Cultural Consultation for Refugees

"It will always be Temporary": A qualitative study of Syrian young adults expressing histories of collective violence and forced displacement in participatory theatre

Given the increased prevalence of mental health problems in Syrian refugee communities, there have been efforts to develop adequate mental health care for their well-being. Herein, clinical literature is increasingly emphasizing the importance of locating refugees' healing at the nexus of personal and social realities, understanding the process of trauma narration within social restorative spaces of witnessing and communal support. Alongside this debate, there is growing interest in the relevance of participatory theatre for refugees. This innovative approach understands how voicing narratives of life histories within a broader social sphere may support personal and socio-political transformation. In this article, we aim to further the understanding of participatory theatre's relevance to these issues, focusing on the reparative dimensions of trauma narration. Based on a case study of a theatre project with Syrian young adults resettled in Belgium, we explore the different ways participants expressed experiences of collective violence and displacement in dialogue with each other, their diasporic and home communities, and their host society, and consider how these processes relate to their construction and meaning and coping with trauma. In a final section, we discuss the implications of our findings, raising questions about the value of participatory theatre as a reparative space and outlining suggestions to introduce and mobilize reparative modes of trauma narration in therapeutic practices in refugee trauma care.

Gender differences in Syrian refugees in Jordan: Psychological, self-esteem, family function, marital satisfaction, and life satisfaction

AIM

The current study examined gender differences in mental health, self-esteem, family function, marital satisfaction, and life satisfaction between men and women living in a refugee camp for Syrian refugees in Jordan.

METHOD

A snowball method used by local female and male students trained to collect data according to culturally competent methods. The following research instruments were deployed: Symptoms Checklist-SCL90, Self-esteem Scale, the McMaster Family Assessment Device, Marital Satisfaction Scale, and life Satisfaction Scale.

RESULTS

A sample of 290 adults (196 women and 94 men) living in a refugee camp in Jordan participated in the study. Findings revealed that marital satisfaction, self-esteem, and life satisfaction were significantly different between males and females, indicating less subjective well-being for women. Many of the mental health symptoms in this study were more common for women than men; particularly noteworthy were somatization, obsessive compulsive behavior, interpersonal sensitivity, depression, hostility, psychoticism, and higher scores on the Global Severity Index (GSI).

CONCLUSION

While some stressors are not gender-specific, there are unique factors that women face which place them at increased risk of mental health problems. Implications for practice include a greater understanding of the challenges and resilience mechanisms that are related to gender and culture.

Psychologists' Perspectives on the Psychological Suffering of Refugee Patients in Brazil

Worldwide there are 79.5 million displaced people, many of which face war, violence, tragic flights and struggles in host countries. Research shows augmented prevalence rates of mental disorders among refugees internationally, but little is known about refugee mental health in Latin American countries. Furthermore, only a few studies have taken into consideration the knowledge of clinical psychologists who treat refugee patients. The present study examines the experiences of 32 psychologists in Brazil regarding their refugee patients' psychological suffering and mental disorders. Semi-structured interviews were conducted in various locations in Brazil and analysed following a consensual qualitative research approach. Four clusters of refugee patients' suffering were synthesised: post-migration stressors, traumatic experiences, flight as life rupture, and the current situation in the country of origin. The most frequently described conditions in patients were anxiety and depression. However, the results also show that the use of manuals for the classification of mental disorders is contested among psychologists in Brazil. Most psychologists stressed patients' socio-political suffering and saw patients' symptoms as normal reactions to their experiences. There is a need to acknowledge the socio-political suffering of refugees in Brazil and foster their mental health by tackling current post-migration stressors such as discrimination.

(Mis)recognition in the Therapeutic Alliance: The Experience of Mental Health Interpreters Working With Refugees in U.K. Clinical Settings

Mental health interpreters play a crucial role in clinical support for refugees by providing a bridge between client and clinician. Yet research on interpreters' experiences and perspectives is remarkably sparse. In this study, semi-structured interviews with mental health interpreters explored the experience of working in clinical settings with refugees. We conducted inductive analysis informed by a reflexive thematic analytic approach. Our analysis identifies interpreters' pleasure in being part of people's recovery, offset by the pain of misrecognition by clinicians that signals low self-worth and invisibility. Three sites of tension that create dilemmas for interpreters are identified: maintaining professional boundaries, managing privately shared information, and recognizing cultural norms. These findings are discussed in terms of the implications for clinicians working with interpreters, with a focus on the importance of a relationship of trust founded on recognition of the interpreters' role and the unique challenges they face.

