Social Workers, White Supremacy Culture, and Refugee Mental Health Care

Background and purpose

While research has explored individual barriers that negatively affect refugee care, there is a lack of research on how licensed clinical social workers (LCSWs) might affect refugee clients to whom they offer mental health care. In particular, we know little about how LCSWs understand and deliver mental health care services to refugee clients. This is important because LCSWs are frontline workers in refugee mental health care and may impact refugee mental health outcomes.

This paper helps fill this gap by examining the language of LCSWs when talking about and enacting refugee mental health care. I analyzed LCSW language to better understand how LCSWs make sense of refugee clients and refugee mental health care, and how white supremacy culture (WSC) characteristics are enacted through LCSW language.

Methods

I conducted twelve in-depth, semi-structured interviews with LCSWs providing mental health care to at least one refugee client over the past year. Participants were recruited by email sent through three MSW programs at three universities. The sample was 100% female, US-born and white, though none of these characteristics were selection criteria. Interviews elicited participants’ journey to becoming a clinical social worker including their clinical practice framework and perspectives on working with refugee communities. Interviews were transcribed verbatim and coded thematically using open and axial coding. I then applied Gee’s Critical Discourse Analysis during selective coding to identify robust themes. Finally, I applied Fairclough’s Critical Discourse Analysis framework to explore text, interaction and context within the structure of Okun's white supremacy culture characteristics.

Findings

Data analysis revealed that LCSWs often used language informed by WSC characteristics to make sense of refugee mental health care and refugee clients. LCSWs linked WSC characteristics to their education, their organizational policies and expectations, and requirements of insurance companies. Additionally, participants adapted their mental health care practice due to lessons learned when practicing refugee mental health care. LCSWs used a discourse of care that enacted antidotes to WSC. Antidotes are practices that interrupt and counter the dominance of WSC characteristics and prioritize a culture of racial equity, social justice and belonging (Okun, 2021). LCSW use of antidotes revealed that refugee mental health care is improved when LCSWs use a clinical case management framework and are flexible in their approach.

Conclusion/Implications

LCSWs in the U.S. bring particular beliefs, knowledge, and ideologies about refugees and about mental health care, which impacts the mental health care they provide. Drawing on their own experience and reflections, participants offered concrete ways to improve the mental health care available to refugee clients.

By identifying and acknowledging WSC characteristics in LCSW language, social work education can intentionally address WSC antidotes, which may improve LCSW practice. Organizational policies can integrate clinical case management into LCSW practice, allowing LCSWs to meet refugee client needs directly. Finally, state and federal health policies could legislate funding or insurance coverage for clinical case management as part of quality mental health care and improved mental health outcomes. In these ways, refugee mental health care outcomes may improve.