Term Paper on "Refugees Mental Health"

Term Paper 6 pages (2172 words) Sources: 1+

[EXCERPT] . . . .

Children Refugees

It is estimated that over one billion people of all ages worldwide are affected by mass violence. They suffer from the experience of war, ethnic conflict, torture and terrorism, and, in a large number of cases, are separated from their families. About 50 million individuals are displaced, with 1 out of every 200 homeless (UN Chronicle). The World Health Organization (WHO) reports that 450 million persons suffer from some form of mental or brain disorder, including alcohol and substance abuse; this means that one in four families has at least one member affected. Further, approximately 121 million suffer from depression. The future does not appear any better: The Global Burden of Disease Study (Murray et al. 2002), expects mental illness to rise by 15 per cent between 1990 and 2020. The study did not include many post-conflict nations; it has been estimated that their inclusion would result in statistical findings two to four times greater. Children are among the most vulnerable of all refugees; the percentage of individuals under 21 with mental illness is significant.. Not only do they suffer from war or other forms of persecution in their countries of origin, but many continue to endure human rights abuses in countries of asylum. More than half of the world's refugee population consists of children, yet their privileges and special protection needs are frequently neglected.

A literature review indicates that little has been done to respond to the mental health issues of refugee children. Social workers and other individuals who are equipped to handle the myriad of problems associated with refugee life need to conduct research to determine which are the best intervention approaches and why. According to the literature review on this topic, one of the best ways of best determining the children who most need mental heath services and of reaching their caregivers who provide support, is through the schools. The teachers and administration have ongoing contact with the children and can more readily reach the caregivers when needed. It would be helpful to confirm this conclusion, so that refugee children with mental health problems and their caregivers in other areas of the world can quickly and effectively receive the help they so desperately require. This study will compare educational and communication processes that are possible to reach children and their caregivers and their effectiveness.

LITERATURE REVIEW

Children refugees across the world are undergoing cruel and unbearable pain and suffering. The situation was unconscionable prior to the Asian disaster, and now it is much worse with the earthquake and tsunami ramifications. In addition to homelessness, children are being forced to join the LTTE (Liberation Tigers of Tamil Eelam) in Sri Lanka, and some may even be stolen for child slavery. Hundreds of thousands of children are affected by the disaster. They remain among the most vulnerable survivors, at risk of disease, dehydration and separation from their families. In some areas such as Sri Lanka, children account for nearly half of the disaster's victims (Wiseman). These children will be impacted for years.

Children refugees elsewhere in the world suffer none the less, with mental illness a major concern. According to a study by Lustig et. al. (2004), "The impact of war among young refugees manifests empirically as psychopathology defined by Western models of illness." The researchers reviewed stressful experiences and stress reactions among child and adolescent refugees, as well as interventions and ethical considerations in research and clinical work, within the framework of the chronological experiences of child refugees; namely, the phases of preflight, flight, and resettlement. From a mental health perspective, "cultural bereavement" connotes refugees' responses to losing touch with attributes of their homelands. Elements of cultural bereavement include survivor guilt, anger, and ambivalence.

Likewise, Mollica et. al. (2004) note that "Scientists have recently focused on elaborating the mental health problems of children exposed to extreme violence." Their statistics include:

Prevalence of mental health disorders in children

and adolescents affected by complex emergencies

Post-traumatic stress disorder

Complex emergency populations

6-year follow-up of 30 young Khmer refugees 50% in 1984

38% in 1990

170 Cambodian adolescent refugees 26.5%

12.9%

59 young Cambodian-Americans Point: 24%

Lifetime: 59%

209 Khmer adolescents 12.9-41.2%

99 Cambodian refugees Point: 31.3%

Lifetime: 37.3%

12 Bosnian adolescents in U.S. 25%

Cambodian refugees in U.S. Point: 28.6%

Lifetime: 37.1

Another comparative study by Fazel (2003) of children seeking asylum in England examined the rates of psychological disturbance in a sample of UK children who were refugees and compared them with a group of children who were from an ethnic minority but were not refugees as well as a group of indigenous white children. More than a quarter of refugee children had significant psychological disturbance -- greater than in both control groups and three times the national average. These refugee children show particular difficulties in emotional symptoms.

According to a study by Manchester (2004), around 40,000 people of refugee backgrounds live in New Zealand. Since the early 1980s, the country has settled an annual quota of 750 refugees, one-third of them under the age of 18. Children can suffer from a combination of behavioral problems, mental health concerns such as anxiety, depression, post traumatic stress disorder symptoms, and sometimes care and protection issues. Most refugees, including children, arrive in New Zealand hugely traumatized by the experiences they have been through in their home countries or from their years living in refugee camps. Suddenly they are in a new environment where they do not understand the culture or language. The have been uprooted from their homes and, in many cases, families.

Regarding the issue from an opposite standpoint, Mikus Kos (1999) notes that "It took a long time for the profession (mental health) to recognize that all children exposed to negative life experiences and adversities will not be psychologically damaged." In the past, professionals were interested in the environmental causes of psychosocial disorders and always could find conclusive relationships between the past traumatic events and unpleasant experiences of clients, as well as their present psychological or psychosocial disorders. The question, "Why this child has psychosocial disorders emotional, behavioral, or whatever" could always be very convincingly answered. However, they did not pay attention to the huge number of children experiencing chronic adversities or traumatic events whose development remained healthy. The question "Why not?," why so many youths exposed to similar or even same adversities and risk factors were not psychologically disturbed, only appeared as a frequent issue in the professional literature in the last decade.

Similarly, because of the large and growing numbers of refugee children, more social workers and those in the mental health field are looking for additional ways to determine the best approaches for handling and reducing the incidents of mental health issues. They are studying the different types of intervention that may be utilized for this purpose to find the most effective approach (es).

The research by Mikus Kos (1999), for example, found that the percentage of refugee families seeking mental health care for their children is small. It is usually the teachers who recommend treatment. Thus, "with refugee children became evident that if the mental health profession wants to reach an important number of children, it has to develop out-reaching and population oriented models. The most important among them is the implementation of mental health activities in primary schools, which are the institutions gathering all children of school age."

Mollica (2003) notes that mental health treatment in most cases is non-existent or unsuccessful due to the approach taken. Despite increasing knowledge of science-based interventions and culturally effective programs, the current method to meeting mental health needs of war-affected individuals and their societies is inadequate Within most post-conflict countries, mental health policy is essentially not available. Further, there is no global and collaborative approach to the mental health and physical healing of traumatized groups.

Lustig (2004) adds, "The literature on empirically tested interventions developed for refugee youths is sparse." During resettlement, refugee youth may seek treatment with a clear hierarchy of needs, beginning with safety and survival. They may initially, and sometimes solely, seek services such as welfare benefits, education, and occupational training. "From an ecological/transactional perspective, treatment may invoke individual or environmental protective factors to improve outcome. An important treatment goal is to reduce risk factors that may contribute to poor outcomes, often requiring interventions at multiple levels of the social ecology."

Lustig (2004) also reports that empirically tested interventions operating among interacting ecological levels have been preliminarily promising. School-based, trauma and grief-focused group psychotherapy, targeting the ontogenic and exo-system levels, reduced posttraumatic stress, depression, and grief symptoms among 55 war-exposed, Bosnian adolescents. However, traditional Western mental health approaches have often not been effective with immigrants and refugees. Barriers to service request for refugee children include the stigma of mental illness and treatment in their birth countries, a dearth of clinicians who speak refugee languages, low priority given to mental health among other overwhelming needs, and lack of resources to pay for services. "The range of desirable services at various social/ecological levels merits… READ MORE

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