October 10, 2016; Nature
More than 1.4 million migrants applied for asylum in the European Union (EU) in late 2015 and early 2016. Most of these people are fleeing from armed conflict and persecution in Syria, Afghanistan, and Iraq. The struggles and plights of this growing refugee stock continue to be subjected to fiery policy debates. Countries often struggle to accommodate and integrate them. It is a growing tragedy NPQ discusses regularly.
In tribute to October 10th’s World Mental Health Day, we now bring your attention to another pressing issue in the refugee crisis. Picture a train station in Sweden, with crowds of “lost looking young people milling around the concourse, in clothes too flimsy for the freezing air.” Amongst them are asylum seekers volunteering to take part in research on post-traumatic stress disorder (PTSD) at Stockholm’s Karolinska Institute. Clinical psychologist Emily Holmes works with these vulnerable people. She is one of the growing number of European researchers working to draw more attention to “the enormous burden of mental health disorders in migrants and refugees.”
The Nature article cites that refugees have a 66 percent higher incidence of schizophrenia and other psychotic disorders compared to other migrants. More than 60 percent of adults (and 40 percent of children) have witnessed violence. Sixty percent of adults (and 25 percent of children) report having seen dead bodies. Almost 60 percent of adults (almost 20 percent of children) have been victims of violence. More than 40 percent of adult refugees have experienced torture. Almost 40 percent (about 25 percent of children) experienced natural disasters, war (a slightly higher percentage for children), and imprisonment. Slightly more than 20 percent have experienced rape (a small percentage of children as well). Although “very few with mental health problems become violent, regardless of their origins,” enhanced mental health services can serve as a proactive policy and humanitarian measure.
Referring to what he calls a “public-health tragedy” left unrecognized, clinical psychologist Thomas Ebert from the University of Konstanz, Germany, observes that “more than half of those who arrived in Germany last year showed signs of mental disorder, and a quarter of them have a PTSD, anxiety or depression that won’t get better without help.” He explains that such help comes from developing effective, inexpensive therapies that can be deployed fairly quickly amongst migrant populations. Doing so not only provides valuable services to refugees and other displaced people, but supports policy makers striving towards enhanced integration efforts. According to Elbert, “it is illusory to think that people can learn a new language and find work when they can’t function properly mentally. If we want quick integration, we need an immediate plan for mental health.”
“The latter post-migration phase is becoming increasingly important” with regards to understanding refugees’ trauma and stress. Dr. Malek Bajbouj, an Arabic-speaking psychiatrist of Syrian descent at Berlin’s Charité University Hospital opened a first-of-its-kind clearing center for refugees with mental health problems in Germany. Already 1500 people suffering from ongoing frustrations regarding the loss of control and social standings in their lives have passed through the doors of the former hospital building in the center of Berlin. The biggest challenge is to serve them in the most cost-effective and efficient ways possible. Researchers and medical professionals are searching for pragmatic solutions.
An approach called narrative exposure therapy (NET) involves training laypeople who share common language and cultural backgrounds with asylum seekers. They can then work as counselors for refugees with mental health disorders. Maggie Schauer (clinical psychologist at the University of Konstanz, and both wife and colleague of Elbert) is developing this approach with Elbert based on the results of a prior clinical trial on child soldiers in Uganda. While the German federal government deals with regulatory resistance from professional associations against psychotherapy assistance lacking academic qualifications, the local state government is providing support for the project in an amount equivalent to $112,000 “to test whether NET works as well on refugees in Germany as it has in war-torn countries.” With additional support from the Google foundation, Elbert’s colleague, clinical psychologist Sarah Ayoughi (of the social-care organization IPSO) is arranging for additional trainings of laypeople in Erfurt, Germany. Ayoughi has the experience to train such laypeople in psychotherapy, much in the same way she did during a clinical trial involving physicians with no psychotherapy background in northern Afghanistan. The Afghan trial indicated that treated refugees’ depression and anxiety symptoms improved for up to three months after just 5–8 training sessions.
Bajbouj believes that “the political desire to get refugees into the workforce fast may end up easing the way for more relaxed rules about psychotherapy.” Meantime, other researchers in Europe encourage similar projects. Much like Dr. Jean-Paul Selten’s research at the Netherland’s Maastricht University, Dr. Meyer-Lindenberg from the Mannheim Central Institute for Mental Health is applying research into the “poisonous nature of social stress.” Meyer-Lindberg was awarded a grant from the German state of Baden-Württemberg that evaluates the social stress patterns, and promotes the social inclusion of refugees using smartphones. The proposed solution is innovative and cost-efficient. On a similar note, Dr. Bajbouj is working on an Arabic version of the smartphone app PTSD Coach. In Sweden, Holmes is also looking to technology to explore how video games on smartphones can subdue refugees’ PTSD flashbacks. Holmes says that “the important thing now is to develop simple new approaches to therapy that can be scaled up, and to prove that they help.” Pragmatic, and inspiring indeed.—Noreen Ohlrich