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Permanently Temporary: Mental Health and Refugee Status

By Dena Javadi
on December 11, 2015

You’ve arrived. Signs welcomed you and hundreds of others (for a while anyway). You have a temporary room. Temporary furniture. Temporary clothes. A temporary identity. Until your asylum decision is made. Then you move onto being semi-permanently temporary, sometimes living for decades as temporary citizens with stunted rights and privileges. It’s part of the narrative of displacement that refugees have always faced, and it exacerbates existing stressors that could end up being debilitating.

Addressing these challenges requires thoughtful, intentional investment in three key areas: 1) affordable, accessible and appropriate mental health services to both assess and improve mental health status; 2) support in navigating through a new country’s various sectors, laws and cultural nuances; and 3) space for compassion, empathy, and an understanding of our shared humanity to grow throughout the global community.  I know I sound like a bleeding heart liberal with that last one (I hope I am…), but it’s crucial. As long as politicians can use public fear of the ‘other’ to uphold xenophobic policies and gain votes, newcomers will be fighting an uphill battle just to maintain temporary security rather than focusing energy on contributing to and thriving in a new place.

As resettlement efforts are being rolled out across countries receiving refugees, it is important to understand the particular needs of these populations and how to best support and build upon their existing capacity to thrive in a new home. Mental health is therefore a key component to consider. Refugees have faced and will continue to face stressors that increase their risk of mental health issues, making them more vulnerable to substance abuse, anxiety and depression, which then trigger a host of other health and social welfare challenges. Preventing this vicious cycle is critical in creating supportive environments where refugees can integrate successfully into their host countries. The approach needs to be multi-pronged and person-centred so as to avoid blanket programmes that tend to further stigmatize certain populations.

Mental health stressors can be split into pre-migration, transit, and post-migration stressors. Providing refugees with mental health assessments upon arrival to understand the effects of pre-migration stressors that may have led to post-traumatic stress from living in warzones or camps, as well as challenges faced during the journey, is an important first step. This needs to be followed by establishing systems in place to mitigate negative consequences during the post-migration period, including displacement, social isolation, economic strain, alienation, language and cultural barriers, discrimination, and/or loss of status or identity. How people react to these stressors is mediated by biological, psychological and social conditions faced throughout the life-course. (I’ve watched my parents have two wildly different approaches to coping with immigration. I took field notes. It was obvious where my career was heading…). Gender-related factors, natural inclinations towards fight or flight responses, the willingness/ability to move on – all of these play a role in how people cope with stressors and even how they engage with the systems and tools put in place to handle them. While some of stressors can be course-corrected during those first few critical years post migration, others will require tailored and continuous support. Of course, like anything, unintended consequences could arise from otherwise well-meaning efforts; therefore, policies should be in place to avoid adverse outcomes such as screenings creating stigma or imposing barriers to job security, residency status or insurance coverage.

Unfortunately, investing in mental health still ignites a flurry of political brakes (unless of course it’s serving as a red herring for gun violence but I digress), so you can imagine how appealing investing in refugee mental health would seem from a certain political standpoint. The economics of it suggest taking in refugees is actually beneficial to economic growth (not that “economic growth” should continue to be the gold standard indicator for a functional and resilient society but that’s for another time). For example, the return on investment – according to Dr. Kwame McKenzie, a psychiatrist with the Centre for Addiction and Mental Health in Canada – is 7$ for every dollar spent on mental health promotion in children. This investment and stewardship for refugee mental health (and in fact all mental health), should be spread across sectors. Mental health promotion doesn’t start or end with the health sector. Helping refugees find jobs, learn the language, build social networks, navigate the school systems, know their rights, live in safe and affordable housing, understand laws and the judicial system- all of these are part of supportive integration and building resilience. It’s also not a one-way street. Communities receiving refugees also need to build their resilience to grow. Both literally and figuratively. The richness that comes with the integration of new cultures into a community is priceless where there is an appreciation for the diversity and a mutual desire to share and to learn. There exist many experiences, successes, and lessons learned to help communities that are not accustomed to newcomers, better prepare for supporting refugees in overcoming challenges that could become post-migration stressors. Sharing these strategies and lessons across communities (and across countries) is one way of building resilience.

It takes a quick skim of headlines to see that our world is an unstable one (that is, after of course double checking that the headlines are not in fact satirical…). Thus far, our approach to the sense of insecurity created by this has been to turn further inward, clutch those guns and immigration laws a bit tighter. But this approach is heavily flawed as the current state of insecurity knows no borders.

Our inward-looking glasses – you know, the ones that were a bad purchase to begin with – no longer work. The refugee “crisis” is now hung in temporary permanence – at least until we deal with growing global insecurity. As a global community, we have an obligation to work together to mitigate challenges as much as possible for both refugees themselves and for receiving countries handling additional strain on their social sectors.

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