Monday, August 12, 2013

Health in all Dimensions

Caring for Health Beyond the Physical: Mental Health of Refugees
The second week of July, the Arizona Daily Star ran a story highlighting a recent study looking at the mental health of Bhutanese refugees from a variety of states across the country. Researchers administered a standard mental health test to all Bhutanese refugees in its sample, which spanned the states of Arizona, Georgia, New York, and Texas, and found signs of depression and other mental illnesses to be prevalent within the population. It concluded that there could be a “high burden” of undiagnosed mental illness among the Bhutanese refugees resettled in the United States[1]. This study serves to analyze a noted trend of suicide within the U.S. Bhutanese refugee population. U.S. Department of Health and Human services reported 16 suicides among approximately 57,000 Bhutanese refugees who settled in the United States since 2008, according to the Arizona Daily Star article.
The mental health of refugees has been a rising concern and focus of studies in recent years. One study published in the Journal of Immigrant Minority Health in 2012 examined food security of Cambodian refugees, who were two decades resettled in Lowell, Massachusetts, as it related to depression and acculturation. Their findings demonstrated that those of food insecure households were more likely to be depressed, to be low-income, and to be less acculturated than those of higher food security[2]. From this, they concluded that high depression and stress within the population could be contributing to low food security and that low income could be contributing to both depression and low food security. The relationship found between depression and food security was not clear with which might be influencing which, so there is also the possibility of low food security leading to the depression and stress seen within the population.
While these two studies are community specific and do not necessarily depict a perfect, complete picture of the present refugee communities in Tucson, they do hold many truths about the refugee experience in general. For this reason, they can be drawn upon to highlight some needs within the refugee community. The Arizona Daily Star article echoed the voice of the study it quoted and called for prioritizing mental health among the services provided to refugees. They even suggested that social-support and mental-health components be added in along side the job and language training.
The services provided to refugees upon arrival generally focus on their physical health and their new cultural surroundings. There is not an extensive focus on the mental health of the refugees. As members of a community that works with and alongside refugees, we have a role in addressing this need. This role could vary from donating time for social support to recognizing certain warning signs of mental illness and depression. The International Rescue Committee (IRC) is one community organization that targets this issue through their Center for Well Being here in Pima County. Their services include behavioral health, support for survivors of torture, and refugee well-being programs. Case management, counseling, and group therapy are available to address physical and mental hardships encountered as a refugee resettling to a new country, and both western and non-western traditions are used in the treatment of physical and psychological illnesses. Furthermore, they accept and follow-up on referrals from volunteers and agencies that work with refugees.
Additionally, due to the circumstances of refugees’ resettlement and process of resettlement as a whole, refugees remain vulnerable to both economic hardships and poor health outcomes long after resettlement in the United States. For this reason, the food security study called for more funding and promotion of programs that “target reach” refugees beyond the resettlement process, as many refugees continue facing economic and mental-health hardships that can contribute to food insecurity as well as other chronic diseases.
Iskashitaa Refugee Network’s programs extends beyond the beginning of resettlement and target hunger and food security as one primary goal. Buying food from a grocery store is a normative task for many Americans, but for refugees struggling to learn the language and cultural customs of the United States, it can be a challenge. It can also cause a great economic burden when it is considered on top of expenses like rent and utilities. By redistributing community grown food to refugees, Iskashitaa helps to alleviate the financial burdens they might be encountering and to provide fresh fruit and vegetables that are often the most difficult to come by due to their cost and absence in the food banks and pantries, which might act as a primary source of food for the refugees in need. As a member of the community, you can spread the word about programs, like Ishashitaa, where refugees can get donation to fill their needs. An extensive list of local food banks and pantries can be found on the Iskashitaa website. The largest barrier to the utilization of these resources is the knowledge of their existence. If refugees are not aware that such these resource or program exists, then there is no way they can use them. Raising awareness of and supporting such programs can help to alleviate some of the financial and emotional stresses of the resettlement experience.
The experiences of the refugees are often far beyond what many others might ever endure in their life. Refugees are a resilient demographic whose strength and endurance shows in all aspects of their lives. Nonetheless, there can be lasting mental effects as a result of such hardships. Mental health is an incredibly personal affair, but, nonetheless, the resources must first be made available and known. Early diagnoses and culturally appropriate resources available for the full span of their lives could make a huge difference in the lives of refugees across the United States and the world.

Miranda Jennings, Nutritional Studies Intern

[1] “Suicide of refugees from Bhutan studied,” Arizona Daily Star, July 8, 2013
An electronic, follow-up article was published July 13th on the Arizona Daily Star website
[2] Jerusha Nelson Peterman et al.,  “Food Insecurity Among Cambodian Refugee Women Two Decades Post Resettlement,” J Immigrant Minority Health 15, (2013): 372-380