Implementation of an Initial Mental Health Assessment for Newly Arrived Refugees

Background and Purpose: Resettlement agencies in the United States assist newly arrived refugees with immediate needs including initial housing, orientation, school & ESL, health care, and job-placement. The U.S. refugee policy relies heavily on self-sufficiency in the short term to obtain employment. Since physical health is an important factor for employment, the U.S. government requires all refugees to be physically examined immediately after arrival. Mental health screening is encouraged but not required, and depends on availability of services. Therefore, refugees’ psychosocial needs are usually not identified due to a lack of resources. Resettlement staff may distinguish common severe psychiatric disorders and make referrals accordingly, but less severe mental health issues are mainly overlooked. Unfortunately, for many refugees these issues can prevent them from attaining or maintaining self-sufficiency, including employment. Thus, there is a need for an initial screening process that assesses psychological well-being. The goal of this study is to identify refugees’ mental health needs and connect them with better rehabilitation and psychosocial services. Additionally, researchers aim to develop a best practices model for mental health assessment that is trauma-informed, client-centered, and strengths-based.

Methods: The Refugee Health Screener-15 (RHS-15) has been added to the intake process at the WNY Center for Survivors of Torture in Buffalo. RHS-15 is a valid and effective screening tool to assess the mental health status of refugees. It is administered through semi-structured interviews with all newly arrived refugees, ages 18 and older. Screenings are conducted at the client’s home or the agency office. Consent is obtained through phone or on-site interpreter if the refugee does not speak English. Since the RHS-15 is available in 12 different languages, it is also used as a self-reported tool. The researchers are trained in implementing research practices that use a trauma-informed and human rights framework.

Results: The RHS-15 was administered to 44 refugees between June 2016 and February 2017. The mean age of the sample is 34.40 ± 12.45. The sample consists of refugees from Democratic Republic of Congo (32%), Syria (10%), and Iraq (10%), among others. The average camp stay for Congolese refugees is 17 years, whereas it is 9 years for refugees from other countries. 24 participants (55%) screened positive for further mental health support. 25 participants (57%) had high scores on the distress scale (not necessarily the same participants). There was no significant relationship between sociodemographic characteristics and RHS-15 scores.

Conclusions and Implications: Participants were provided appropriate referrals, as needed, through collaboration with agency staff. The results will be utilized to integrate the application of RHS-15 into the intake for all newly arrived refugees. The research team will use these results to promote mental health awareness and increase the utilization of this screening in other resettlement agencies in Western New York. Results will also be disseminated to advocate for increased funding and resources for services for refugees’ psychosocial well-being. Future studies could use this assessment tool and adapt it to a mixed-methods study to identify mental health needs in-depth and develop interventions to improve refugee well-being.