In 2013, 194 countries adopted the World Health Organization’s (WHO) Comprehensive Mental Health Action Plan 2013-2020. This plan acknowledged the growing burden of mental health issues and underscored the urgent need for resources geared towards prevention, intervention, and treatment. 

Refugees represent one of the most vulnerable populations that the mental health system has consistently struggled to support. According to the latest Global Trends 2023 report, over 10 million refugees have sought protection in high-income countries due to forced displacement and human rights violations. 

Six years later, however, the action plan was extended until 2030, allowing more time to achieve Sustainable Development Goal 3.4, which aims to reduce deaths by non-communicable diseases and promote mental well-being. Two of the six core principles of the plan, universal health coverage and evidence-based practice, highlight the importance of access to equitable mental health services for all individuals and emphasize the need for evidence-based practice to account for cultural differences.

Despite refugees facing heightened vulnerabilities and unique traumatic events such as war, extreme violence, poverty, and familial loss or separation, they remain disproportionately underserved when it comes to mental health care. Recent research by clinical psychologist Lars Dumke and colleagues identified seven common barriers that refugees and asylum seekers face in accessing mental health services. These include limited understanding of mental health issues, language barriers, lack of awareness of available services, and fear of stigma.

In addition, the challenges refugees face leading up to, during, and following forced displacement put them at a greater risk for severe and persistent mental health issues, namely post-traumatic stress disorder (PTSD), depression, and anxiety. Refugees are seven times more likely to experience PTSD and three times more likely to struggle with depression compared to the general population in high-income host countries.

While access to adequate care is a major hurdle, Dumke emphasizes, “Providers’ competence, lack of understanding, and attitudes (including perceived stereotypes, prejudices, and discrimination) can be central barriers in mental health care for refugees.” 

Refugees often encounter resistance at every stage of the treatment process, a reality that pushes them further away from the help they urgently need. Dumke adds, “Many refugees report feeling misunderstood and discriminated against in mental health care settings, which undermines trust and can result in treatment rejections, inadequate treatment, or discouraged engagement with clinicians.”

One reason for the treatment gap may be due to differences in culture, values, and traditions observed by refugees compared to residents in high-income countries. Amanda Sim, associate professor and member of the Offord Centre for Child Studies at McMaster University in Canada, has conducted extensive research on the mental well-being of forcibly displaced individuals. She notes, “Our research suggests that refugees have a more holistic conceptualization of mental health that does not align well with existing western models of care which emphasize clinical interventions.”

This is also highlighted by Dumke and colleagues’ findings that show that refugees often view mental health issues as physical ailments, sometimes attributing them to religious or supernatural beliefs like curses, witchcraft, or evil spirits. This underscores the fact that cultural differences shape how mental health is understood, and some refugees may not identify with western conceptualizations of mental health problems. It is critical to acknowledge that many evidence-based practices may not be as successful or appropriate for refugee populations.

Born and raised in a refugee camp in Africa, Egette Indelele has experienced the struggles of accessing mental health care. She reflects on her past as both resilient and isolating: “I carried the weight of my family’s sacrifices, the pressure to succeed, and the fear of not belonging. Yet, mental health was never openly discussed. There was a stigma around seeking help and a lack of resources. If they did exist, they weren’t accessible to someone like me.”

After immigrating to the United States, Indelele’s painful acculturation journey inspired her to create Safe Haven Space, a charitable organization aimed at providing well-being services to refugee students and families while addressing the stigma surrounding mental health.

“I never want another refugee to feel as alone or unsupported as I once did,” Indelele says. “They deserve the support to embrace their full potential in their new homes.”

It is important to address the mental health needs of refugees at systemic, organizational, and societal levels. These changes include policy reforms, access to translators, culturally adapted evidence-based practices, and mandatory competency training for clinicians. Sim emphasizes the importance of providing “mental health support that explicitly addresses social determinants such as housing, employment, and social isolation that have a profound impact on their mental health outcomes.”

If greater resources were dedicated toward understanding the intersecting identities and traumatic experiences of refugees, there would be an increase in relevant and effective treatment for these growing populations. Until then, individuals must continue to advocate for the rights of those whose voices are often forgotten. 

-Amanda Fernandes, Contributing Writer

Image Credit: 

Feature Image: Photo by Sander Sammy on Unsplash, Creative Commons

Body Image 1: Photo by SAIF AL-GBURI on Unsplash, Creative Commons 

Body Image 2: Photo by Ryanniel Masucol on Pexels, Creative Commons