Exploring National Practices and Barriers Related to Mental Health Screening of Refugees
Methods: The research team developed a survey to explore practices, knowledge gaps and the perceived need for a mental health screening protocol for refugees. A survey was sent to the Refugee Health Coordinators for each state in the U.S., including the District of Columbia. Two states without Refugee Health Coordinators, Mississippi and Wyoming, were excluded from the survey. Data were collected using a web-based survey tool managed by the University of Minnesota College of Education and Human Development. The web-based survey comprised 28 semi-structured questions on mental health screening and referral practices. To analyze the survey data, we used descriptive statistics including frequencies, proportions, means, standard deviations and cross tabulations. We also conducted correlation analysis between refugee arrival data, state refugee program data and screening rates. Multiple response analyses were performed on types of screening tools and barriers to screening and social service access. Open ended survey responses were categorized and singe responses to “other” categories were listed. PASW 18 for Windows was used for the analysis. Qualitative data from follow-up interviews with 10 states was listed by state and categorized. Additional information concerning the process of informal interviewing was summarized.
Results: Only half of the states provide any mental health screening to newly arrived refugees. Of the states that provide screening for mental health symptoms, more than half utilize informal conversation. Further, less than half the states reported directly asking refugees about their exposure to war trauma or torture. The most frequently cited reasons for not providing mental health screening were the lack of culturally sensitive instruments and the lack of time and resources.
Implications: These barriers underscore the need for brief, culturally validated instruments for screening refugees in the public health setting.