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UNC study: Resettled refugees eager to receive mental health services

A UNC pilot study has found that many newly arriving refugees who resettle in Durham and Orange counties are in need of mental health services and are eager to get that help. Those are the findings from the School of Social Work’s “Refugee Mental Health and Wellness Initiative,” a collaborative project launched last year with the nonprofit Church World Service in Durham and the U.S. Committee for Refugees and Immigrants.

Josh Hinson, a social work clinical instructor, helped develop and lead the study, which focused on the use of mental health screenings to assess the needs of resettled refugees and efforts to connect them to services. Albert Thrower, a second year MSW student, and first-year students, Allison Hill and Erin Magee, assisted with the mental health screenings and provided services, while Laura Garlock, a first-year student, helped analyze the project’s findings. The study was funded by a $14,000 grant from the School’s Armfield-Reeves Innovation Fund.

“I think what surprised us the most is that the vast majority of the refugees who were offered the opportunity wanted to participate in the mental health screenings,” said Hinson, who along with his study team, presented the findings in late March to a group of about 30 people, including area refugee service providers and to providers via video conference from Texas, Ohio, and Virginia.
“And while we didn’t hear a lot of trauma stories, the majority of the need we heard was around the need for social support and help with daily stressors, such as help with finding a job or help with transportation or help with paying rent and things that come with settling into the country.”

About 70,000 refugees resettled in the United States last year. Roughly 2,200 were placed in North Carolina in 2012, 11 percent of whom resettled in Durham and Orange counties. The federal government generally contracts with public and private agencies to offer basic services, such as assistance with finding housing and employment. But few regularly provide mental health screenings, though research has shown that refugees experience high rates of mental illness, Hinson said.

For the UNC study, Hinson’s research team relied on a two-page questionnaire to gauge refugees’ physical health and emotional needs. The survey covered a range of topics and asked participants to rate on a scale the degree to which presented symptoms had been bothersome over the past month. For example, participants were asked about “feeling helpless; feeling down, sad or blue; suddenly scared for no reason; and nervousness or shakiness inside.”

According to the study’s findings, Church World Service referred a total of 77 refugees for mental health screenings; 86.4 percent agreed to participate in the pilot project. All total, the study team successfully screened 51 clients. Most were between the ages of 20 to 40, male, and from the countries of Sudan, Iraq, and Burma.

Hinson said the majority of those screened “were over the threshold for needing services,” and were offered individual and group therapy treatments. About a quarter of those screened declined treatment, while 35 percent chose individual therapy; 17 percent chose group therapy and 21 percent chose both treatments. All total, 50 psychotherapy sessions and 13 group treatment sessions were conducted.

“Individual therapy included a complete biopsychosocial assessment and just trying to get as much history as possible about the individual’s health and needs,” Hinson said. “And then students tried to approach the needs of the refugees with cognitive behavioral therapy. We also looked at narrative counseling and motivational interviewing, but none seemed to be entirely satisfactory with the refugees.”

Group therapy, which was conducted over eight weeks, focused on topics, including goals and dreams, the mind and body connection, and creating a community of wellness.
“It was a very holistic approach, recognizing and normalizing the refugee experience of culture shock and displacement and talking about mental health and also connecting it to physical well-being,” Magee explained during the group presentation.

Although the refugees were enthusiastic about the offer of mental health services, many had different ideas about what those services should look like, suggesting that a one-size-fits-all model will not work, said Thrower.

“The importance of shaping mental health services to suit our clients’ needs cannot be overstated,” Thrower said during the group’s presentation. “That’s my personal big takeaway from this—this idea of constantly growing and constantly learning and constantly adjusting what I’m doing to meet the needs of my clients, which is huge with this population. It’s been an ongoing lesson in cultural humility for sure.”

Long-term, Hinson said he and project collaborators are already exploring ways to continue to serve refugees identified for services through the study. He also hopes to secure additional funding to conduct further research, an effort that could influence the availability of mental health screenings for refugees nationwide.

“Our hope is that continuing this research will help us to more conclusively determine the costs and benefits of providing mental health services,” Hinson said, “and that that research could be a tool for policy advocacy.”

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, at (919) 962-6469 or

Also see:

UNC Global Transmigration Refugee Wellness Initiative website