Culturally-Sensitive Mental Health Services for Immigrant ... Presentation Agenda • Overview – Facts

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  • Culturally-Sensitive Mental Health Services for Immigrant and Refugee Populations

    Samantha Allweiss, LCSW Samer Hussein, BA

    Professional Development Training Kansas City

    November 15th, 2018| 9am-11:00 a.m.

    © 2017 RefugeeOne. All Rights Reserved. Materials cannot be reproduced without advance permission.

  • Presentation Agenda

    • Overview – Facts and figure, populations served

    • Defining mental health – The universal themes of migration trauma

    • Mental health trends in the immigrant/refugee community – The prevalence of adverse mental health symptoms

    • Practice Strategies– A quick intervention guide for community-based workers & strategies for working with interpreters (Samer Hussein)

    • Final remarks with Q & A session

  • Department of State Office of Admissions – Refugee Processing Center Refugee Admissions by Region FY 1975 through 31 – Jan 2017

    Refugee Processing Centers Admissions Data http://www.wrapsnet.org/admissions-and-arrivals/

    http://www.wrapsnet.org/admissions-and-arrivals/

  • Refugee Admissions

  • Refugee Admissions Number of Refugees Resettled

    Country FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12 FY 13 FY 14 FY 15 FY 16 FY 17 FY 18 Totals

    1 Afghanistan 9 19 2 1 16 16 49 74 5 191 3% 2 Angola 1 1 0% 3 Bhutan 38 43 12 23 5 9 8 3 141 3% 4 Bosnia 7 7 0% 5 Burma 2 35 132 98 153 140 73 140 91 109 66 17 18 1,074 19% 6 Burundi 17 35 3 20 12 0 87 2% 7 C A R 2 3 7 7 11 1 0 31 1% 8 Congo 1 14 10 6 52 71 118 174 100 108 654 12% 9 Cuba 45 83 25 31 68 84 59 24 13 57 23 3 1 516 9% 10 Eritrea 5 14 6 1 16 10 23 1 76 1% 11 Ethiopia 2 4 1 7 2 1 1 14 7 3 42 1% 12 Ivory Coast 6 6 0% 13 Iran 11 21 2 3 6 1 0 44 1% 14 Iraq 5 2 53 113 95 54 82 61 45 62 41 43 5 661 12% 15 Liberia 44 27 4 2 8 1 1 87 2% 16 Mauritania 1 9 7 5 22 0% 17 Pakistan 4 1 5 10 0% 18 Russia 1 6 18 25 0% 19 Sierra Leone 1 1 0% 20 Somalia 80 23 38 103 61 144 107 90 70 121 140 109 105 87 6 1,284 23% 21 Somali Bantu 56 71 10 9 146 3% 22 Sudan 75 24 31 6 1 13 8 4 1 14 44 8 22 37 1 289 5% 23 Togo 2 2 0% 24 Uganda 1 1 0% 25 Ukraine 2 9 10 21 0% 26 Rwanda 5 5 0% 27 Vietnam 7 18 13 23 2 63 1% 28 Syria 85 28 113 2% 29 CAM 1 1 0%

    TOTAL 326 272 138 243 400 492 468 370 309 479 480 459 589 415 161 5,601 100% cumulative 326 598 736 979 1379 1871 2339 2709 3018 3497 3977 4436 5025 5440 5601

  • Refugee Populations

  • Migration Experiences Matter

    • The adjustment process and mental health problems for any new immigrant is directly influenced by the three elements of their migration journey: • Pre-migration experiences

    • Experiences in transit

    • Post-migration / resettlement experiences

  • Life in a Refugee Camp

    • Sleeping accommodations • Medical facilities • Hygiene facilities • Food distribution centers • Education/common areas • Security check-points • Daily activities

    View Salam Neighbor on Netflix

  • Life in an Urban Camp

    • Overcrowded apartments in urban settings

    • Status similar to undocumented immigrant without authorization to work despite UNHCR Protection Letter

    • Minimal access to education or medical care

    • Easily harassed and bribed with threat of arrest. Violations of human rights common

  • Experiences in Transit

    • Great uncertainty of what comes next and excitement about the future.

    • Most refugees typically sell/give away all their items when they are approved for travel, and travel a great distance to get their port of exit.

    • While some may have a route planned, some refugees do not know their receiving city until their day of travel.

    • The Executive Order signed Jan. 28, 2017 has left a great deal of fear and disbelief for many immigrants and refugees.

  • Post-migration Experiences: New Arrivals in the U.S.

