Download mental health in mn refugee populations

WHAT DO WE KNOW?
MENTAL HEALTH IN MN REFUGEE
POPULATIONS
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
FINDINGS:

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

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



Specialty clinics:





Transportation
Interpreter services
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.)