Critical Analysis: Specific Mental Health Risks for Refugees

Introduction

World Health Organization defines mental health as, "a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community" (Who.int, 2018). Therefore, an individual is not only healthy by the absence of physical diseases but also in their mental wellbeing. Both internal and external factors affect a person's mental state. To understand the psychologial health risks of the refugees, one must learn the life of refugees and the problems they are facing. Refugees are displaced persons living outside the boundaries of their countries. Therefore, this paper analyses the specific mental health risks for refugees.

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Risk Factors

Refugees as per United Nation High Commission for Refugees (UNHCR) is, "Someone who has been forced to flee his or her country because of persecution, war or violence. A refugee has a well-founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group. Most likely, they cannot return home or are afraid to do so. War and ethnic, tribal and religious violence are leading causes of refugees fleeing their countries." To date, 68.5 million people have fled from their countries. The rate of people with psychological problems are higher within the refugees and immigrants in comparison to the general population. (Mann & Fazil, 2006). This is as a result of traumatic events that they pass through before and during the resettlement period. Refugees undergo through persecution in their home country. The immigrants seek asylum for fear of physical or mental torture.

Culture Shock

The first impact of migration is a culture shock, especially in differing gender roles and language barriers. These factors affect their ability to integrate with the local community.

Loss of Family and Friends and Human Rights Abuse

The main instances that people leave their countries are in events of the war. During the fighting, there is a lot of bloodshed and deaths. The refugees may probably have lost relatives and loved ones during the fights. Therefore, they experience grief, fear, and trauma. Also, refugees leave their homes against their free will hence experience loss of social status and rejection. Immigrants also worry about relatives that they may have left behind and the state of their home country.

Social Status and Unemployment

Living in a foreign country and most probably in camps affects the immigrant's emotions. How the people in the state of asylum treats them will also influence their mental wellbeing. In cases where the refugees feel that they are well taken care off, they are less likely to have disturbed psychological tendencies. Also, the outcomes of permanent residency requests may influence how they cope with their daily stresses. If refugees undergo through a strenuous screening process for residency and get a denial, they could develop feelings of rejection, which might aggravate the mental problems. In addition to the reception in the host population, refugees may face unemployment and underemployment. Lack or inadequate source of income leads to stress, especially if before migration they had an adequate income.

Therefore, refugees have many different factors that may influence their state of mind. Since individual experiences vary from one person to another, conventional treatment may not apply to each person. Various people have different adjustment mechanism depending on their upbringing and the level of impact of current experiences.

Practice Dilemmas

Since mental health and psychological interventions are standard, there is a problem in tailoring treatment to suit the refugee populations. The manifestation of refugee problems is mainly due to trauma from human rights violations in their countries, and fleeing experience. Therefore, a practitioner faces a challenge in treating immigrants due to cultural diversities, and their different level of emotional distress. A professional has first to educate themselves with the events of the home country of immigrants to understand the best means of treatment.

Furthermore, if the refugee's experience fear and distrust towards strangers, they may not be willing to open up about their emotions to the professionals. Establishing confidence for a successful intervention to take place in usually challenging in cases of immigrants. In addition to trust issues, the practitioner may face communication barriers since the language of communication may differ. Therefore, introducing a third party as an interpreter may complicate further the intervention process. Cultural differences may affect the treatment outcome. The refugees and the practitioners may face a barrier in fundamental beliefs. For instance, male refugees from Arab nations who practice Islam may not be receptive to therapy conducted by an American female.

Another challenge in the intervention process of the refugees if the willingness to attend therapy sessions. Since immigrants experience trauma and grief, they may not be willing to utilize the treatment services provided. There are five stages of grieving. These include denial, anger, bargaining, depression and acceptance (Kubler-Ross & Kessler 2014, p. 4). The refugees who may be going through the first four stages may not be receptive to treatment. However, refugees who are experiencing acceptance may seek intervention and would be willing and motivated to get better. Mental health treatment occurs when an individual acknowledges that they have a problem. Therefore, the effectiveness of therapy will happen in those refugees who have accepted that they need help to cope with life stresses and losses.

In addition to the challenges related to their refugee status, immigrants may also have other factors that complicate their treatment. For instance, some of them could be alcohol and drug abusers. Therefore, a practitioner may face challenges dealing with the two problems concurrently. A refugee with an issue of substance abuse will require a more comprehensive treatment as compared to the one who is only facing psychological stresses as a result of their refugee status.

