Understanding the Mental Health of Refugees: Trauma, Stress, and the Cultural Context
In 2011 approximately 800,000 individuals were forcibly displaced from their homes and fled their countries. While the number of refugees generated that year was the highest in over a decade [1] it represents only 2 % of the overwhelming 42.5 million forc
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Understanding the Mental Health of Refugees: Trauma, Stress, and the Cultural Context B. Heidi Ellis, Kate Murray, and Colleen Barrett
Introduction In 2011 approximately 800,000 individuals were forcibly displaced from their homes and fled their countries. While the number of refugees generated that year was the highest in over a decade [1] it represents only 2 % of the overwhelming 42.5 million forced migrants. Most refugees flee their homes with little time to prepare [2] and, in turn, frequently are ill-equipped with the financial, linguistic, and other resources needed to address the challenges of their journey that lies ahead. The nature of the premigration and flight experiences for refugees, which are frequently marked by fear, forced departure, and experiences of torture and trauma, distinguishes them from other voluntary migrants. As Papadopoulos [3] stated, “…it is important to remember the obvious fact that becoming a refugee is not a psychological phenomenon per se; rather, it is exclusively a sociopolitical one, with psychological implications” (p. 301). As refugees resettle in third party countries, sometimes after prolonged stays in refugee camps, many experience mental health problems associated with past trauma, ongoing stress, or both. Since 1975 approximately three million individuals have been resettled in the USA [5]; this represents an important population to respond to clinically. In order to effectively serve this population, mental health professionals including, academics, researchers, and clinicians will need to understand the impact of the refugee experience and cultural context on psychological functioning. This chapter will review the unique
B.H. Ellis, Ph.D. Department of Psychiatry, Boston Children’s Hospital/Harvard Medical School, 21 Autumn Street, 1st floor, Boston, MA 02115, USA e-mail: [email protected] K. Murray, Ph.D., M.P.H. Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA C. Barrett, M.P.H. (*) Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA R. Parekh (ed.), The Massachusetts General Hospital Textbook on Diversity and Cultural Sensitivity in Mental Health, Current Clinical Psychiatry, DOI 10.1007/978-1-4614-8918-4_7, © Springer Science+Business Media New York 2014
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Table 7.1 Definitions according to UNHCR 2011 global trends document Refugees
Individuals recognized by the 1951 Convention definition as persons who have crossed an international boundary because they are unable or unwilling to avail themselves of the protection of their former country due to a well-founded fear of persecution based on race; religion; nationality; membership of a particular social group; or political opinion Asylum seekers Individuals who have applied for international protection but their refugee status claims have not been verified Internally displaced Individuals who have been forcibly displaced but have persons not crossed an international boundary. The UNHCR provides protection and/or
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