The Cultural Perceptions on Mental Health Illness and Challenges Among Rwandan Refugees in the U.S

Background and Purpose: Refugees are forced to migrate to escape political, religious, and or social marginalization to obtain protection in another country. Following the Rwandan genocide in 1994, a subset of refugees from the region ultimately resettled in the U.S. Refugees are likely to arrive with significant mental health needs due to exposure to traumatic experiences in their home countries, challenging migrations and post-resettlement stressors exacerbating mental health issues. Given refugees face multifaceted challenges, minimal evidence has been documented concerning resettled Rwandan refugees specifically. Understanding Rwandan refugees’ mental health perceptions and challenges to mental health care is important in recognizing their unique needs to develop culturally informed and targeted mental health interventions.

Methods: The current study utilized descriptive phenomenology to describe Rwandan refugees’ lived experiences with mental health. A purposive snowball sampling technique was used to recruit thirteen individuals who self-identified as Rwandan refugees. Participants completed a demographic questionnaire. Data collection consisted of in-depth interviews. All interviews were audio-recorded and professionally transcribed verbatim. Colaizzi's (1978) steps of descriptive phenomenology data analysis were utilized to analyze and describe the findings. The transcribed data were uploaded to Atlas.ti.8 for organization, coding, and analyzing.

Results: Data analysis revealed two major themes: (1) Cultural perceptions and beliefs of mental health and (2) post-resettlement challenges that negatively influenced mental health. In discussing cultural perceptions and beliefs of mental health, participants indicated that those with mental illness are perceived as “crazy” or “foolish”. Participants also discussed that mental illness might be understood through spiritual or religious view. For example, mental health was associated with supernatural and spiritual causes indicating that such concerns required no professional help but rather spiritual healing. In discussing the connection between spiritual factors and mental health, participants emphasized that people with mental illness might be: “bewitched ” or “possessed with evil spirits”.Collectively, participants alluded that such perceptions often excluded individuals from society because they are seen as “useless” and “destructive” individuals. Such ostracizing perception created feelings of shame that inhibited individuals to disclose or seek mental health care. Moreover, in discussing challenges that negatively influenced mental health, participants stated despite the availability of mental health services, those with mental illness continue to go undiagnosed because people lacked the knowledge in recognizing mental health issues. Participants highlighted the challenges of adjusting to the new system, not knowing where to find mental health services, facing financial challenges and experiencing communication barriers placed refugees in greater psychological distress and untreated mental health concerns.

Conclusions and Implications: Refugees migrating to a new host country face complex problems post-resettlement and their mental health needs remain unmet. Findings from this study reveal unique challenges that call for renewed strategies in addressing multifaceted needs. Importantly, focused education on the concept of mental health is paramount. Training and educating key community leaders such as religious leaders, formal and informal services providers to recognize mental health concerns, normalize mental health issues within the community could foster positive mental health outcomes among refugees.