    • What are the most important things a refugee living in the US should know?

  • Adjustment to a New Country is Tough

    • Surviving winter. • The rights of a U.S. citizen. • Public benefits and using U.S. currency. • Grocery shopping. • English – reading and writing. • Finding a job. • Riding public transportation. • Getting children/adults enrolled in school. • Finding a doctor, dentist, or other medical

    professionals. • Living in an apartment and using all the

    appliances. • Riding in an elevator or using a revolving door.

  • Universal Themes Surrounding the Immigrant/Refugee Experience and Trauma • Refugees come with their unique and

    collective trauma narrative • History of fear and uncertainty • Need for safety • Loss of homeland, loved ones and

    cultural underpinnings • Worry about the future • Feelings of guilt for families left behind

    or for personal safety • Feelings of loneliness, homesickness &

    isolation • Cumulative impact of migration

    experiences on mental health.

  • What is Mental Health?

    Definition -- Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood (mentalhealth.gov)

    Over the course of your life, if you experience mental health problems, your thinking, mood, and behavior could be affected.

    Many factors contribute to mental health problems, including: • Biological factors, such as genes or brain chemistry • Life experiences, such as trauma or abuse • Family history of mental health problems

  • How do Immigrants and Refugees Define Mental Health?

    • The term “mental health” has a negative connotation in many cultures.

    • Mental health is sometimes correlated with “being crazy” or a product of moral failing. Conversely, mental illness can be seen as a gift or curse, or something unspoken (“it just is”).

    • It is only understood through physical health symptoms.

    • Many cultures see mental health as a private matter that is not to be discussed.

    • Some cultures do not realize that poor mental health symptoms are a problem; it is part of the collective group experience and seen as normal.

  • Prevalence of Adverse Mental Health Symptoms for Adults

    • Common symptoms: • Prolonged sadness with poor coping skills • Increased anxiety and frustration levels • Poor sleep patterns and appetite • Difficulty concentrating • Suicide risk • Intimate Partner/Family Violence • Substance abuse • Severe mental illness: Schizophrenia,

    Bipolar I, Major Depressive Disorder , PTSD

  • Somatic Symptoms

    • In many cultures, mental health problems present in physical ailments including: • Chronic pain and headaches • Tingling/burning sensations in their extremities • Chest pain / rapid heart beat • Persistent coughs and sores • Persistent fever with chronic fatigue (flu-like

    symptoms)

    üEvaluations are needed to rule-out a medical condition.

    üEducation is necessary to help clients understand the nature of their symptoms in terms that are safe and accessible.

  • Mental Health Trends among Refugees

    *Based on data collected 2011-2016 from the RefugeeOne Wellness Program

    Country of Origin Language Common Symptoms

    Mode of Treatment

    Iraq Arabic MDD, PTSD Generalized Anxiety Somatic symptoms

    Individual + Psychiatric *education-levels signif.

    Syria Arabic MDD, PTSD Somatic symptoms

    Individual + Psychiatric Group

    Bhutan Nepali Generalized Anxiety, DV (local/national)

    Group Psychoeducation

    Burmese Karen, Burmese, Rohingya

    Generalized Anxiety Substance Abuse, DV (local/national)

    Group Psychoeducation

    Democratic Republic of Congo

    Swahili, Kinyarwanda

    Somatic symptoms MDD

    Group Psychoeducation

    Columbia Spanish MDD, Generalized Anxiety

    Individual + Psychiatric

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  • The Two-Generational Model of Trauma

    • Trauma has the ability to freeze the relationship between parent and child.

    • Excess stress disrupts the architecture of the brain in a young child.

  • Poor Mental Health in Children: What Does it Look Like? (Resource: NCTSN)

    Birth 0-2 years Age 3-6 years

    • Cognitive: Poor verbal skills, memory problems

    • Behavioral: Excessive temper*, attention- seeking (+/- behaviors)*, regressive/aggressive behaviors*, cries excessively, easily startled*, separation anxiety*, irritability*, sadness*, withdrawn*

    •Physiological: poor appetite, low weight, poor sleep*, sleep difficulties*

    • Cognitive: Difficulty learning, poor skill development

    •Behavioral: Acts out, imitates traumatic events, verbally abusive, unable to trust and make friends, believes they are to blame, anxious, fearful, avoidant, lack self- confidence

    •Physiological: Experiences stomachaches/headaches, regressive traits including bed-wetting

  • The Effects of the Current Administration Immigrant arrests soar under Trump –

    ABC News – 5/17/17 With Ally in Oval Office, Immigration Hard-