Mental Healthcare for refugees
Atención en Salud Mental para refugiados
DOI:
https://doi.org/10.52379/mcs.v1i3.37Keywords:
mental health providers, mental healthcare, refugeesAbstract
The aim of this paper is to highlight some of the difficulties that mental health providers face when trying to provide the best standard of mental healthcare to refugees, especially in countries where the political environment is skeptic of, or even hostile to, creating programs specifically designed to improve the standard of living of this population. We also focus briefly on the dichotomy between the need to do research in this population in order to obtain data that will help us offer the best care possible to them, and the peril of undermining their autonomy by subjecting them to studies they might have otherwise refused to be part of, if they were in a less precarious position. Throughout the article, we offer practical advice that mental healthcare providers can follow to ensure that they are offering the best possible care to their patients while remaining respectful of their rights.
Keywords: Mental health providers; Mental healthcare; Refugees.
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References
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7. Burnes Bolton L, Giger JN, Georges CA. Structural and racial barriers to health care. Annu Rev Nurs Res. 2004;22:39-58. URL.
8. Kirmayer LJ, Weinfeld M, Burgos G, du Fort GG, Lasry J-C, Young A. Use of health care services for psychological distress by immigrants in an urban multicultural mi-lieu. Canadian Journal of Psychiatry 2007;52(5):295-304. https://doi.org/10.1177/070674370705200504
9. Derr AS. Mental Health Service Use Among Immigrants in the United States: A Sys-tematic Review. Psychiatric Services 2016;67(3):265-274. https://doi.org/10.1176/appi.ps.201500004
10. Whitley R, Kirmayer LJ, Groleau D. Understanding Immigrants’ Reluctance to Use Mental Health Services: A Qualitative Study from Montreal. The Canadian Journal of Psychiatry 2006;51(4):205-209. https://doi.org/10.1177/070674370605100401
11. Crosby SS. Primary care management of non-English-speaking refugees who have experienced trauma: a clinical review. JAMA 2013;310(5):519-528. https://doi.org/10.1001/jama.2013.8788
12. Mollica RF. Assessment of Trauma in Primary Care. JAMA 2001;285(9):1213. https://doi.org/10.1001/jama.285.9.1213-JMS0307-3-1
13. Eisenman DP, Keller AS, Kim G. Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed? The Western Journal of Medicine 2000;172(5):301-304. URL.
14. Shannon P, O’Dougherty M, Mehta E. Refugees’ perspectives on barriers to commu-nication about trauma histories in primary care. Mental Health in Family Medicine 2012; 9(1):47-55. URL.
15. Turrini G, Purgato M, Ballette F, Nosè M, Ostuzzi G, Barbui C. Common mental disor-ders in asylum seekers and refugees: umbrella review of prevalence and intervention studies. International Journal of Mental Health Systems 2017;11:51. https://doi.org/10.1186/s13033-017-0156-0
16. Priebe S, Giacco D, El-Nagib R. Public Health Aspects of Mental Health Among Mi-grants and Refugees: A Review of the Evidence on Mental Health Care for Refugees, Asylum Seekers and Irregular Migrants in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2016. URL.
17. Dapunt J, Kluge U, Heinz A. Risk of psychosis in refugees: a literature review. Transla-tional Psychiatry 2017;7(6):e1149. https://doi.org/10.1038/tp.2017.119
18. Hollander AC, Dal H, Lewis G, Magnusson C, Kirkbride JB, Dalman C. Refugee migra-tion and risk of schizophrenia and other non-affective psychoses: cohort study of 1.3 million people in Sweden. BMJ. 2016;352:i1030. https://doi.org/10.1136/bmj.i1030
19. Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, et al. Evidence-based clinical guidelines for immigrants and refugees. Canadian Medical Association Journal 2011;183(12):E824-E925. https://doi.org/10.1503/cmaj.090313
20. U.S. Department of Health and Human Services [Internet]. Washington DC: U.S. De-partment of Health and Human Services; c2012 [cited 05 Nov 2017]. Summary Check-list for the Domestic Medical Examination for Newly Arriving Refugees [approx. 8 screens]. Available from: http://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/checklist.html
21. U.S. Department of Health and Human Services, Centers for Disease Control and Pre-vention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine [Internet]. Washington DC: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine; c2015 [cited 05 Nov 2017]. Guidelines for Mental Health Screening During the Domestic Medical Examination for Newly Arrived Refugees (Vol. 1) [ap-prox. 7 screens]. Available from: https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/mental-health-screening-guidelines.html#two
22. Walker P, Barnett E, Stauffer W. Healthcare for adult immigrants and refugees. Bar-on E, ed. UpToDate. Waltham, MA: UpToDate Inc. URL.
