Changing Public Health Policy to Include Mental Health Screening of Refugees: Examining the Stakes and Stakeholders
Saturday, January 19, 2013: 10:00 AM-11:45 AM
Nautilus 4 (Sheraton San Diego Hotel & Marina)
Cluster: Race, Ethnicity, and Immigration
Patricia Shannon, PhD, University of Minnesota-Twin Cities
Many refugees arrive in the United States needing health care (Johnson & Thompson, 2008). Refugees are offered health screening at public health clinics after arrival in the United States and are frequently referred to follow-up care to address health issues like parasites, tuberculosis and physical and cognitive disabilities. While all states offer comprehensive health screening, mental health screening is more varied. Some states do not offer any mental health screening, while others have comprehensive screening and referral programs (Savin, Seymour, Littleford, Bettridge, Giese, 2005). Current literature suggests that refugees are at increased risk of depression, anxiety and post-traumatic stress disorder due to war-related trauma and the difficulty of resettlement in a new culture (Porter & Haslam, 2005). Refugees whose mental health symptoms go untreated can have difficulty with resettlement and adjustment even years after arrival in the US (Mitschke, Mitschke, Slater, & Teboh, 2011; Potocky-Tripodi, 2003). Including mental health screening at initial public health screening appointments could allow refugees with mental health symptoms to seek referral and treatment early in their resettlement, leading to more stable and productive lives after resettlement. Some evidence suggests that public health professionals are reluctant to include mental health screening in health screening appointments because of a lack of relevant, valid screening tools for refugees, a lack of time and resources and a lack of culturally appropriate referral options (Kirmayer et al., 2011). If mental health screening is to be included in public health screening and care for refugees, stakeholders need to be engaged at multiple levels including at the federal policy level, as well as the direct service level. This symposium presents findings from a multi-phased research project that has developed and pilot-tested a brief mental health screening tool at several refugee-serving public health clinics in the Twin Cities and tested a psycho-education curriculum for refugees with mental health symptoms. The first paper will present an overview of the issue including data from a nation-wide survey of state-level mental health screening practices, evidence of the need for training on mental health issues and an overview of the various stakeholders including doctors, refugees and policymakers. The second paper will provide an overview and results of the mental health screening initiative in Minnesota including a description of the measurement development, the cultural adaptation process and outcome and prevalence data on war trauma and mental health symptoms from the clinics. The third paper will present an overview and the outcomes of the development and testing of community-based psycho-education groups to address mental health symptoms and mental health stigma. The fourth paper will discuss progress toward evaluating the mental health delivery system for newly arriving refugees.
* noted as presenting author