J. Patrick O’Neal, Interim Commissioner
Georgia Department of Public Health
sheriff o shittu
Addressing the mental health problems in the
refugee community in the state of Georgia.
The population of refugees and war victims
have continued to rise with the current state of unrest and multinational
conflicts globally. The United States serve as a country of succor to many,
accommodating multiculturalism and liberalism, and providing humanitarian aid
to many international countries. There have been over 2.5 million refugees
resettled in the United States since the start of its humanitarian program
(Murray et al., 2010). Many refugees and asylum seekers come into the country
seeking shelter, security, a better standard of living and subsequent
integration into the American society. However, refugees often endure traumatic
experience and long grueling journey to be here. They are also made to undergo
rigorous security and vetting process before being resettled in the country.
Many refugees often experience unemployment and discrimination with a resultant
low socio-economic status. These along with either language barrier or cultural
discrepancies hinder proper integration into their host communities, which all
contribute to an increased risk of developing various mental health problems (Kirmayer
et al., 2011)
Some studies have reported high incidence of
post-traumatic stress disorder (PTSD), major depression, generalized anxiety
and panic attacks, for example, in Latino and Asian refugees’ post-resettlement
in the United States (Kim 2016). The
incidence of diagnoses varies with different populations and their
pre-settlement experiences. Other
studies show rates of PTSD and major depression in settled refugees to range
from 10-40% and 5-15%, respectively, while Children and adolescents have higher
incidence rates of PTSD from 50-90% and major depression from 6-40% which are
often psychological sequelae of the pre-settlement experience (“Mental Health”
Furthermore, there appears to be inadequate
attention given to the post-resettlement mental health care of these refugees
especially when compared to the general medical health care given, such as the
screening for infectious diseases e.g. tuberculosis and other tests.
and varied cultural contexts and languages, scattered refugee populations, and
the relative lack of evidence-based interventions have made it difficult to
carry out concerted and standardized efforts.
Piloting a program in the state of Georgia,
which mandates all refugees to be evaluated for mental health conditions over a
period of 12-24 months following resettlement, may help adequately monitor and
manage the various mental health disorders that may arise post-resettlement. Current
practice promotes evaluation and follow up within 3-6 months by the primary
health and referral when needed (Savin et al, 2005). However, with many
psychiatric conditions being a time- based diagnosis, some symptoms are subtle
and are only apparent after several months. This may lead to under-diagnoses of
certain mental health conditions and counteracts the effectiveness of
preventive mental health care. Studies also suggest a variety of interventions,
including trauma-focused interventions, group therapy, multidisciplinary
interventions and pharmacological treatments as a multipronged approach in the
management of mental health conditions in refugees (Slobodin et al, 2014)
Furthermore, this proposal also aims to expand
the role of social workers in the care of refugee population. An example of
expansion of role of social workers was successful in Colorado (Savin et al, 2005).
It seeks to encourage prioritizing dynamic and friendly integration of the
refugees into their host community through culturally sensitive considerations
and increased awareness of the healthcare services available and entitled to
them (Murray et al., 2010). This enables an increase in the tolerability and
effectiveness of the proposed prolonged psychotherapeutic follow-up. Critiques
may argue against the extra scrutiny this proposal adds to the resettling
process for refugees, however, evidence suggest benefits outweighs its drawback.
In conclusion, a multipronged, and prolonged
approach is needed to combat the increasing number of refugees with mental
illness, with a thorough arrival review considering their pre-settlement
experience, a prolonged follow-up and socio-culturally sensitive integration
and prompt psycho-pharmacologic intervention when necessary.
Murray, K. E., Davidson, G. R. and Schweitzer,
R. D. (2010), Review of Refugee Mental Health Interventions Following
Resettlement: Best Practices sand Recommendations. American Journal of Orthopsychiatry, 80: 576–585.
L. J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A. G., Guzder, J., … Pottie, K. (2011). Common
mental health problems in immigrants and refugees: general approach in primary
care. CMAJ?: Canadian Medical Association Journal, 183(12),
Kim, I. (2016). Beyond
Trauma: Post-resettlement Factors and Mental Health Outcomes Among Latino and
Asian Refugees in the United States. Journal of Immigrant and Minority
Health, 18(4), 740–748.
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D., Seymour, D., Littleford, L., Bettridge, J., & Giese, A. (2005).
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