Refugees and PTSD
by Janine S White
Refugees and asylum seekers come from many cultures, countries, ages and genders. The definition is a person who has had no choice but to leave their home for their safety. This could be to escape war, to flee persecution or due to a natural disaster which has left them with no safe place to reside. Although grouped together under the umbrella term of refugee, each experience is unique to that individual. Every feeling evokes something personal, each recollection creates a memory for them which is specific to their events.
As the migration from one country to another is not through choice, but through experiences unimaginable to most, it is unsurprising that Asylum seekers and refugees are likely to have high rates of mental health issues. According to mentalhealth.org research indicates that they are five times more likely than the general population to have mental health needs. Sixty one percent of these are expected to be serious needs.
The identification of mental health issues experienced by refugees has been lacking due to complex barriers. With people originating from a multitude of countries, cultures, languages and context, the approach needs to be person centred rather than standardised.
Most common mental health diagnosis for refugees include:
Post-traumatic stress disorder, which is when an event is so traumatic that the brain is unable to process it, leaving an open wound in the mind. 70% of PTSD sufferers within the UK do not seek help, yet it has a significant impact on quality of life. Symptoms can include:
· Increased anxiety and emotional arousal
· Avoidance and numbing
· Re-experiencing the traumatic event
· Guilt, shame, over reactions, fear, physical aches and pains
Major depression is something that 1 in 10 people get. Those who have been through trauma are more likely to experience the long-term symptoms, although it is manageable through a GP. Symptoms include:
- low mood, feeling sad, irritable or angry
- having less energy to do certain things
- losing interest or enjoyment in activities
- loss of concentration
- becoming tired more easily
- disturbed sleep and loss of appetite
- loss of self-confidence)
- feeling guilty or worthless.
Other mental health diagnoses can include generalised anxiety, panic attacks, adjustment disorder and somatisation. According to Refugee Health, between 10–40% of settled refugees suffer with PTSD. For children, this is raised to between 50–90%.
With the numbers of refugees suffering from mental health issues, it is imperative that they are well supported while attempting to settle in their new home.
Claudia María Vargas suggests some principles of care that could be beneficial to all refugees and asylum seekers.
· Multidisciplinary care to support with health, education, trauma, housing and employment.
· Complementary therapies to support the intense suffering and pain for survivors of torture. Incorporating the treatment of damage to the bodies and minds.
· Family-centred care to learn how PTSD or other diagnosis affect the individual and the family. Through valuing cultural diversity and language, it will become possible to find relevant community support and ways to reconnect families with their heritage.
· A strengths model to understand the survivors of the traumatic events. Although the individual has been victimised, they have also succeeded in escape to create a better life for themselves and their children. They are survivors.
· Cultural responsiveness to understand the potential effects on future generations. To understand the history of the exile and provide a welcoming environment.
It must be remembered that a refugee has already been through enormous trauma within their originating country. They then put themselves at risk to find a safe home because staying where they are poses more danger to them that what could go wrong in search for safety. Once they have arrived at their destination the trauma does not end. They face interviews, asylum decisions and the judgement of officials. Placing them in a situation where they are disbelieved, their self esteem stripped from them and the trauma of reliving their experiences to professionals who they have never met before. If they manage to succeed in their application, they then continue to face trauma by being an ‘other’ in their new country. Learning to understand new cultural norms and languages so that they may merely survive. If it is possible to support their mental health through these traumas it can only be beneficial.