Hello, I'm Suzan Song,
Director of the Division of Child,
Adolescent, and Family Psychiatry
of George Washington University,
and a Humanitarian Protecting Advisor
for survivors of forced displacement
globally and domestically.
There has been an unprecedent surge
in the number
of displaced people worldwide,
including refugees, asylum seekers,
undocumented immigrants
and unaccompanied minors.
Around the world,
more than 65 million people
are currently displaced
by war, armed conflict or persecution.
As of early 2018,
almost 31 million children worldwide
were displaced by violence and conflict.
If these current trends continue,
one in one hundred people
will be a refugee in the near future.
Unfortunately, most refugees and
survivors of force-displacement
will not receive
needed mental health care.
due to scarcity of services,
lack of access to qualified care,
and stigma against mental disorders.
Refugees are those who've fled
their country of origin
due to well-founded fears of persecution
based on race, religion,
nationality, political opinion
or membership
in a particular social group.
Where as refugees request
protection while overseas
and they're given
permission to enter the US,
People seeking asylum also have
a well-founded fear of persecution.
But they seek protection
while inside the US.
Refugees and
other conflict affected persons
are reported to have
a 15 to 30 percent prevalence
of PTSD and depression,
compared to the 3.5% prevalence of PTSD
among non-refugee populations.
The strongest predictors
of poor mental health
are exposure to torture and
a cumulative number of traumatic events.
But torture, separation from family,
stressful asylum processes,
isolation and disadvantage
in the host country
all worsen mental health.
The post-migration environment,
mainly prolonged detention,
insecure immigration status,
poor access of services
and limitations on work and education
can worsen mental health.
These do not provide the full scope of
emotional issues
that many conflict defected person face
including complicated grief,
complex trauma,
despair, isolation,
anger and lack of trust.
Many people are experiencing
normal responses
to very abnormal experiences.
Over time, most refugees
show low or no symptoms.
A small number show
a pattern of gradual recovery
and a small minority remain chronic.
So we need to evaluate the distinction
between situational forms of distress
and a clear mental disorder for refugees.
We do this by focusing on a dynamic
interplay of exposure
to past traumatic experiences,
ongoing daily stressors
and the core psycho social systems
that one is embedded in.
Psychiatrists can help these populations
with culturally competent clinical work
with refugees and asylum seekers.
At a policy level by conducting
asylum evaluations
and at the advocacy level
by promoting equity of access,
sustainability of services for refugees
and forcibly displaces people,
and by partnering
with inter-disciplinary community members
such as lawyers,
educators and policy makers
to provide a safe system
for which refugees
and survivors of forced displacement
can rely on.