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Helping refugees who need mental health assistance

By Susan White

For years, refugees who have resettled throughout the United States have received temporary basic services, such as assistance in finding a job and new home, to help them quickly adjust to life in a new country. But are these services enough? Could these newcomers also potentially need mental health assistance?

Josh Hinson, a clinical instructor at UNC’s School of Social Work, aims to tackle that question with the “Refugee Mental Health and Wellness Initiative,” a pilot study that explores the mental health needs of newly arrived refugees in North Carolina. Hinson received a $14,000 grant from the School’s Armfield-Reeves Innovation Fund to launch the project.

The pilot study will focus on mental health screenings in Orange and Durham counties, where about 11 percent of the 2,200 refugees who arrived in the state last year resettled. The federal government designates who qualifies for refugee status. Individuals fleeing persecution from their homelands or other dangers are generally approved to enter the United States, and a set number of refugees are granted permission to do just that each year. About 70,000 refugees are expected to resettle in this country in 2013.

Many of North Carolina’s newcomers are Karen refugees from Southeast Asia. But the state also continues to see an increase in individuals from Somalia, the Sudan, Iraq, the Central African Republic and the Democratic Republic of the Congo, Hinson said. Although the refugees arrive for different reasons, they share at least some similarities, he said.

“By nature of having received the refugee designation, they have suffered some sort of trauma,” he said. “In fact, nationally, refugees are some of the most traumatized people in the world. And yet, rarely in the resettlement process are they screened for mental health.”

However, research has shown, that many refugees “experience high rates of stress-related disorders, including chronic physical illnesses, mental illnesses, and substance abuse,” Hinson explained.

“They come here, and they are in a new community and away from their own homes, and they may be separated from their family, friends and culture,” he said. “And while they come in with a safety net, generally that’s all taken away within six months, and then they’re on their own. Essentially, they are expected to assimilate.”

Hinson’s pilot study aims to pinpoint the extent and severity of refugees’ mental health needs and to connect individuals to services. Albert Thrower, a second year MSW student, and first-year students, Allison Hill and Erin Magee, are assisting with the mental health screenings.

Laura Garlock, a first-year student, will help to analyze the project’s findings.

The project staff is working closely with UNC’s Refugee Health Initiative and the national nonprofit Church World Service to identify at least 80 clients interested in participating in the screenings. The study relies on a brief questionnaire that has been used widely among resettlement agencies around the country to gauge refugees’ physical health. The survey covers a range of topics, asking participants to rate experiences with, for example, symptoms such as muscle, bone, and joint pain.

“Other questions ask things like, ‘If over the last month, have you been feeling down, sad or blue,’ or ‘if you have done too much thinking or had too many thoughts,’ ” Hinson added.

Although the questionnaires have been translated into numerous languages, translators are available if needed, he said.

Hinson’s student staff will offer services, such as individual or family therapy or psychiatric case management to individuals showing signs of distress or who score at a level indicating a mental health problem.

“If it’s clear that they have a severe mental illness, then we look into a psychiatric evaluation, and we will do case management around that,” Hinson noted.

Because of the stigma of mental illness, especially in some cultures, Hinson said he was initially worried about getting some refugees to participate in the project. But so far, none have shown any reluctance.

“Everybody who has been screened has said, ‘Yes, I’d like services,” he said. “There was even an Iraqi man who told one of our students, ‘Yeah, I want to talk to somebody because nobody has ever asked me how I feel.”

Such a response reassures Hinson of the value of the project, which, he added, probably would not have launched without the Armfield-Reeves support. Long-term, he hopes the study’s findings will lead to more concrete critical services for refugees.

“It’s obviously something the community needs—both refugees and providers alike.”

For more information about the Armfield-Reeves Innovation Fund, other fundraising priorities or the impact of private giving at the School of Social Work, please contact Mary Beth Hernandez, associate dean for advancement,