Immigrant and Refugee Mental Health

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.