Transcript Slides

REFUGEE/ASYLEE MENTAL HEALTH
Yavar Moghimi, M.D.
Clinical Instructor of Psychiatry and Behavioral Sciences, GWU SMHS
Whitman-Walker Health
Palestinian Refugees
Internally Displaced Persons
In Rwanda
Immigrant Detention Center
Asylum Seekers
Illegal Immigrants/Economic Migrants
U.S. Refugee Resettlement Program
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US has accepted more refugees for resettlement
than all other countries combined. The choices of
countries that are targeted for refugee resettlement
are based on geo-political interests in cooperation
with UNHCR
 Office
of Refugee Resettlement (ORR):Health & Human
Services
 Refugee Corps: US Citizenship & Immigration
Services/Dept of Homeland Security
 Bureau of Population, Refugees, and Migration: State
Department
Volunteer Agencies
Asylum & Liminality
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Asylees must demonstrate an unwillingness or
inability to return to his/her home country due to
past persecution or a well-founded fear of future
persecution.
 race,
religion, nationality, political opinion or
membership in a particular social group
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One-Year Filing Deadline
Usually cannot work legally during this time
Immigrant Detention
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Fastest Growing Prison Population in the U.S.
Oftentimes lacking in legal representation
Re-traumatization of torture/incarceration
experiences in home country
On average spend about 10 months in detention
These detention centers are oftentimes a part of
larger prisons/jails with criminal population
Family detention centers becoming more
commonplace
Granted Asylum!
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Security
Possibility of Family Reunion
Permission to Work
Recognition of the legitimacy of
their suffering
New Opportunities
Violence Against Women’s Act
(VAWA)
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Federal legislation passed in 1994 granting
protection to victims of abuse who are not citizens to
obtain lawful status without having to rely on their
abuser for petition
Oftentimes applied for women who are immigrant
female survivors of domestic violence, so that they
are not forced to choose between deportation and
remaining in the abusive relationship upon which
their legal status depends
T & U Visa
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T Visa- Protection to victims of trafficking to assist
law enforcement authorities in the investigation or
prosecution of human trafficking cases
U Visa- Immigration protection to crime victims who
have suffered substantial physical or mental abuse
as a result of the crime
LGBT/HIV Persecution
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Laws against homosexuality in 88 countries in the
world
In 2009 travel ban lifted for HIV+ individuals to
travel to US
R
Russian LGBT propaganda law
Uganda Anti-Homsexuality Act
Torture Victims Relief Act
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Federal funds designated to torture rehabilitation
programs across the U.S. & Internationally
 Northern
Virginia Family Services (D.C.)
 Advocates for Survivors of Torture & Trauma
(Baltimore)
 Harvard Program in Refugee Trauma (Boston)
 Bellevue/NYU Program for Survivors of Torture (NYC)
Essential Elements of Torture
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Severe pain or suffering-physical or psychological
Inflicted intentionally
With a certain purpose (obtain information or a
confession, punish, etc.)
By a person acting in a public/official capacity
Post-torture Syndromes
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PTSD
Anxiety Syndromes
Depression
Psychosis
Insomnia
Substance Abuse
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Chronic Pain
Somatic Disorders
Traumatic Brain Injury
Loss of Function
 Deconditioning
 Physical
Disability
 Emotional Disability
Idioms of Distress/Explanatory Models
of Illness
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Patients do not read the DSM and may express their
symptoms in distinct culturally-bound presentations (e.g.
neurasthenia, calorias)
Exploration of how the patient explains their symptoms
is important to understand what may or may not be
appropriate ways of treating their symptoms
While past traumas may elicit symptoms that are
consistent with DSM-defined PTSD, oftentimes the
concerns of survivors are centered on the lack of
economic and social opportunities available to them in
the present.
Refugees/Asylees and Triple
Traumatization
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Trauma in home country that causes flight
Killings, torture, and other violence
 Persecution and discrimination
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Loss, Departure and Flight
Separation from usual surroundings
 Dangerous, costly, and unpredictable journey
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Demand and Barriers in Receiving Country
Short-term: Distrust and Insecurity
 Long-term: Language/Cultural Barriers, Marginalization,
Discrimination
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Post-traumatic Growth
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The narrative of traumatization does not
adequately capture the refugee/asylee
experience.
Many of those that face persecution in their home
countries willfully risk their lives because of a sense
of injustice in their societies. This may
psychologically prepare them for the consequences
of their actions.
Anthropological Counterparts
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Cultural Bereavement
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Collective Trauma
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The loss of home, material possessions, social networks, and
the sense of social and spiritual belonging and connection to
a land, its symbols and its people
Conditions of extreme stress that destroy a community as a
result of an acute and unexpected assault or through a
chronic, prolonged course
Social Suffering
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Collective and individual human suffering associated with
life conditions shaped by powerful social forces
WHAT ROLE CAN PHYSICIANS
PROVIDE IN HELPING
REFUGEES/ASYLEES?
The Different Hats Medical Providers
Can Wear
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Clinician
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Medical Expert
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Advocate
Clinician
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Screening recent migrants for past exposure to
violence, trauma, torture
Screening for current exile-related social stressors
Referral to appropriate social service/mental
health/legal agencies
Medical Expert
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Writing physical/psychological reports documenting
the effects persecution/torture had on the asylee’s
health, ideally not as the patient’s clinician
 Physician’s
for Human Rights Asylum Network
 GW Human Rights clinic
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Oral testimony in asylum hearing
Documenting the Effects of Torture
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Patient may experience interview as an reenactment of interrogation
Physical exam can be re-experienced as invasive
physical torture experienced previously
May want to schedule interview/exam over several
visits to build trust/rapport first
Advocate
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Torture Abolition and Survivors Support Coalition
Amnesty International
Physicians for Human Rights-Asylum Network
Over 500 immigrant-based organizations in the
Washington DC metro area (e.g. spiritual, cultural
preservation, social services, clinical, etc.)
 Sanctuary
movement that sprouted up to support
Central American “economic migrants”
It takes a village
Employme
nt
Spiritual
Language
Cultural
Social
Services
Medical
Legal
Mental
Health
Local Resources
Torture Abolition and Support Survivors Coalition
(TASSC) www.tassc.org
 Northern Virginia Family Services (NVFS) www.nvfs.org
 Advocates for Survivors of Torture & Trauma (ASTT)
www.astt.org
 Physician’s for Human Rights (PHR) Asylum Network
www.physiciansforhumanrights.org
 Tahrih Justice Center
www.tahirih.org
 DC Center Global
www.thedccenter.org/programs_global.html
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