L5 - Refugees and Mental Health 1

Question 1

What is a refugee?

Answer 1

A person with a well-founded fear of being persecuted in their country, who has fled from it to another country and cannot return (due to fear of persecution).

Question 2

What is an asylum seeker?

Answer 2

Someone who wants to claim refugee status/international protection but has not yet been processed

Question 3

Are refugees and asylum seekers considered the same for psychologists?

Answer 3

No - do not conflate the two

Different mental health challenges, access to support etc.

Question 4

Which group is considered more vulnerable, refugees or asylum seekers

Answer 4

Asylum seekers

Question 5

What% of refugees are under 18 years old?

Answer 5

50%

Question 6

Do refugees have a ‘culture’?

Answer 6

Yes

While they all come from different cultural identities, they have all gone through a similar experience and thus share a common type of culture

Question 7

There are strong links between _________ _____ and mental health in resettlement

Answer 7

pre-migration trauma

Question 8

Persons experiencing the psychological effects of trauma may report feelings of:

Answer 8

Fear

Sadness

Guilt

Anger

Psychosomatic symptoms (e.g. physical complains, heartache, feeling sick)

Question 9

What type of guilt is very strong in refugees?

Answer 9

Survivors Guilt

Question 10

For refugees, trauma related syndromes include:

Answer 10

Significant distress or impaired functioning

Intrusive thoughts and emotions about the traumatic events

Avoidance

Emotional numbing and/or hyper-arousal

Question 11

What diagnosis is most commonly associated with trauma?

Answer 11

Post-traumatic stress disorder (PTSD)

Question 12

PTSD is a common diagnosis for refugees, why has this been criticised?

Answer 12

It was designed for war vets, is it valid for refugees?

Does it pathologise the experience?

How do you define trauma?

Are the assessments we use culturally relevant?

Question 13

What type of trauma is ‘most relevent’ to people who have gone through the refugee experience?

Answer 13

Complex Trauma

Question 14

What is complex trauma?

Answer 14

Ongoing exposure to multiple events leading to diverse impacts and manifestation of psychological distress

Question 15

What type of events does complex trauma typically occur from

4 things

Answer 15

1. prolonged or repetitive
2. involve harm, neglect or abandonment by adults
3. occur during developmentally vulnerable times
4. have the potential to negatively impact a child’s development (Courtois & Ford, 2009)

Question 16

What impact does trauma have on childhood development?

Answer 16

negative impact

Question 17

What is cultural and social bereavement and what effect does it have on refugees?

Answer 17

• *Cultural:** Loss of ability to participate in particular rituals, etc.
• *Social:** Loss of social connections that provided support (elders, etc.)

Negative impact on mental health and wellbeing

Particularly salient for younger children who frequently define themselves
in relation to ethnic identity as part of a particularly social group

Question 18

What factors influenced psychologists to consider complex trauma to be a better measure than PTSD for refugees?

3 things

Answer 18

1. Rates of PTSD differ along cultural lines
2. Peoples from different cultures exhibit different symptoms of trauma (culture may influence how they express trauma)
3. Trauma can be ‘transmitted’ and can be intergenerational

Question 19

For children who suffer from complex trauma due to being exposed to traumatic events they suffer from a variety of ongoing issues, including (4 things)

Answer 19

Higher incidence of mental health disorders into adulthood

Difficulty with peer relationships

Insecure attachment

Chronic physical illness

Question 20

How might children of parents who have been psychologically traumatised by the refugee experience be affected?

Answer 20

Attachment issues

Children may learn cognitive patterns that relate to psychological distress

Question 21

All cultures exhibit the same level of risk for developing complex trauma

True or false

Answer 21

False

some cultures are more at risk

could be due to cultural norms around emotional displays

Question 22

What are the 3 main symptoms that unaccompanied minors that were refugees (10-18y/o) suffer from post-settlement?

3 things

Answer 22

1. Anxiety
   * (e.g. fear, loneliness, difficulty adjusting to foster family, fears betraying biological family)*
2. Survivors Guilt
   * (serioues problem, feelings of not deserving to be alive, happens if difficulty organizing family reunification)*
3. ‘Behavioural Problems’

(resenting being treated like a child after caring for themselves)

Question 23

Pre-migration experiences are always traumatic and lead to psychological trauma

True or False

Answer 23

False

They are not necessarily traumatic and may not necessarily lead to trauma

Refugee populations are diverse and many report feelings of resilience and gaining strength from their experiences and through their cultural identity.

Question 24

In premigration, there are multiple risk factors that most refugees are exposed to that lead to cumulative risk for developing complex trauma

What are some of these factors?

Answer 24

Displacement
• Violence
• Rape & sexual assault
• Loss of loved ones
• Loss of support structures
• Torture
• Lack of control over own life
• Little education
• Poverty

Question 25

What are the unique challenges **post-migration** that refugees face?

Answer 25

**Financial concerns -** such as housing * *Language difficulties =** such as difficulty learning English * •(Especially refugee women in charge of looking after large families with young children)* * *No previous education and/or previous education/professions not recognised** * *Mental health issues -** stemming from experiences of trauma * *The break-up of families**, including extended family support networks * *‘Adapting’ to a new culture -** with different norms and expectations **Experiences of racism -** stemming from media portrayals, stereotypes and negative community sentiment

Question 26

What are the **three theoretical frameworks** that are used to understand refugees mental health?

Answer 26

1. Social Determinants of Health 2. Trauma-informed understandings 3. Acculturation and acculturative stress

Question 27

What is the **social determinants of health** theory for refugee health?

Answer 27

**The social conditions in which people are born, live and work** are **more predictive of peoples health outcomes** than individual factors *e.g. if you are born to parents who are poor and live in a lower class area, then these factors predict your physical health and length of life*

Question 28

What are the **5 factors** that influence your health and lifespan according to the **social determinants of health**

Answer 28

1. Neighbourhood and Built Environment 2. Health and Health Care 3. Social and Community Context 4. Education 5. Economic Stability

Question 29

Explain the theoretical framework of **trauma-informed understandings**

Answer 29

In order to treat refugee mental health we need to have: Awareness of extent to which psychological presentation/behaviours are impacted by trauma Awareness of extensive impact of trauma on wellbeing Awareness of impact of trauma on help-seeking

Question 30

Explain the theoretical framework of **Acculturation** (or **Berry's Acculturation Model)**

Answer 30

Generally, **integration** to the new culture is considered to lead to best outcomes ## Footnote *But needs to be a two-way interaction*

Question 31

Name and explain the 4 types of acculturation in **Berry's Acculturation Model**

Answer 31

Question 32

The numebr of traumatic events increases the likelihood of psychological distress/trauma post-settlement. What impact does **detention** have on this?

Answer 32

Detention exacerbates the impacts of other traumas * for suicidal behaviours of people in detention* * men are 41x higher than average* * women 26x higher than average*

Question 33

What are unique challenges refugees face with **service provision** in regards to mental health *4 things*

Answer 33

**1. "Health literacy" and available services** *(people may not want to seek help, or know where to go)* **2. Mental health help-seeking may not be a priority** *(they report other problems first such as family break up, financial hardship before mental health)* **3. Trust** *(refugee youth report lack of trust towards councellors and mental health workers)* **4. Stigma** *(there is a stigma towards mental health in many refugee cultures)*