A file study of refugee children referred to specialized mental health care: from an individual diagnostic to an ecological perspective

Abstract

The past years have been characterized by a large refugee crisis across the globe. The exposure to preflight, flight, and resettlement stressors puts refugee children and their families at risk of developing emotional and behavioral disorders. A unique Western-based approach of mental health problems seems to be insufficient to address the complexity of interactions between individual vulnerabilities and more ecological surrounding systems. We looked into (1) the reasons for referral; and (2) the process diagnostic outcomes after ethnopsychiatric and psychological assessment. We conducted a thematic content analysis on 93 files of refugee children. The findings suggest that mental health care professionals need to hold into account the multiplicity and intertwining of ongoing challenges to the well-being of refugee children. The integration of a Western-based psychiatric assessment with a more ecologically based view can lead to a more culturally sensitive approach in refugee children and their families. This way, both under- and overdiagnosis of psychiatric disorders could be avoided to further optimalise mental health care in this population.

The health status of newly arrived asylum-seeking minors in Denmark: a nationwide register-based study

“…More than two of every five minors showed need of immediate support as assessed by 'The Child Scale', and one of every four produced at least one abnormal finding in the doctors' physical examination. The presented findings from our research are in line with those previously reported (Lustig et al 2004;Fazel et al 2005;Masmas et al 2008;Bischoff et al 2009;Montgomery 2011;Spallek et al 2011;Reed et al 2012;Julia Lindgren et al 2012;Hebebrand et al 2016;Reza et al 2016;Villanueva O'Driscoll et al 2017). Separation from or loss of the father was more common than separation from the mother.…”

Prevalence of mental disorders in young refugees and asylum seekers in European Countries: a systematic review

“…From a clinical perspective, the studies comprised individuals from diverse social and cultural backgrounds residing in different host countries with varying legal and official support systems and asylum polices. It has recently been shown that the Western-based approach to psychiatric assessment simplifies the complex issue of migration [94].…”

“…For therapeutic actions, facilitating an easier access to mental and physical health services may be essential by adapting to the refugees’ help-seeking behaviour, offering practical support and using interpreters [100–102]. Western-based approaches of care should shift to a more ecological culturally sensitive approach, accounting for the complexity of mental distress of refugee and asylum-seeking children and adolescents [94]. Effective core strategies for psychotherapeutic interventions with refugee minors are developing coping strategies, improving self-esteem, and rebuilding identity [103].…”

The Relationship Among Trauma, Acculturation, and Mental Health Symptoms in Somali Refugees

“…Even with such a large population, they continue to face barriers accessing culturally competent primary and mental healthcare, one being the shortage of trained mental health practitioners with refugee specific cultural competencies. Refugees also describe individual psychotherapy as uncomfortable, especially when bilingual and bicultural mental health staff are unavailable (Bemak & Chung, 2017;O'Driscoll et al, 2017). Research on Somali mental health beliefs and expression is limited but necessary to inform best practices for mental health services.…”