23. Lin KM, Poland RE, Nuccio I, Matsuda K, Hathuc N, Su TP, et al. A longitudinal as-sessment of haloperidol doses and serum concentrations in Asian and Caucasian schizophrenic patients. American Journal of Psychiatry 1989;146(10):1307-1311. https://doi.org/10.1176/ajp.146.10.1307
24. Marcos LR, Cancro R. Pharmacotherapy of Hispanic depressed patients: clinical ob-servations. Am J Psychother 1982;36:505-512.
25. Strickland TL, Lin KM, Fu P, Anderson D, Zheng Y. Comparison of lithium ratio be-tween African-American and Caucasian bipolar patients. Biological Psychiatry 1995;37(5):325-330. https://doi.org/10.1016/0006-3223(94)00133-N
26. Silove D, Ventevogel P, Rees S. The contemporary refugee crisis: an overview of men-tal health challenges. World Psychiatry 2017;16(2):130-139. https://doi.org/10.1002/wps.20438
27. Bhugra D, Gupta S, Bhui K, Craig T, Dogra N, Ingleby JD, et al. WPA guidance on men-tal health and mental health care in migrants. World Psychiatry?2011;10(1):2-10. https://doi.org/10.1176/appi.focus.130406
28. Torales J, Arce A, Zacarías M, Girala N, Moreno M, Szwako A, et al. La Guía TAZ de Psicofarmacología Clínica. 1ª ed. Asunción: EFACIM; 2014. URL.
29. Buhmann C, Andersen I, Mortensen EL, Ryberg J, Nordentoft M, Ekstrøm M. Cogni-tive behavioral psychotherapeutic treatment at a psychiatric trauma clinic for refu-gees: description and evaluation. Torture. 2015;25(1):17-32. URL.
30. Hinton DE, Pich V, Hofmann SG, Otto MW. Acceptance and Mindfulness Techniques as Applied to Refugee and Ethnic Minority Populations With PTSD: Examples From "Culturally Adapted CBT". Cognitive and Behavioral Practice 2013;20(1):33-46. https://doi.org/10.1016/j.cbpra.2011.09.001
31. Van Ee E, Mooren T, Kleber R. Broken mirrors: Shattered relationships within refugee families. In: Pat-Horenczyk R, Brom D, Vogel JM, eds. Helping Children Cope with Trauma: Individual, Family and Community Perspectives. London: Routledge; 2014: 146-162. https://doi.org/10.4324/9781315857756
32. Weine S, Kulauzovic Y, Klebic A, Besic S, Mujagic A, Muzurovic J, et al. Evaluating A Multiple-Family Group Access Intervention for Refugees with PTSD. Journal of Mari-tal and Family Therapy 2008;34(2):149-164. https://doi.org/10.1111/j.1752-0606.2008.00061.x
33. Jacobsen K, Landau LB. The Dual Imperative in Refugee Research: Some Methodolog-ical and Ethical Considerations in Social Science Research on Forced Migration. Dis-asters 2003;27(3):185-206. https://doi.org/10.1111/1467-7717.00228
34. Birman D. Ethical Issues in Research With Immigrants and Refugees. In: Trimble JE, Fisher CB, eds. The Handbook of Ethical Research with Ethnocultural Populations and Communities. California: Sage Publications; 2005: 155–177. URL.
35. European Commission [Internet]. Brussels: European Commision; c2016 [cited 06 Nov 2017]. Guidance note — Research on refugees, asylum seekers & migrants [approx. 5 screens]. Available from: http://ec.europa.eu/research/participants/data/ref/h2020/other/hi/guide_research-refugees-migrants_en.pdf
36. Torales J, Villalba-Arias J, Ruiz-Díaz C, Chávez E, Riego V. The right to health in Para-guay. International Review of Psychiatry 2014;26(4):524-529. https://doi.org/10.3109/09540261.2014.926866
2. The United Nations Refugee Agency [Internet]. Geneva: United Nations Refugee Agency; c2011 [cited 04 Nov 2017]. UNHCR Resettlement Handbook [approx. 21 screens]. Available from: http://www.unhcr.org/3c5e55594.html
3. The United Nations General Assembly. Universal Declaration of Human Rights. The International Journal of Human Rights 1998;2(3):84-88. https://doi.org/10.1080/13642989808406748
4. The United Nations General Assembly [Internet]. Geneva: United Nations General Assembly; c2017 [cited 04 Nov 2017]. International Covenant on Economic, Social and Cultural Rights. United Nations, Treaty Series, 999(14531), 3. [approx. 67 screens]. Available from: http://www.refworld.org/docid/3ae6b36c0.html
5. Sleiman D, Atallah D [Internet]. Geneva: United Nations Refugee Agency; c2016 [cit-ed 04 Nov 2017]. With Syria refugee crisis, Lebanese health services improve [ap-prox. 6 screens]. Available from: http://www.unhcr.org/news/stories/2016/9/57ce7e7d4/syria-refugee-crisis-lebanese-health-services-improve.html
6. Porter M, Haslam N. Predisplacement and Postdisplacement Factors Associated With Mental Health of Refugees and Internally Displaced Persons. JAMA 2005;294(5):602-612. https://doi.org/10.1001/jama.294.5.602
7. Burnes Bolton L, Giger JN, Georges CA. Structural and racial barriers to health care. Annu Rev Nurs Res. 2004;22:39-58. URL.
8. Kirmayer LJ, Weinfeld M, Burgos G, du Fort GG, Lasry J-C, Young A. Use of health care services for psychological distress by immigrants in an urban multicultural mi-lieu. Canadian Journal of Psychiatry 2007;52(5):295-304. https://doi.org/10.1177/070674370705200504
9. Derr AS. Mental Health Service Use Among Immigrants in the United States: A Sys-tematic Review. Psychiatric Services 2016;67(3):265-274. https://doi.org/10.1176/appi.ps.201500004
10. Whitley R, Kirmayer LJ, Groleau D. Understanding Immigrants’ Reluctance to Use Mental Health Services: A Qualitative Study from Montreal. The Canadian Journal of Psychiatry 2006;51(4):205-209. https://doi.org/10.1177/070674370605100401
11. Crosby SS. Primary care management of non-English-speaking refugees who have experienced trauma: a clinical review. JAMA 2013;310(5):519-528. https://doi.org/10.1001/jama.2013.8788
12. Mollica RF. Assessment of Trauma in Primary Care. JAMA 2001;285(9):1213. https://doi.org/10.1001/jama.285.9.1213-JMS0307-3-1
13. Eisenman DP, Keller AS, Kim G. Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed? The Western Journal of Medicine 2000;172(5):301-304. URL.
14. Shannon P, O’Dougherty M, Mehta E. Refugees’ perspectives on barriers to commu-nication about trauma histories in primary care. Mental Health in Family Medicine 2012; 9(1):47-55. URL.
15. Turrini G, Purgato M, Ballette F, Nosè M, Ostuzzi G, Barbui C. Common mental disor-ders in asylum seekers and refugees: umbrella review of prevalence and intervention studies. International Journal of Mental Health Systems 2017;11:51. https://doi.org/10.1186/s13033-017-0156-0
16. Priebe S, Giacco D, El-Nagib R. Public Health Aspects of Mental Health Among Mi-grants and Refugees: A Review of the Evidence on Mental Health Care for Refugees, Asylum Seekers and Irregular Migrants in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2016. URL.
17. Dapunt J, Kluge U, Heinz A. Risk of psychosis in refugees: a literature review. Transla-tional Psychiatry 2017;7(6):e1149. https://doi.org/10.1038/tp.2017.119
18. Hollander AC, Dal H, Lewis G, Magnusson C, Kirkbride JB, Dalman C. Refugee migra-tion and risk of schizophrenia and other non-affective psychoses: cohort study of 1.3 million people in Sweden. BMJ. 2016;352:i1030. https://doi.org/10.1136/bmj.i1030
19. Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, et al. Evidence-based clinical guidelines for immigrants and refugees. Canadian Medical Association Journal 2011;183(12):E824-E925. https://doi.org/10.1503/cmaj.090313
20. U.S. Department of Health and Human Services [Internet]. Washington DC: U.S. De-partment of Health and Human Services; c2012 [cited 05 Nov 2017]. Summary Check-list for the Domestic Medical Examination for Newly Arriving Refugees [approx. 8 screens]. Available from: http://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/checklist.html
21. U.S. Department of Health and Human Services, Centers for Disease Control and Pre-vention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine [Internet]. Washington DC: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine; c2015 [cited 05 Nov 2017]. Guidelines for Mental Health Screening During the Domestic Medical Examination for Newly Arrived Refugees (Vol. 1) [ap-prox. 7 screens]. Available from: https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/mental-health-screening-guidelines.html#two
22. Walker P, Barnett E, Stauffer W. Healthcare for adult immigrants and refugees. Bar-on E, ed. UpToDate. Waltham, MA: UpToDate Inc. URL.
