Mental health of refugees and asylum seekers: Assessment and intervention

Authours:  Rachel Kronick
Location: National

Summary

With unprecedented numbers of displaced persons worldwide, mental health clinicians in high-income countries will increasingly encounter refugee and asylum-seeking patients, many of whom have experienced significant adversity before and after their migration. This paper presents a summary of the recent evidence on the assessment and treatment of refugees across the lifespan to inform clinicians’ approaches to care of refugee patients in mental health care settings. Assessment and interventions for refugees are grounded in an ecosystemic approach which considers not only pre-migratory trauma, but social, familial, and cultural determinants of mental health in the host country. Evidence for psychotherapy and pharmacological treatments are reviewed, highlighting promising interventions while acknowledging that further research is needed. Ultimately, serving refugees necessitates a biopsychosocial approach that engages clinicians as medical experts, therapists, and advocates.

How does this research apply to my work?

Despite the high rates of pre-migratory trauma and significant psychiatric difficulties, it is striking that most refugees with a secure status adapt well. It is important to recognize that the emphasis on refugee pathology is a consequence of the literature that focuses too much on disorder and disease, rather than on resilience and post-traumatic growth.  This paper presents recent evidence on the assessment and treatment of refugees – highlighting the various components that are essential to providing quality mental health care to this population.

What should I take away from this research?

The article highlights important aspects of assessment, including: the integration of family and community into the assessment context; the importance of interpreters during clinical care; avoiding routine screening of trauma in the primary care setting; acknowledging that distress and social suffering should be carefully distinguished from disorder; and, highlighting the importance of considering the patient’s culturally specific explanatory models.

In addition, the article highlights important aspects of treatment, including: the importance of empathy, emotional support and advocacy to reduce social adversity. It also explores various types of interventions.

What’s the next step?

In addressing refugee mental health, clinicians must adopt a truly biopsychosocial approach that contextualizes patient distress in the broader family, social, and global perspectives. This demands medical and therapeutic expertise, as well as an engagement with our role as advocates

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