Barriers for Using Mental Health Services for the Refugee Population
By: Marco Notaro
A 2015 study by Partnership for the Public Good found that from 2003-2014, Erie County resettled just under 10,000 refugees. These refugees come from countries like Burma, the Congo, Bhutan, Somalia and Iraq, seeking to escape from war, political conflict and violence in their home countries. It should not be surprising that many of these refugees come to the US having experienced severe trauma in their home countries or that according to a 2005 study (Fazel et al. 2005), refugees are almost ten times more likely to suffer from post-traumatic stress disorder (PTSD) and are at a significantly higher rate of risk for depression. But despite often needing mental health services, studies have found that too often, refugees who are in need of mental health services often fail to receive services (Saecho et al., 2012).
There are numerous barriers which serve as impediments to refugees accessing social services. Some barriers are fairly easy to guess such as inadequate English skills which can both deter refugees from seeking out social services and also limit their awareness of the availability of necessary social services. But the English barrier can also manifest itself in less apparent ways. Treatment for PTSD or depression often involves counseling which involves a back and forth between the patient and counselor to work through the patient’s problems. If a refugee has only a minimal or limited command of the English language and is unable to find a counselor who speaks the same language, they may struggle to express their problems in a counseling setting.
Studies on mental health in refugee populations have consistently found that in refugee populations, stigma is also a major barrier which prevents refugees from accessing mental health services. Many countries have differing cultural views towards mental health and negative stereotypes about those suffering from mental health issues. Saecho et al (2011) found that in a study of first generation refugees, many participants described a fear of being labeled as ‘crazy’ by members of their community if they sought out mental health services. In cases of sexual assault, there is often a particular shame associated with the topic which can further lead refugees to avoid talking about their experiences. This same study also found that some refugee groups didn’t have experience with mental health services in their native country, contributing to the stigma of using such services since the groups lack a perceived norm for utilizing the services.
Other studies such as Shannon et al (2015), have found that in certain cultures with a history of violent political repression, the experiences which lead to trauma in refugees can often then serve as a chilling effect for seeking help. For many refugees, coming from countries where the politically active were often publically tortured, raped or killed as a means of repressing and silencing whole communities, staying silent was often a necessary means of survival. It is often extremely difficult for refugees who have survived for years through silence and obedience about their oppression and suffering to open up and begin speaking freely about their experiences once they’re in the United States (Saecho, et.al., 2012).
These factors often serve as major impediments for refugees being able to utilize the mental health services which are available to them. Given that refugees are significantly more likely to experience PTSD and depression, these barriers end up having a significant impact which can prevent refugees from accessing necessary treatment to address their mental health issues. A better understanding of the barriers refugees face in accessing social services can hopefully serve as a starting point for service providers in working to overcome the barriers and help a population which is significantly more likely to need their services.