Forced Migration and Mental Health. Rethinking the Care of Refugees and Displaced Persons

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1 Forced Migration and Mental Health Rethinking the Care of Refugees and Displaced Persons

2 International and Cultural Psychology Series Series Editor: Anthony Marsella, University of Hawaii, Honolulu, Hawaii ASIAN AMERICAN MENTAL HEALTH Assessment Theories and Methods Edited by Karen S. Kurasaki, Sumie Okazaki, and Stanley Sue COUNSELING INTERNATIONAL STUDENTS Clients from Around the World Written by Nancy Arthur THE FIVE-FACTOR MODEL OF PERSONALITY ACROSS CULTURES Edited by Robert R. McCrae and Jüri Allik FORCED MIGRATION AND MENTAL HEALTH Rethinking the Care of Refugees and Displaced Persons Edited by David Ingleby LEARNING IN CULTURAL CONTEXT Family, Peers, and School Edited by Ashley Maynard and Mary Martini POVERTY AND PSYCHOLOGY From Global Perspective to Local Practice Edited by Stuart C. Carr and Tod S. Sloan PSYCHOLOGY AND BUDDHISM From Individual to Global Community Edited by Kathleen H. Dockett, G. Rita Dudley-Grant, and C. Peter Bankart TRAUMA INTERVENTIONS IN WAR AND PEACE Prevention, Practice, and Policy Edited by Bonnie L. Green, Matthew J. Friedman, Joop T.V.M. de Jong, Susan D. Solomon, Terence M. Keane, John A. Fairbank, Brigid Donelan, and Ellen Frey-Wouters A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher.

3 Forced Migration and Mental Health Rethinking the Care of Refugees and Displaced Persons Edited by David Ingleby Utrecht University Utrecht, The Netherlands Springer

4 ebook ISBN: Print ISBN: Springer Science + Business Media, Inc. Print 2005 Springer Science + Business Media, Inc. Dordrecht All rights reserved No part of this ebook may be reproduced or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Springer's ebookstore at: and the Springer Global Website Online at:

5 Contributors Julia Bala is a psychologist and systems-oriented psychotherapist working for Centrum 45 in Amsterdam (Treatment of and research into the consequences of organized violence) and associated with Pharos Foundation (Refugees and Health Knowledge Center) in Utrecht. Educated in former Yugoslavia and the USA, she has a PhD in psychology and her main interests since arriving in the Netherlands in 1992 have been psychotherapy, research and preventive projects related to refugee children and families. She has been developing integrative models for their treatment, intervening on multiple system levels and fostering resilience. She has authored many articles in professional journals and has contributed to several edited volumes. Ian Clifton-Everest is Senior Lecturer at the Department of Psychology, London Metropolitan University where he teaches Developmental Psychology. He also works in conflict-ridden areas of Africa, South America and the Middle East where he advises on the design of psychosocial programs for the rehabilitation of war-affected children. He has a special interest in the problems of children abducted into fighting forces. He has written on the impact of violence on mental health, on conflict prevention, children s rights, and education for peace and development Suman Fernando is Honorary Senior Lecturer in Mental Health at the European Centre for Migration and Social Care studies (MASC), University of Kent and Visiting Professor at Department of Applied Social Studies, London Metropolitan University London. He has lectured and written widely on issues of race and culture in mental health. His most recent books are Mental Health, Race and Culture edition Palgrave, 2002) and Cultural Diversity, Mental Health and Psychiatry. The Struggle against Racism (Brunner-Routledge, 2003). Suman Fernando is a practicing psychiatrist and is also involved in community organizations providing mental health services to minority ethnic communities in London. He served on the Mental Health Act Commission (a government inspectorate) for nine years until 1995 and chaired its National Standing Committee on Race and Culture. Choman Hardi does research at the European Centre for Migration and Social Care Studies (MASC), University of Kent. She was born in Kurdistan (Iraq) and during her childhood her family fled twice to Iran. After coming to England in 1993 she studied philosophy and psychology at Queen s College, Oxford and obtained an MA in philosophy at University College, London. She is currently completing her PhD research on the mental health of Kurdish women refugees and has been awarded a Leverhulme Scholarship to study women survivors of Iraq s Anfal campaign against the Kurds. v

