The need for improved mental health care among forcibly displaced persons

Darfurians refugees in Eastern Chad _ Chad, Darfurian refugees, 2012, modified

Published November 11, 2016

At the start of 2017, the number of people worldwide forcibly displaced was over 65 million, an increase of nearly 30 million people since 2011. “Forcibly displaced persons” includes refugees, internally displaced persons (IDPs), asylum seekers and stateless persons. Violence, persecution, conflict, or human rights violations contribute to displacement. 

The scale of global forced displacement has increased rapidly in recent years, and record numbers continue to rise. The adverse events that forcibly displaced people face before fleeing may only be the beginning of difficult situations.

When forcibly displaced persons resettle in a new country, they undergo health screenings for communicable diseases as well as mental health screening. Displaced persons who have experienced war, violence, persecution, and human rights violations often face mental health disorders, including post-traumatic stress disorder, anxiety, emotional and behavioral disorders, somatization and traumatic grief. Poor mental health can have strong negative effects on life, including emotional well-being, the ability to complete daily tasks and the ability to be a contributing member of family and society.

Moreover, forcibly displaced people encounter many barriers to accessing mental health care. Displaced people may not seek out or understand mental-health services in the same way that American-born populations understand it. Because of cultural differences, forcibly displaced people may feel like outsiders, uncomfortable to reach out for help and engage with community members, particularly after long stays in refugee camps, where little or no mental-health services may have been provided. Furthermore, many cultures do not recognize mental health. For example, in Burmese there is no word for depression, making it difficult for patients to describe their experiences. The complicated health system and payment plans in the U.S. are a further hindrance to refugee, as is navigating the transit and other systems needed to access care facilities.

Mental health screening among displaced populations needs to be more thorough. Often, primary care physicians have limited time with patients and emphasize physical health, therefore, patients may not open up about issues that are difficult to discuss or seen as taboo.

Development of mental health interventions for this population has been inadequate; many interventions, such as some trauma-focused therapies, are not appropriate for all populations. According to researchers on refugee mental health, traumatic stress theory “predicts that traumatized refugees will avoid traumatic reminders,” in turn, avoiding services because they do not want to address past events. One of the most pressing needs of the global refugee crisis is for the development of alternative methods to screen for and treat mental health disorders across cultures and populations that have undergone trauma and torture.