23. Lin KM, Poland RE, Nuccio I, Matsuda K, Hathuc N, Su TP, et al. A longitudinal as-sessment of haloperidol doses and serum concentrations in Asian and Caucasian schizophrenic patients. American Journal of Psychiatry 1989;146(10):1307-1311. https://doi.org/10.1176/ajp.146.10.1307
24. Marcos LR, Cancro R. Pharmacotherapy of Hispanic depressed patients: clinical ob-servations. Am J Psychother 1982;36:505-512.
25. Strickland TL, Lin KM, Fu P, Anderson D, Zheng Y. Comparison of lithium ratio be-tween African-American and Caucasian bipolar patients. Biological Psychiatry 1995;37(5):325-330. https://doi.org/10.1016/0006-3223(94)00133-N
26. Silove D, Ventevogel P, Rees S. The contemporary refugee crisis: an overview of men-tal health challenges. World Psychiatry 2017;16(2):130-139. https://doi.org/10.1002/wps.20438
27. Bhugra D, Gupta S, Bhui K, Craig T, Dogra N, Ingleby JD, et al. WPA guidance on men-tal health and mental health care in migrants. World Psychiatry?2011;10(1):2-10. https://doi.org/10.1176/appi.focus.130406
28. Torales J, Arce A, Zacarías M, Girala N, Moreno M, Szwako A, et al. La Guía TAZ de Psicofarmacología Clínica. 1ª ed. Asunción: EFACIM; 2014. URL.
29. Buhmann C, Andersen I, Mortensen EL, Ryberg J, Nordentoft M, Ekstrøm M. Cogni-tive behavioral psychotherapeutic treatment at a psychiatric trauma clinic for refu-gees: description and evaluation. Torture. 2015;25(1):17-32. URL.
30. Hinton DE, Pich V, Hofmann SG, Otto MW. Acceptance and Mindfulness Techniques as Applied to Refugee and Ethnic Minority Populations With PTSD: Examples From "Culturally Adapted CBT". Cognitive and Behavioral Practice 2013;20(1):33-46. https://doi.org/10.1016/j.cbpra.2011.09.001
31. Van Ee E, Mooren T, Kleber R. Broken mirrors: Shattered relationships within refugee families. In: Pat-Horenczyk R, Brom D, Vogel JM, eds. Helping Children Cope with Trauma: Individual, Family and Community Perspectives. London: Routledge; 2014: 146-162. https://doi.org/10.4324/9781315857756
32. Weine S, Kulauzovic Y, Klebic A, Besic S, Mujagic A, Muzurovic J, et al. Evaluating A Multiple-Family Group Access Intervention for Refugees with PTSD. Journal of Mari-tal and Family Therapy 2008;34(2):149-164. https://doi.org/10.1111/j.1752-0606.2008.00061.x
33. Jacobsen K, Landau LB. The Dual Imperative in Refugee Research: Some Methodolog-ical and Ethical Considerations in Social Science Research on Forced Migration. Dis-asters 2003;27(3):185-206. https://doi.org/10.1111/1467-7717.00228
34. Birman D. Ethical Issues in Research With Immigrants and Refugees. In: Trimble JE, Fisher CB, eds. The Handbook of Ethical Research with Ethnocultural Populations and Communities. California: Sage Publications; 2005: 155–177. URL.
35. European Commission [Internet]. Brussels: European Commision; c2016 [cited 06 Nov 2017]. Guidance note — Research on refugees, asylum seekers & migrants [approx. 5 screens]. Available from: http://ec.europa.eu/research/participants/data/ref/h2020/other/hi/guide_research-refugees-migrants_en.pdf
36. Torales J, Villalba-Arias J, Ruiz-Díaz C, Chávez E, Riego V. The right to health in Para-guay. International Review of Psychiatry 2014;26(4):524-529. https://doi.org/10.3109/09540261.2014.926866
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01/05/2018
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Copyright (c) 2017 Julio Torales, Israel González, Iván Barrios, João Castaldelli-Maia, Margarita Samudio, Antonio Ventriglio
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