Addressing the Mental Health of Displaced People

Almost 71 million people around the world have been forcibly displaced due to persecution, conflict, violence, or human rights violations. The scale of the issue means that globally, one in every 108 people is either an asylum-seeker, a refugee, or internally displaced. The trauma of leaving a home, community, work and often both friends and family, understandably often leads to significant distress, yet once gone, they undergo often dangerous journeys to reach safety.

For example, according to research based on experiences of refugees fleeing to Libya by UNCHR, for many, the journey was characterised by horrific abuses including random killings, torture, forced labour and beatings whereby 31% of respondents who arrived in 2018 witnessed or survived violence. Yet on arrival in the host country, migrants then have to adapt to a new environment, often with a new language and a different majority culture, whilst also dealing with concerns about the fate of their loved ones. They also often struggle with stressful, bureaucratic requirements for obtaining permission to stay in a new country, the potential threat of deportation or detention and long waiting times until their status is determined.

As a result, the sustained mental strain a displaced person is under is significant - and often leaves deep scars. Research shows that asylum seekers and refugees are more likely to experience poor mental health than the local population, including higher rates of depression, PTSD and other anxiety disorders. For example, studies suggest that asylum seekers are five times more likely to have mental health needs than the general population and more than 61% will experience serious mental distress. However, data shows that they are less likely to receive support than the general population.  

According to the WHO, barriers such as education level and background, inability to speak the local language, the ability to interact with health care professionals or reluctance to admit and issue and seek help - are just some of the reasons preventing refugee or migrants from accessing professional mental health care. In addition, bureaucratic or policy barriers – such as limited entitlement to free care, multiple administrative hurdles that require time, effort and money to jump, or simply a lack of infrastructure in place to match those in need with relevant services – can further distance them from the help they need. “The careless treatment of refugees and migrants we witness along these routes is unacceptable,” said Bram Frouws, Head of the Mixed Migration Centre. “Sadly, the data we provide will not be the last report documenting these violations, but it adds to the mounting evidence base that can no longer be ignored.”

In some cases, steps are being taken to address mental illness among displaced populations. For example, in an UNHCR interview, Falak Selo, previously a philosophy student at the University of Damascus was forced to flee  her neighbourhood when Syria’s civil war reached them 2013. Her mental health was affected, and her resilience and coping strategies were tested to the limit. Having rebuilt her mental strength, she now volunteers as a community worker with the UN Refugee Agency’s mental health and psychosocial support (MHPSS) to offer support to other Syrian migrants, running workshops and counselling sessions that help them process their experiences.

Such programmes are becoming more vital since the onset of the coronavirus pandemic. The UNHCR has confirmed a surge in mental health issues among refugees and forcibly displaced people since the pandemic emerged. It is thought that the sharp rise is because the virus has created elevated levels of anxiety and depression that stem from concern about the loss of income as a result of lockdowns and curfews as opposed to worry about contracting the virus itself. “While many refugees and internally displaced people are remarkably resilient… their capacities to cope are currently being stretched to the limit” said UN High Commissioner for Refugees Filippo Grandi in a statement last month. 

Lockdowns have also prevented psychiatrists and counsellors working for the MHPSS unit from accessing displacement camps forcing many to provide counselling services through helplines and phone consultations. This is where community support workers such as Falak Selo become even more important as they are able to deliver mental health sessions on doorsteps, drawing on their training on psychological first aid. “In our way of living, families tend to gather in front of their houses for chatting and having tea,” explains Falak. “We are targeting these groups of people while ensuring physical distancing between us and them.” Indeed, when even these sessions are impossible, the UNHCR and MHPSS unit has adapted further, collaborating with a radio station based in Domiz 1 camp to set up a special programme every Wednesday where a clinical psychologist from UNHCR shares mental health tips and take calls from listeners to raise awareness of how people can help to manage their own mental health. The UNCHR say this is the only local programme that is dealing with the mental health consequences of the pandemic rather than its threat to public health.

Whilst these programmes are evidence that some progress in enabling displaced people to reach the mental health support they need has been made, greater efforts are needed to strengthen the protection of displaced people the world over, to ensure they are supported throughout these desperate journeys. In a recent report, the World Health Organisation (WHO) outlines four action areas regarding the mental health of refugees and migrants that global policy-makers must address. These include;

1. Promoting Social Integration; According to research from the WHO, social isolation and unemployment is linked with higher prevalence of mental disorders in refugees and migrants. Establishing systems to reduce social isolation allows migrants to form peer groups and communities that can make a tangible difference in reducing stress.
2. Overcoming barriers to access to mental health care; Administrative, structural and social barriers to treatment can lead to further complications of a mental disorder. The WHO suggests it is crucial that communication of the support on offer, who is entitled to it and how to access it, is better communicated to migrants, aid agencies and mental health providers. Provision of such information can help patients to seek treatment, as and when available, and help clinicians to make appropriate referrals.
3. Facilitating engagement with services; Once refugees have accessed mental health services, there are a number of potential barriers to establishing a positive relationship with clinicians and engaging in treatment affecting both the uptake and effectiveness of treatment. Among the barriers to engagement are language difficulties, cultural beliefs and cultural expectations. To ease these issues, the WHO suggests; ensuring availability of interpreters and cultural mediators to translate issues and treatment options, and better access to technology that can help deliver these services where trained people are not available. Technology can also help professionals reach those who are in difficult to reach or dangerous locations, circumnavigate language issues and provide smart diagnosis without delay.
4. Treating displaced people with manifest mental disorders; Most displaced people with mental disorders can be treated with the same approaches commonly provided in the general population. Therefore, existing mental health infrastructure should be able to manage displaced people in need. Work needs to be done to remove the concern about helping displaced people by communicating an agreed approach to managing mental health of displaced populations with a greater level of consistency.

It is important to note that despite the horrors migrants and refugees are forced to suffer as a result of their displacement, according to academic research many displaced people have existing strengths and skills that prevent mental disorders from emerging, or help them to achieve full social integration and become an important resource for their adopted country. But, as the number of displaced people continues to rise, as a result of an increase in climate emergencies and worsening political tensions in some regions, the mental health crisis among displaced people is set to soar. The current pandemic has added fuel to this fire but if policy makers can work together to agree an approach to support displaced people in mental distress, more lives can be saved.