A persistent and difficult problem Working with complex issues with asylum seekers and refugees

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1 A persistent and difficult problem Working with complex issues with asylum seekers and refugees Gina Sembrano Clinical Psychologist Refugee Trauma Recovery Wellington New Zealand Psychological Society Annual Conference 1-4 September 2016, Massey University, Wellington

2 Difficulties and challenges that refugees and asylum seekers experience 1. Pre-migration traumatic events 2. Challenges in country of refuge 3. Resettlement difficulties

3 Pre-migration traumatic events (Tribe, 2002) Causes war human rights abuses (oppressive regimes, imprisonment, torture) Persecution on grounds of politics, religion, gender or ethnicity

4 Consequences Internal displacement Extreme poverty and deprivation Gender-based violence Loss of Country Culture Family Education/Profession/Social status Language Friends Plans for future

5

6

7 Resettlement challenges Struggle to adapt to new culture psychologically and socially. Social and economic strain Separation from families Role changes in the family Social alienation, discrimination and status loss Lack of family and community support Poor physical and mental health Emergence of PTSD symptoms Acculturative stress

8 Specific challenges in refugee mental health (Kirmayer et al., 2011) Communication difficulties because of language and cultural differences; The effect of cultural shaping of symptoms and illness behavior on diagnosis, coping, and treatment; Differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; Aspects of acceptance by the receiving society that affect employment, social status and integration.

9 Common mental disorders (UNHCR/WHO, 1996) depression; psychotic episodes; mental disorder due to long-term psychosis; mental disorder caused by hurtful and frightening events; mental disorder caused by beatings or other injuries to the head; emotional disturbances associated with intense fear and worry; emotional disturbances related to poor sleep.

10 Potential predisposing factors for psychological health problems (Canadian Task Force on Mental Health Issues, 1988, Kirmayer et al., 2011) Separation from family and community An unwelcoming host community Prolonged or severe suffering prior to exile Being elderly or adolescent Lacking knowledge of the host language Loss of socio-economic status

11 Hindering factors to treatment (Mirdal et al., 2011) Factors related to the patient Factors related to therapist Factors related to interpreters Factors that are external to the therapy

12 Factors related to patient (Tribe 2008, Mirdal et al., 2011 Kirmayer et.al., 2011) 1. Counselling and psychotherapy are unknown to most clients 2. Cultural and religious interpretations of mental illness 3. Language barrier 4. Low literacy 5. Fear of shame and stigma 6. Pressure from community 7. Severe comorbidity 8. Lack of motivation

13 Factors related to therapist: Common errors (Mitchell, 2014) 1. Failure of the therapist to establish a mutually agreed upon objective. 2. Therapist assumes an all knowing attitude. 3. Poor timing 4. Accepting the invitation to take the pain 5. Failure to recognize and respond to the client s stage of change. 6. Cognitive distortions of therapist.

14 Implicatioms for an appropriate mental health service (Hassan et al., 2016) Professionals should be careful not to over-diagnose and avoid psychiatric labelling as these can be alienating and stigmatizing; A shift of emphasis from vulnerability-based assessment and intervention frameworks to resilience and recoverybased approaches, recognizing refugees and asylum seekers as active agents in their lives in the face of adversity; Building a solid therapeutic alliance with clients will allow both practitioner and client to navigate among diverse explanatory models and sources of help (e.g. religious, family and community resources);

15 Implications cont d Clinical interventions need to go hand in hand with interventions to mitigate difficult living conditions, and strengthen community-based protection mechanisms, to help individuals regain normalcy in their daily lives Interventions aimed at improving living conditions and livelihoods may significantly contribute to improving the mental health of refugees and asylum seekers perhaps more than any psychological and psychiatric interventions;

16 Risks to mental health professionals (Mirdal, 2002) 1. Avoidance 2. Overinvolvement 3. Vicarious victimization 4. Stress-related burnout

17 References Beiser-Hou, Language acquisition, unemployment and depressive disorder among Southeast Asian refugees: a 10-year study, in: Social Science and Medicine, pp Drozdek B Challenges in treatment of posttraumatic stress disorder in refugees: towards integration of evidence-based treatments with contextual and culture sensitive perspectives, in: European Journal of Psychotraumatology, pp Hassan H., et al Mental health and psychosocial wellbeing of Syrians affected by armed conflict, in: Epidemiology and Psychiatric Sciences, 25: Kirmayer L., et al Common mental health problems in immigrants and refugees: general approach in primary care, in: Canadian Medical Association Journal, Mann C., Q. Fazil Mental illness in asylum seekers and refugees, in: Primary Care Mental Health, 4: Mirdal G.et al Traumatized refugees, their therapists, and their interpreters: Three perspectives on psychological treatment, in: Psychology and Psychotherapy: Research and Practice, pp Tribe R Mental health of refugees and asylum-seekers,in: Advances in Psychiatric Treatment, pp World Health Organization Building Back Better. Sustainable Mental Health Care After Emergencies.

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