As a young boy living in what was then Zaire, Bertin Bahige remembers fleeing the Rwandan genocide in 1994 by crossing a river that formed the border between the two central African countries.
“Little did I know it would be me a few years later,” Bahige said.
Bahig’s harrowing refugee journey began when he was kidnapped and forced to become a child soldier when war broke out in his country, which in 1997 became the Democratic Republic of Congo. He fled to a refugee camp in Mozambique at the age of 15, where he lived for five years. It was a few years until he arrived in Baltimore in 2004 through the refugee resettlement program.
Bahige, now 42, said the way he grew up was to “just buckle down and tough it out,” and he adapted that philosophy to life in the U.S. He worked multiple jobs and took community college classes until he went to university. of Wyoming on a scholarship. She is now an elementary school principal in Gillette, Wyoming, and said her coping strategy, then and now, is to keep herself busy.
“In retrospect, I don’t think I even dealt with my own trauma,” she said.
Refugees are coming to the United States in greater numbers this year after resettlement numbers hit a 40-year low under President Donald Trump. These new arrivals, like the refugees before them, are 10 times more likely to develop post-traumatic stress disorder, depression and anxiety than the general population. Many of them, like Bahig, have fled their homelands due to violence or persecution. Then they must deal with the emotional pain of integrating into a new environment that is as different as Wyoming in Central Africa.
It is concerned about the welfare of the new generation of refugees.
“The kind of system a person used to live in can be completely different from the new world life and system they live in now,” Bahige said.
Although their need for mental health services is greater than that of the general population, refugees are far less likely to receive such care. Part of the deficit stems from social differences. But a larger factor is the overall shortage of mental health providers in the United States, and the myriad barriers and barriers to accessing mental health care that refugees face.
Whether they end up in rural areas like the northern Rocky Mountains or urban settings like Atlanta, refugees can face months-long waits for care, as well as a lack of physicians who understand the culture of the people they serve.
Since 1975, approximately 3.5 million refugees have been admitted to the United States. Annual admissions fell during the Trump administration from about 85,000 in 2016 to 11,814 in 2020, according to the State Department.
President Joe Biden raised the refugee admissions cap to 125,000 for the 2022 federal fiscal year, which ends on September 30. With arrivals at less than 18,000 in early August, that cap is unlikely to be reached, but admissions are increasing monthly.
Refugees receive a mental health screening along with a general medical evaluation within 90 days of their arrival. But the effectiveness of that test depends largely on a screener’s ability to navigate complex cultural and linguistic issues, said Dr. Ronit Mishori, a professor of family medicine at Georgetown University and senior medical adviser to Physicians for Human Rights.
Although trauma rates are high among refugee populations, not all displaced people need mental health services, Mishori said.
For refugees dealing with the effects of stress and adversity, resettlement organizations such as the International Rescue Committee provide assistance.
“Some people will come in and request services right away, and some won’t need it for a couple of years until they feel completely safe, and their bodies haven’t adjusted, and the trauma response starts to fade a little bit,” said McKinley Gwinner, of Missoula. , IRC’s mental health navigator in Montana.
Unlike Bahig’s host state of Wyoming, which has no refugee resettlement services, IRC Missoula has placed refugees from the Congo, Syria, Myanmar, Iraq, Afghanistan, Eritrea and Ukraine in Montana in recent years. A major challenge in accessing mental health services in rural areas is that few providers speak the languages of those countries.
In the Atlanta suburb of Clarkston, which has a large population of refugees from Myanmar, the Democratic Republic of Congo and Syria, translation services are more available. Five mental health clinicians will work with IRC caseworkers under a new program at the IRC in Atlanta and Georgia State University’s Prevention Research Center. Clinicians will assess refugees’ mental health needs as caseworkers assist them with housing, employment, education and other issues.
Seeking mental health care from a professional can be an unfamiliar concept for many refugees, says Fardus Ahmed, a Somali-born former refugee mental health physician at the University of Colorado School of Medicine.
For refugees in need of mental health care, stigma can be a barrier to treatment. Some refugees fear that if U.S. authorities find out they are struggling with mental health, they could face deportation, and some single mothers worry they will lose their children for the same reason, Ahmed said.
“Some people think that asking for services means they’re ‘crazy,'” she said. “Understanding the perspectives of different cultures and how they perceive mental health services is very important.”
Long wait times, lack of cultural and language resources, and social differences have led some health professionals to suggest alternative ways to address the mental health needs of refugees.
Dr. Suzanne Song, a professor of psychiatry at George Washington University, said expanding opportunities beyond individual therapy to include peer interventions can rebuild dignity and hope.
Spending time with someone who shares the same language or figuring out how to use the bus to get to the grocery store is “incredibly healing and allows someone to feel a sense of belonging,” Gunn says.
In Clarkston, the Prevention Research Center will soon launch an option for refugees to play a more direct role in addressing the mental health needs of community members. The center plans to train six to eight refugee women as “layer therapists,” who will counsel and train other women and mothers using a technique called narrative exposure therapy to address complex and multiple traumas.
Treatment, in which patients create a chronological narrative of their lives with the help of a therapist, focuses on a person’s lifetime of traumatic experiences.
Jonathan Orr, coordinator of the Clinical Mental Health Counseling Program at Georgia State University’s Counseling and Psychological Services, said the therapy is culturally adapted and can be implemented in underserved communities.
The American Psychological Association, however, only conditionally recommends narrative exposure therapy for adult patients with PTSD, suggesting that more research is needed.
But the method worked for Mohammad Al, a 25-year-old Kurdish refugee living in Snellville, Georgia, after coming to the United States from Syria in 2016.
Alo was working full-time at Georgia State when the Covid-19 pandemic began. While the downtime during the pandemic gave him time to reflect, he didn’t have the tools to process his past, which included fleeing Syria and threats of violence.
When her busy schedule returns, she feels unable to cope with her new anxiety and loss of focus. Narrative exposure therapy helped him deal with that stress, he said.
Regardless of treatment options, mental health is not necessarily a top priority when a refugee arrives in the United States “When someone lives a life of survival, vulnerability is the last thing you’re going to portray,” says Bahige.
But Bahige also sees resettlement as an opportunity for refugees to address their mental health needs.
He said it’s important to help refugees “understand that if they take care of their mental health, they can succeed and thrive in all aspects of the life they’re trying to build. Changing that mindset can be empowering, and it is.” Something I’m still learning.”
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