6 vi Contributors Choman Hardi is also a writer and has published three collections of poetry in Kurdish and one collection in English (Life for us, Bloodaxe Books). She has also facilitated creative writing workshops in the UK and abroad. She was the chair of Exiled Writers Ink!, an organization of refugee writers. Anders Hjern is Researcher at the Swedish National Board of Health and Welfare, Centre for Epidemiology, Stockholm and community pediatrician in southern Stockholm. He has a particular interest in public health issues in multicultural societies. He is Associate Professor in Child and Adolescent Medicine at Karolinska Institutet in Stockholm and has published more than 40 articles on public health issues related to inequality and migration in children and youth. David Ingleby is Professor of Intercultural Psychology at Utrecht University. After working for the Medical Research Council in London and teaching in Social and Political Sciences at Cambridge University, he moved in 1982 to Holland to take up a chair in Developmental Psychology. Since 1991 he has concentrated on issues of migration and culture and was awarded his present chair in His edited volume Critical Psychiatry: The politics of mental health (Pantheon, 1980; Penguin, 1981) has just been reissued by Free Association Books. Together with Charles Watters he teaches in the European MA network on Migration, mental health and social care. He has a lifelong interest in the social dimension of psychology and in interdisciplinary research and practice. Olle Jeppsson is a Pediatrician at Huddinge University Hospital, Karolinska Institutet, Stockholm. He has been involved with clinical work with refugee families for many years and has also worked on child health in Mozambique, Ethiopia, Angola, Lebanon and Yemen as well as teaching international child health at the Karolinska Institute. During he was employed by Swedish Save the Children to evaluate their programme in Kenya for unaccompanied minors from Sudan. Sander Kramer has been a researcher and teacher at the Utrecht School of Governance, Utrecht University since He is also a social worker and has experience of residential care and day care for children with learning and developmental problems, as well as prevention programs for migrant youth. His interest in refugees and asylum seekers was broadened by studying Cross-cultural Psychology at Utrecht University. He is currently Course Leader in Utrecht of the European MA on Migration, mental health and social care which is given simultaneously in England, Holland and Sweden. Derrick Silove is Foundation Professor of Psychiatry at Liverpool Hospital, Sydney (University of New South Wales) and visiting adjunct professor at Karolinska Institutet, Stockholm. He is a long-serving board member of the Service for the Treatment and

7 Contributors vii Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, also working in the Service as a psychiatrist. He currently directs the East Timor National Mental Health Project. His main interest is in pursuing research, advocacy, service planning and social development for refugees, asylum seekers and societies recovering from conflict and oppression. He has published over 150 journal articles, book chapters, monographs and major reports, most in the field of refugee/post-conflict mental health. Paul Stubbs is Senior Research Fellow, Institute of Economics, Zagreb, Croatia. Born in the UK, he was trained as a sociologist and has lived and worked in Croatia since He is currently researching the role of international actors in regional development. His main interests, reflected in research, activism and consultancy are: social policy and welfare governance in post-yugoslav countries; peace-building and social development; community development and mobilization; corporate social responsibility and social reporting; civil society and social movements; online activism; and ethnographies of aid and development. His critical stance on war trauma derives from grassroots work in refugee camps in Croatia and from sociological analyses of mental health professionals. Many of his publications can be downloaded from (website of the Globalism and Social Policy Programme). Derek Summerfield is Honorary Senior Lecturer at the Institute of Psychiatry, King s College, London and Research Associate, Refugee Studies Centre, University of Oxford. He was formerly consultant to Oxfam and other aid agencies, and Principal Psychiatrist to the Medical Foundation for Care of Victims of Torture, London. He has been widely involved in training, lecturing and publishing. Charles Watters is Director of the European Centre for the Study of Migration and Social Care (MASC), University of Kent. He is the author of a number of studies into the mental health and social care of refugees and co-author of a study into good practice in the field, drawing on a range of international examples. Recent interests include research on mental health care for displaced persons in Brazil, an evaluation of the Breathing Space mental health project for refugees, reception arrangements for young refugees in the UK, and comparative international study of pathways to mental health and social care for refugees. He is coordinator of the European MA program Migration, mental health and social care.

8 Contents 1. EDITOR S INTRODUCTION 1 David Ingleby PART I. HUMANITARIAN AID AND RECONSTRUCTION 2. FROM TRAUMA TO SURVIVAL AND ADAPTATION: Towards a framework for guiding mental health initiatives in post-conflict societies 29 Derrick Silove 3. TRANSFORMING LOCAL AND GLOBAL DISCOURSES: Reassessing the PTSD movement in Bosnia and Croatia 53 Paul Stubbs 4. TRAUMATIC STRESS IN CONTEXT: A study of unaccompanied minors from Southern Sudan 67 Olle Jeppsson and Anders Hjern 5. MEETING THE MENTAL HEALTH NEEDS OF CHILDREN WHO HAVE BEEN ASSOCIATED WITH FIGHTING FORCES: Some lessons from Sierra Leone 81 Ian Clifton-Everest PART II. SERVICE PROVISION IN HOST COUNTRIES 6. MY WHOLE BODY IS SICK... MY LIFE IS NOT GOOD : A Rwandan asylum seeker attends a psychiatric clinic in London 97 Derek Summerfield 7. MENTAL HEALTH CARE FOR REFUGEE CHILDREN IN EXILE 115 Anders Hjern and Olle Jeppsson ix

9 x Contents 8. GETTING CLOSER: Methods of research with refugees and asylum seekers 129 Sander Kramer 9. KURDISH WOMEN REFUGEES: Obstacles and opportunities 149 Choman Hardi 10. BEYOND THE PERSONAL PAIN: Integrating social and political concerns in therapy with refugees 169 Julia Bala 11. MENTAL HEALTH SERVICES IN THE UK: Lessons from transcultural psychiatry 183 Suman Fernando 12. MENTAL HEALTH AND SOCIAL CARE FOR ASYLUM SEEKERS AND REFUGEES: A comparative study 193 David Ingleby and Charles Watters Author Index 213 Subject Index 217

Refugee s Mental Health: Global and Local Perspectives

Refugee s Mental Health: Global and Local Perspectives Mr. Kim Yuval Course Number: 702.2194 Class Time: Class Location: E-Mail: Kimyuval@gmail.com Course Description: Contemporary armed conflicts and