Therapy setting may not be favourable and especially where many persons are sharing a common area with minimal privacy. Since most of the intervention for refugees happen in their dwellings, the location may not allow for confidential conversations. Although the practitioner may try to have a secluded therapy, there is no guarantee that enough room will be available for the same. For the intervention process to be effective, the clients must be willing to talk without inhibitions on what they may be going through. However, individual therapy may be combined with family and group therapy to have a greater impact on behavioural and emotional change and healing.

Available Services

One of the services available for mental health treatment and care is biomedicine. These interventions aim at improving psychological symptoms in a client with mental health challenges. Biomedicine involves a combination of three procedures namely, "drug therapies, electroconvulsive (shock) treatment, and psychosurgery" (Hungerford 2012, p. 5). Drug therapy is the use of drugs in the treatment of depression and traumatic tendencies. Professional with a background of medicine will use this form of intervention together with psychotherapy. The drugs fall into three groups namely antianxiety drugs, antipsychotic drugs and antidepressants.

Electroconvulsive treatment of mental problems involves the use of electronic shock on patients to produce a seizure (Abrams 2002, p. 2). The impact is applied to one or those sides of the brain by use of electrodes, and it causes temporary unconsciousness of the patient. It is not a common form of treatment since the therapist prefers other types of modern treatment like drug therapy. Furthermore, it may not result in the permanent cure of patients. Psychosurgery is a procedure where trained personnel use surgery in treatment with the aim of psychological and behavioural change (Leveque 2014, p. 8). However, there are side effects in the use of the method in the treatment of mental problems like violence.

The other method of treatment of mental health problems is psychotherapy. A trained practitioner conducts the therapy by exploring the patients` thoughts, behaviour, emotions, and feeling in trying to establish the causative factors and enhance clients coping mechanisms. The use of psychotherapy is useful in the treatment of patients as individuals, in families, and as members of a group.

Individual therapy method includes cognitive behaviour therapy and communication therapy among others. Family therapy is also useful in the treatment of individuals within the family as a social support system. Group therapy is for some individual going through the same challenges. For instance, in the case of refugees, groups of up to 7 persons may be constituted for therapy, Group interventions help individuals in sharing what they go through and making them know that others member experience the same challenges and emotions (Stone 1996, p. 3).

However, the use of biomedicine in treatment may not help clients in developing coping mechanisms (Murray, Davidson & Schweitzer, 2010). Also, they may deny the clients the ability to experience the pain associated with grief and trauma which is necessary for healing and future adaption to anxiety and stressful situations. Psychotherapy treatment is a holistic approach to emotional healing of clients. The refugees learn to identify stressors and cope with problems in life. However, some patients may need additional intervention such as medical therapy to heal (Sammons & Schmidt 2003, p. 27)

The available therapy services are usually free to the refugees to encourage them to participate. Also, they are conducted by trained personnel who have skills in dealing with trauma cases. Use of skilled staff gives clients confidence that they are going to be better. The refugees are emotionally delicate hence must work with persons who are empathetic, professional and knowledgeable in treatment mechanisms. The therapies take time. Accordingly, therapists must establish a healthy relationship and rapport for effective treatment.

Challenges in Delivering Appropriate Nursing Care

Mental health treatment in the refugee population is facing challenges. The problems affect the effectiveness of the treatment process. Inadequate finances is one of the problems. Therapy is usually expensive hence challenges in financial support to catter for therapy materials and personnel, the intervention may have a lesser impact. Moreover, there are a few trained therapists in the areas of trauma counselling. The refugee population has special needs. Effective treatment is only possible through engaging, relevant qualified personnel. The treatment environment is sometimes not favourable due to inadequate privacy for counselling. Since the refugees have limited space, getting enough personal space is barely impossible. Therefore, fewer clients are willing to undego through therapy sessions under this conditions.

Recommendations

Since the refugee problem is part and parcel of today's occurrence, the UNHCR should put in place measures to lessen the suffering of refugees in their new countries. These include influencing governments to hasten the process of processing asylum approvals. Since with residency status, the immigrants can have access to employment and other independent development opportunities.

The UNHCR should ensure that there is ad...