What does mental health have to do with inclusion?
Good mental health is legally recognized as a right of all people but not everyone is able to exercise and enjoy it to the same extent. While up to 40% of resettled adults and more than 50% of resettled children and adolescents show signs of depression, their access to mental health services is often hindered because of their circumstances.
Lizzy Grosvenor, a Social Psychology Masters student and project intern at Give Something Back to Berlin, attended a study session recently called ‘Managing mental health as a refugee, asylum seeker and migrant’. The goal of the training was to increase mental health literacy of refugee and migrant youth and people working with them. We asked Lizzy to tell us about this crucial yet rarely discussed topic.
AN INTERVIEW BY BÖBE BARSI
Communications and Partnerships Officer
To paint a clear picture of the challenges that refugees and migrants face in terms of their mental health, we should first understand what exactly the right to mental health means.
Access to health is a basic human right for all, as distinguished by the United Nations Charter of 1961. The Office of the UN High Commissioner of Human Rights claims there is no health without mental health, and good mental health is much more than simply the absence of a mental impairment. It means positive emotions, engagement, positive relationships, meaning and accomplishment, as positive psychology defines it. So good mental health is legally recognized as a right of all people regardless of migration background or legal status.
However, to say that everyone belonging to society is able to exercise and enjoy this right would be a great leap of faith. Many factors may hinder a person’s ability to access good, culturally competent and comprehensive mental health care and services, which is the biggest obstacle to obtaining good mental health. And, as is often the case, minority populations endure the most obstacles in the face of these supposedly established human rights.
So we all enjoy this right, but people need some level of mental health literacy to be able to fully exercise it. Do refugees, asylum seekers and migrants need a higher level or different kind of literacy than people without a migrant background?
Mental health literacy, in my opinion, is in need of great improvement even beyond these groups. Discussions around mental health are still quite stigmatized whether because of traditional cultural beliefs, social norms or simply from an ignorance of the masses. I feel that all people must work toward a higher level of literacy, however most services and care around this concept are deeply rooted in Western medicine and rhetoric.
When discussing the mental health literacy of these potentially vulnerable populations, we need to recognize the importance of what I’ll call “Cultural compromise”.
Mental health care providers must work to meet individuals in a middle ground and develop a genuine awareness that cultures label and manage mental health in various, perhaps extremely different ways.
We must find a way to address issues and improve mental health while not imposing, assuming or discriminating different perspectives.
Are the main challenges regarding their mental health different for migrants and refugees?
While certain issues are experienced by both groups, they’re experienced to different degrees. What often distinguishes migrants from refugees is intent or motivation for migration. Refugees do not voluntarily migrate, and often are forced into places which they could not prepare to encounter. They face language barriers, multiple levels of harmful bureaucracy, social exclusion and can potentially carry deep rooted psychological traumas from their journey. While these issues may also be present for migrants, the weight of the migration experience may not weigh as heavy on them, or leave quite as many scars.
How does mental health affect inclusion processes?
A study from 2008 found rates of PTSD and major depression of up to 40% of resettled adults, and from 50-90% of resettled children and adolescents. I find this horrifying. This is not to say that all resettled people are traumatized or vulnerable but the migration and resettlement experience does pose significant risk to the accumulation of traumas.
Research claims the experience of such trauma can inhibit our 5 core adaptive systems; attachment, justice, identity, role and existential meaning. These systems are essential in the process of integration and can inhibit not only an individual’s well-being, but their trust and participation in society. Without trust or participation, inclusion would be a bit more than tricky.
Without proper attention, evaluation and treatment mental health can impair all migration processes.
I believe inclusion processes have much work to do in regards to acknowledging the importance of mental health.
What are the main difficulties these two groups experience when it comes to mental health care and services?
I believe the most significant issue faced by both populations is access. Access to mental health can be understood in 5 dimensions; approachability, acceptability, availability, affordability and appropriateness. Each of these dimensions illustrate the different difficulties in the journey towards good mental health.
Approachability can be understood as poor access to information on rights, services and costs of services. Acceptability refers to limited cultural competence by mental health care providers. Availability means just as it sounds, not having facilities close to where you live or having difficulty in accessing a facilities’ services due to poor capacity. Affordability, of course, refers to the cost of services. While some countries offer free emergency care, many offer no financial assistance at all. And finally, appropriateness which looks at the relevance of the care given as well as the quality.
What are the biggest challenges on access to mental health support for refugee and migrant youth?
The core challenges for youth do not vary greatly from adults. I believe, again, access to care is the most significant issue for all. However, youth are often coming from systems which made their decisions for them, systems which either accurately or inaccurately diagnosed them. Systems which socialized certain ideas of the importance of or definitions for good mental health.
Youth in migration and resettlement may be unaccompanied, they may be integrated or excluded from education systems, they may take on new, more mature roles in their family structures. However, they may pick up languages quicker, they may access more easily like-minded communities, they may be met with more empathetic health care providers. Again, it is important that host communities acknowledge the various impacts of resettlement experiences, including intergenerational differences.
How can refugees and migrants be enabled to seek support from peers and professionals?
More intercultural dialogue! I believe, and proven from my own experiences, inclusive dialogue is essential. Having more open discussions around what it means to enjoy mental health, understanding what feelings or experiences are not healthy, what habits can be improved, what tools can exist to improve our daily experiences. And more community building! More safe 3rd spaces where these populations can gather, can find solace, companionship, where they can create trustworthy relationships.
Social inclusion is key to developing and sustaining mental health.
Oftentimes in the resettlement experience, migrants and refugees become isolated from larger, sustainable communities. There is not good information shared about spaces they can enjoy, places that accept people from all backgrounds, communities that do not tolerate discrimination and create opportunities for individuals to learn and develop ideas together.
Lizzy Grosvenor and other participants at the study session
‚Managing Mental Health as a Refugee, Asylum Seeker and Migrant‘.
The session was organised by VYRE (Voices of Young Refugees in Europe)
and Euro Youth Mental Health
at the Council of Europe’s Youth Center in Strasbourg.
Are there negative narratives surrounding mental health and refugees and migrants?
Oh, absolutely. I think these negative narratives stem from cultural insensitivity. Host communities or health care providers may be taught to stigmatize these individuals because the rhetoric around mental health is, like I said, developed from Western perspectives.
Throughout the study session, we discussed how the use of terms such as “vulnerable” and “resilient” can actually be quite harmful to these populations. Through calling them vulnerable we risk labeling them as inferior, creating more inequality, adding to the divide. The label of resiliency does not encompass the impact of traumas, the mental health that may stop some from being seen as “resilient”.
How can these narratives be challenged?
Awareness of discriminatory rhetoric, education around cultural sensitivity – but also INCLUSION. Inclusion of refugee, asylum and migrant voices within discussions and decisions made around their access and rights to mental health. More open conversations, more empathy, and more time to spend and learn from and with one another.