in contact with every resettled refugee already. Aren’t they the refugee experts?

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