The Refugee Experience

Transcription

1 The Refugee Experience Presentation by CAPT John J. Tuskan, Jr., USPHS Refugee Mental Health Program SAMHSA/CMHS ACF/ORR Charlotte, NC April 17, 2008

2 ORR Refugee Health Team Health & Mental Health Technical Assistance U.S. Department of Health and Human Services Office of the Secretary Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services (CMHS) Refugee Mental Health Program John Tuskan (240) Administration for Children and Families (ACF) Office of Refugee Resettlement Marta Brenden (202)

3 Website: Listserv ( see REFUGEEHEALTH-L) L)

4 Definition of a Refugee: The 1951 Convention and 1967 Protocol Relating to the Status of Refugees Article 1 -- Definition of the term Refugee A(2) [Any person who]... owing to well-founded fear of being persecuted for reasons of race, religion, nationality, or political opinion, is outside the country of his nationality and is unable or, owing to such fear or for reasons other than personal convenience, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence, is unable or, owing to such fear of for reasons other than personal convenience, is unwilling to return to it. (as amended y Article 1(2) of the 1967 UNHCR Protocol relating to the status of refugees)

5 Refugees & Others Refugee Forced to flee home and is outside of country of origin & has wellfounded fear of persecution Asylum Seeker Makes a claim that he/she is a refugee Migrant Moves to a foreign country for a variety of reasons & for a certain length of time (e.g., work; usually a minimum of one year) Immigrant Takes up permanent residence in a country other than original homeland Economic Migrant Leaves country of origin for economic reasons Internally displaced Person (IDP) Like refugees, forced to move, but remains in own country Stateless Person Not considered a national by ANY or does not enjoy fundamental rights enjoyed by others in their home state

6 Top 10 Countries of Origin of Major Refugee Populations 1 January 2007 (Source: UNHCR) 1. Afghanistan 2,108, Iraq 1,451, Sudan 686, Somalia 464, Democratic Rep. Congo 402, Burundi 397, Vietnam 374, Turkey 227, Angola 207, Myanmar 203,000 *Note: Some 334,000 Palestinian refugees also come under UNHCR mandate, while a further 4.4 million are cared for by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)

7 Top 5 Countries of Refugee Resettlement in 2006 (source: UNHCR) 1. United States (fiscal year) 51, Australia 13, Canada 10, Sweden 2, Norway 1,000 *Other Countries: Finland, New Zealand, Denmark, Netherlands, United Kingdom, Ireland, Brazil, Chile, Argentina, Iceland, Mexico

8 Refugee Arrivals 85,000 79,338 72,489 52,868 53,813 27,113 28,067 FY 1999 FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005

9 How Refugees Enter the U.S. 2,000,000 + Refugees in U.S. since 1980

10 U.S. Resettlement Department of State Department of Health & Human Services Bureau of Populations, Refugees, & Migration Administration for Children and Families Voluntary Agencies Office of Refugee Resettlement Church World Service Ethopian Community Dev. Council Episcopal Migration Ministries Hebrew Immigrant Aid Society International Rescue Committee Iowa Bureau of Refugee Services Lutheran Immigrant & Refugee Services US Conference of Catholic Bishops US Committee for Refugees & Immigrants World Relief Corporation States & Discretionary Grantees

11 Three Pillars of Refugee Resettlement Federal & State Agencies Voluntary Agencies Ethnic & faith-based community organizations

12 There is no greater sorrow on earth than the loss of one s s native land Euripides, 431 B.C.

13 Refugee Experience Cataclysmic, Extreme Affliction World-shattering and world-shaping experience Loss of sense of coherence internal locus of control Often raises questions: ultimate meaning purpose of life nature of reality good & evil God & man

14 Journey to Well-Being Link between migration, resettlement & health Pre-migration: exposure to infectious & parasitic diseases, physical & psychic trauma During migration: malnutrition, exposure to the elements, physical & psychic trauma Post-migration: increasing susceptibility to chronic diseases, problems of resettlement (discrimination, unemployment, ESL, crime, etc.)

15 Vulnerable Subgroups (may require special or additional attention) children/youth women elderly survivors of torture

16 Current Migration & Mental Health Trends Context of exit vs. context of resettlement Suffering to endure pain, anguish, sorrow, distress, anxiety Refugee resilience strengths-based approach Holistic health promotion & disease prevention ecological approach

17 ECOLOGICAL MODEL of REFUGEE BEHAVORIAL HEALTH Society Political climate Discrimination/racism Attitudes towards immigrants Socioeconomic structure Tolerance World & national events Family Structure & routine Gender roles Country of origin Race & ethnicity Immigration legal status English Language Health/mental health Intergenerational issues Domestic violence Integration Clan Culture Refugees School or Work Quality Parental Involvement Safety Bullying/violence/gangs Ethnic & religious make-up of faculty Cultural competence Local Community SES Rural, suburbs, inner city Access to services Cultural competence of providers Safety Ethnicity Tolerance Integration Faith communities Opportunity Local culture Safety & security Identity Acculturation-Integration Education Health & Well-Being Medical & psychiatric conditions Substance use and abuse Disabilities Religion/Faith Degree of observance Spirituality Integration of faith community into the mainstream community Custom & culture vs. religion Marginalization or integration Political involvement Peer Group Recognition & Acceptance Attitudes about school Engagement with School Attitudes about drugs and crime Attitudes about sexual behavior Gang involvement Ethnic mix Religious mix CAPT John Tuskan, revised May 02, 2007

18 A Meta-analysis: Predictors of Refugee Mental Health Aftereffects of displacement by war cannot be understood simply as the product of an acute and discrete stressor These aftereffects depend crucially on the economic, social and cultural conditions from which refugees are displaced and in which refugees are placed. Porter, M & Haslam, N., JAMA,, (2005) Vol 294, No.5

19 Recent Study: Impact of pre-resettlement trauma, resettlement stress & capacity to handle stress Four dimensions of resettlement stress accounted for 62% of total variance in stress Social & economic strain and alienation accounted for most common symptoms of mental disorder For core PTSD symptoms, pre-settlement trauma had strongest impact Capacity to handle stress in terms of meaning, control & manageability can be facilitated Lindencrona, F, et al, Soc Psych Psych Epidemiol,, (2008) 43:

20 Post-Conflict Behavioral Health Pyramid serious mental illness physical handicaps severe functional impairments family problems hopelessness & despair lack of trust social justice & revenge physical and mental exhaustion major life events, challenges, distress & suffering Refugee Population Psychosocial Adjustment Problems (30 40%)

21 Adaptation and Resettlement Long-term processes: Continue after mastering language and reaching economic, professional, and social stability Active processes that may continue over the lifetime of the refugee Refugee may need special support at vulnerable times such as job loss and/or any point in time

22 In Summary: Some Key Concepts Refugees are normal people exposed to extremely stressful events Transitory resettlement/adjustment problems are common Continued negative experiences increase risk of unsuccessful adjustment/adaptation & illness Non-conventional interventions/solutions should be considered

23 Some Key Concepts Interventions should be adjusted to evolving needs of refugee groups Providers (e.g. case managers) are responding to the psychosocial needs of refugee by successfully performing their jobs

24 Thank you. Captain John Tuskan Federal Refugee Mental Health Program Telephone: