A Seattle counselor’s perception of refugee mental health
by Erin Flemming, Megan Manning, Alisa Reznick, Azusa Uchikura
You just fled to Seattle from Syria. You saw your friends and family killed before your eyes. You can’t sleep, you can’t eat, you cry often. The “logical” conclusion is that you have depression, post traumatic stress disorder (PTSD) or some other mental health issue.
Your culture doesn’t acknowledge mental health disorders.
Beth Farmer from the International Counseling and Community Service (ICCS) works with refugees in the Seattle area, many of whom are in situations where cultural differences make it more difficult to provide mental health support for refugee families.
“If your language doesn’t really have words for depression or if the word for depression equals ‘crazy’… or people don’t understand what counseling is because there’s no infrastructure,” she said. “You kind of have to explain to people what you’re doing in a non-stigmatizing, kind of normalizing way, kind of building a cultural bridge.”
Farmer added that she needs to understand where her patients are coming from. She said the patients she sees don’t necessarily have the same definition of the mental health system as the U.S.
“You may … have a psych hospital,” Farmer explained, “It could be a very decrepit horrible place that people go to when they’re severely mentally ill and they may never get out. And if that’s your frame of reference, then talking about mental health is going to be pretty scary. “
Symptoms, rather than diagnoses
Farmer said for the refugees she works with, it often helps to talk in terms of symptoms instead of diagnoses.
Symptoms like lack of sleep, lack of appetite and crying are easier to recognize and assess regardless of what a person’s cultural background is.
“The barriers to accepting services are dramatically reduced because people can say ‘yes, I am having nightmares,” Farmer said.
Though it’s ideal to come to an agreement before treatment of a mental health disorder begins, Farmer says that there are situations when that can’t happen.
Farmer said she has come across situations where her patients needed to be institutionalized against family members’ will. Farmer said this is especially difficult because these families want to care for the patients themselves.
Seattle and refugee mental health
Though refugee mental health treatment can be challenging, Farmer believes that King County is especially progressive in incorporating mental health of refugees in their broader health evaluation process.
The ICCS is a program through the Lutheran Community Services that specializes in immigrant and refugee counseling services in the greater Seattle area. There are also other organizations in Seattle like the Asian Counseling and Referral Service or the Jewish Family Service of Seattle, which all have programs that specializes in refugee and immigrant mental health support.
However, Farmer said these resources were not always around.
“I do think there’s more stigma in a lot of other countries for sure,” she said, “[but] I think there’s still quite a lot of stigma in [the U.S.] about being mentally ill, maybe not so much on depression but certainly with more … persistent severe mental illness.”
She adds that the stigma toward mental illness, which is common among refugee populations, is understandable.
“The stigma in this country was even higher when the mental health infrastructure was more punitive, was scarier and when people didn’t understand the causes of … mental health and mental health issues,” she explained.
To Farmer, bridging the understanding and cultural differences is the key to treating mental illnesses among refugees. It’s important to set aside what is “logical” or “obvious” to somebody as an American or trained professional and to know the patient’s mindset.
“I would love our broader community to see the refugees in our neighborhoods not as victims, but as survivors,” Farmer wrote in an email. “People who are eager to get an education, work, give to their communities, and raise strong families.”
Spreading the understanding of mental and global health
Mental health is a big component of global health in general. It will be one of a wide range of general global health topics, which will be discussed at the ninth annual Western Regional International Health Conference, hosted by the University of Washington.
For Registration: www.brownpapertickets.com/event/209976