Psychiatrie transculturelle : pour une éthique de tous les mondes

La psychiatrie transculturelle s’intéresse à l’impact de la culture sur la santé mentale et la maladie et remet le patient au centre de la relation en respectant ses manières de faire et de penser, individuellement mais aussi collectivement. La culture définit les représentations ontologiques, les théories étiologiques et les logiques thérapeutiques qui influencent l’expression symptomatologique de la souffrance et les modes de résilience des individus, tout aussi variés que les cultures desquelles elles émergent. Or la psychiatrie occidentale est de la même manière indissociable de la culture dans laquelle elle est née, ce qui pose la question de la souffrance psychique et des soins en situation transculturelle. La psychiatrie transculturelle amène le clinicien à se remettre en question et à élargir la clinique aux questions sociales, géopolitiques et historiques qui teintent les liens du tissu social, les relations de pouvoir et l’accès aux soins pour les individus des communautés culturelles. Comment faire que notre rencontre avec les patients venus d’autres mondes et ne partageant pas la même langue que nous soit éthique? Comment soigner face à l’altérité culturelle? Et quels impacts pour la santé mentale des jeunes d’aujourd’hui qui grandissent dans ces sociétés mondialisées aux défis identitaires complexes qui peuvent mener à des radicalités? Nous proposons dans cet article quelques réponses à ces défis éthiques et cliniques, en passant par le métissage des représentations, gage d’un meilleur vivre ensemble et d’une créativité renouvelée, pour un « ethos de la solidarité » dans les soins en santé mentale.

Loss of loved ones or home due to a disaster: Effects over time on distress in immigrant ethnic minorities

Exposure to mass trauma may bring about increased sensitivity to new or ongoing stressors. It is unclear whether sensitivity to stress associated with ethnic minority/immigrant status may be affected by severe exposure to mass trauma. We examined whether the loss of loved ones or home due to a disaster is associated with more persistent disaster-related distress in ethnic minorities compared with Dutch natives in the Netherlands. In residents affected by a fireworks disaster ( N = 1029), we assessed disaster-related distress after 3 weeks, 18 months, and 4 years. The effects of loss of loved ones or home and ethnic minority/immigrant status on distress were analyzed using latent growth modeling. After controlling for age, gender, education, employment, and post-disaster stressful life events, the loss of loved ones was associated with more persistent disaster-related distress in ethnic minorities compared with natives at 18 months, and the loss of home was associated with more persistent disaster-related distress in ethnic minorities compared with natives between 18 months and 4 years. Our results suggest that the loss of loved ones may increase sensitivity to stress associated with ethnic minority/immigrant status during the early phase of adaptation to a disaster. Loss of home may lead to further resource loss and thereby increase sensitivity to stress associated with ethnic minority/immigrant status in the long term. Efforts to prevent stress-related psychopathology following mass trauma should specifically target ethnic minority groups, notably refugees and asylum seekers, who often experienced multiple losses of loved ones as well as their homes.

Mental Health of Refugees and Asylum Seekers: Assessment and Intervention

With unprecedented numbers of displaced persons worldwide, mental health clinicians in high-income countries will increasingly encounter refugee and asylum-seeking patients, many of whom have experienced significant adversity before and after their migration. This paper presents a summary of the recent evidence on the assessment and treatment of refugees across the lifespan to inform clinicians' approaches to care of refugee patients in mental health care settings. Assessment and interventions for refugees are grounded in an ecosystemic approach which considers not only pre-migratory trauma, but social, familial, and cultural determinants of mental health in the host country. Evidence for psychotherapy and pharmacological treatments are reviewed, highlighting promising interventions while acknowledging that further research is needed. Ultimately, serving refugees necessitates a biopsychosocial approach that engages clinicians as medical experts, therapists, and advocates.

In or out? Barriers and facilitators to refugee-background young people accessing mental health services

Refugee young people have been identified as a group with high risk for mental health problems, due to their experience of trauma, forced migration, and stressors associated with settlement. A high prevalence of mental health problems is reported in this group, however some research suggests refugee young people have low rates of mental health service access. There is little information available on barriers and facilitators to mental service delivery for this group. Using data from 15 focus groups and five key informant interviews with a total of 115 service providers from 12 agencies in Melbourne, Australia, this paper explores barriers and facilitators to engaging young people from refugee backgrounds with mental health services. Eight key themes emerged: cultural concepts of mental health, illness, and treatment; service accessibility; trust; working with interpreters; engaging family and community; the style and approach of mental health providers; advocacy; and continuity of care.