Health and Mental Health Needs of Recently Resettled Refugees in the US: A Social Justice Imperative

Background and Purpose: Over 60,000 individuals were admitted as refugees into the United States in each of the past 3 years. Individuals and families designated as refugees often encounter multiple stressors and barriers to acculturation in the U.S. Federally funded resettlement agencies typically provide reception and initial case management services to newly arrived refugees for a period ranging from about 4 to 8 months after arrival. This qualitative inquiry study was conducted in order to explore the health and mental health challenges faced by one group of recently resettled refugees, members of the Karen ethnic tribe from Burma. Methods: Semi-structured individual interviews were conducted with 20 Karen refugees from Burma living in a large southwestern metropolitan city. Using a snowball sampling technique, Karen adults ranging in age from 19 to 78 were identified, consented, and participated in oral in-depth interviews which were recorded and later transcribed. All of the participants had lived in the United States for less than 3 years, and all had spent several years living in one of several refugee camps in Thailand along the Thai-Burma border prior to their arrival in the United States. The interviews were conducted in the participants' native language, Karen, by a trained bi-lingual community member. Interview questions focused on the biopsychosocial needs of recently resettled Karen refugees at the individual and community levels. The analysis of the verbatim transcripts incorporated a grounded theory approach, allowing each individual participant's experience to be explored first in isolation, and then later within the broader context of the entirety of the larger study. Results: Findings suggest that recently resettled refugees experience major obstacles in locating and accessing employment and health care due to language and transportation barriers. Interviewees reported disappointment and frustration at the short window of time in which they were provided governmental assistance, and expressed a need and desire for assistance in learning English and navigating specific aspects of American life such as transportation, job skills, and financial planning. Several interviewees expressed a sense of disillusionment and a desire to return to the refugee camp in Thailand, and a number of these participants exhibited symptoms of depression such as sleep disturbances, lack of affect, and general malaise. Conclusions: A number multi-faceted needs exist for recently resettled refugees. Results of this needs assessment indicate that many of the basic needs of refugees are not being met following the initial relocation period, and significant efforts need to be taken toward achieving social justice for this vulnerable population in the U.S. This study illuminates the need for policy changes at the federal level to allow for a more comprehensive model of care for newly arrived refugees, and provides a foundation for policy advocates on which to build a sustainable support system for new refugees in the U.S.