MENTAL HEALTH IN MN REFUGEE POPULATIONS

WHAT DO WE KNOW?

PREVALENCE WHO: An average of more than 50% of

refugees present mental health problems….

WHO: PTSD or depression 30-40% in post conflict populations Bulletin of WHO, Jan, 2005 83 (1)

CDC: 30-70% of people who have lived in war zones suffer from symptoms of post traumatic stress (PTSD) and depression

SPECIFIC POPULATIONS Bhutanese refugees: 3 out of 4 have had

PTSD at some point in life (Medicine, Conflict &Survival, 24 (2008) 5-15)

Karenni refugees: depression 42%, anxiety 41%, and PTSD 4.6% (Science &Medicine, 58 (2004) 2637–2644 )

Iranian, Iraqi, Lebanese, Somali, Columbian, Salvadoran, Ethiopian, Angolan and Bangladeshi 8 years after exile: 50% PTSD (The Journal of Nervous and Mental Disease, 185 (1997)39-45

Burmese political exiles: 40% depression (American Journal of Public Health, 86 (1996)1561-69)See: An Annotated Bibliography on Refugee Mental Health,2005

www.refugeewellbeing.samhsa.gov

FAZEL, WHEELER AND DANISH Prevalence of serious mental disorder

in 7000 refugees resettled in western countries: a systematic review. The Lancet, (2005) Volume 365, Issue 9467, Pages 1309-131420

Depression: Estimated 8% of refugees resettled in

the United States had major depression Higher than the population rate and similar to the rate in primary

care patients in U.S Anxiety

4% of the refugees were reported to have Generalized Anxiety Disorder

9% adults were diagnosed with post-traumatic stress disorder

44% of refugees with PTSD also had major depression

11% of 260 refugee children from three countries met criteria for PTSD

FINDINGS:

OTHER FINDINGS War trauma has been found to be highly

predictive of PTSD but not of depression ( Hsu et al., 2004 Clinical Psychology Review, Volunte24, Issue 2 May 2004, Pages 193-213)

Refugees with a dx of PTSD and depression had higher rates of suicidal ideation than those with only PTSD but a lower rate of suicide attempts Acta Psychiatrica Scandinavica.96:108-117

PTSD in the absence of depression was more predictive of suicidal behavior than PTSD with depression The Lancet, Volume 365, Issue 9467, Pages 1309-1314

WHAT DOES THIS MEAN FOR MINNESOTA?

COLORADO MENTAL HEALTH SCREENING 9/30/99-6/30/01 2001

2001 PUBLIC HEALTH REPORTS /MAY–JUNE 2005 /VOLUME 120

9.2% of adults screened positive for MH sxs

37% accepted MH services 63% did not

What would that look like in Minnesota? 9.2% = 147 refugees 55 would accept services

BARRIERS/DIFFICULTIES IN REFUGEE MH Help seeking Waiting lists Poor provider location Treatment population limitations

SPMI Admitted torture survivors

Psychotropic meds without psychoed or referral

Providers unwilling to work with interpreters Ethical and legal obligations of licensed providers

WHAT ARE OUR RESOURCES? Eight months of health insurance

Transportation Interpreter services

Specialty clinics: CUHCC Wilder SE Asian Program Center for Victims of Torture

County Mental Health Clinics, Rule 29 Clinics and private practitioners

Federal law requires that we see these clients if referred to us

BARRIERS: CULTURAL Lack of shared problem understanding

Professional focus: war trauma and PTSD Refugee focus: family separation and

unemployment as the cause of distress

Lack of understanding of presentation of suffering

“YOUR SOUL IS LIKE YOUR SHADOW. Sometimes it just wanders off like a butterfly

and that is when you are sad and that’s when you get sick and if it comes back to you that is when you are happy and you are well. Sometimes the soul goes away but the doctors don’t believe it…The doctors can fix some sicknesses that involve the body and blood but for us Hmong some people get sick because of their soul so they need spiritual healing.” From: The Spirit Catches You and You Fall Down

by Anne Fadiman

PRESENTATION OF SUFFERING High levels of somatic presentation of distress Idioms of distress

Culturally specific experiences of suffering Not to be confused with mental illness

“While the distress experiences seen in diverse cultural groups sometimes signify the presence of physical or psychological disorders, they may also symbolically represent interpersonal and intra-psychic conflicts, or may be culturally coded ways of expressing social discontent” (Arnault, et.al., “Is there an Asian idiom of distress? Somatic Symptoms in Female Japanese and Korean Students. Archives of Psychiatric Nursing. 2008 February ; 22(1): 27–38.)