The first rule of refugee mental health is that you don’t talk about refugee mental health.
Sue Johnston calls it “the M word” and says, “If you say ‘mental health,’ what they hear is mental illness.”
Johnston was hired a year ago by the Minnesota Council of Churches for a three-year project to identify, expand and develop mental health services that are accessible to refugee communities. She outlines some of the factors in this presentation “Toward a Multicultural Understanding of Mental Health.” (PDF)
An estimated one-third to one-half of refugees in Minnesota are recovering from traumatic experiences, but terms like post-traumatic stress disorder and depression can carry a stigma, making people less likely to seek the help they need.
Instead, Johnston says, “we try to focus on symptoms, like ‘thinking too much,’ or ‘difficulty sleeping.’ Symptoms seem to be a common language across cultures.”
Even torture victims may perceive that psychologists are only for “crazy people,” she’s found, and that can lead them to believe that if they seek any kind of help, it means they’re crazy.
Part of it is cultural; the United States has a nuanced mental health system with a variety of support groups and therapy options, but for some people, institutionalization is the only form of mental health treatment they’ve ever heard of.
But you don’t have to be from another country to be wary of psychologists and therapists.
“I think there’s a good number of people in our culture,” Johnston says, “who feel the same way as the refugee: ‘Are you kidding me? I’m not talking to a stranger about my intimate problems.’ “
Fortunately, talking about traumatic events is not the only way to address them. “There are many ways to heal from emotional and physical wounds,” Johnston says. “Interacting with each other. Decreasing isolation. Doing activities that are healing activities, like gardening, like physical exercise, like dance, like the arts.”
She wants to work with traditional healers from different communities and seek out ways to collaborate. “In the next year or two, we’ll be trying to figure that out — how do we find these healers and how do we reach out to them,” Johnston says. Religious leaders will be invited to participate as well.
Another solution is to bring services to places where refugees already go.
“One idea we talked about was placing healers at the African food shelf. It not only makes it easier for people to get to, but it also desensitizes people’s anxieties around mental health professionals and lets them learn what services they have to offer.”
The project is still in the early stages, but the plan is to identify culturally appropriate resources that are already out there, help existing services become more accessible to refugee communities and brainstorm ways to fill in the gaps.
“As we’re talking to people about the grief or anxiety that they feel, or their inability to feel safe, we have to help them understand that they’re not crazy,” Johnston says. “If you’ve lived in a war zone, if you’ve been ripped away from your community or your home, that’s a normal human response.”