Syrian Refugees in Canada: Clinical Experience in Mental Health Care

Author(s):  
Khalid Bazaid
2021 ◽  
Vol 12 ◽  
Author(s):  
Jonathan Bär ◽  
Alexander Pabst ◽  
Susanne Röhr ◽  
Melanie Luppa ◽  
Anna Renner ◽  
...  

Background: The high prevalence of mental disorders related to posttraumatic stress among Syrian refugees is often in contrast with their low utilization of mental health care in the host countries. Mental health self-stigma, i.e., internalized stigma of having a mental disorder, could prevent individuals from seeking mental health care. Therefore, we aimed to provide evidence on different aspects of mental health self-stigmatization among adult Syrian refugees with posttraumatic stress symptoms residing in Germany. Moreover, we investigated associations with sociodemographic and psychopathological variables in order to identify those at higher risk of self-stigmatization.Material and Methods: Overall, 133 participants with mild to moderate posttraumatic stress symptoms were recruited in the metropolitan areas of Leipzig, Dresden and Halle, Germany, using a multimodal approach. Mental health self-stigma was assessed using the Self-Stigma of Mental Illness Scale – Short Form (SSMIS-SF), consisting of four subscales (Stereotype awareness, Stereotype agreement, Application to self , Harm to self-esteem), each scoring from 5 (low) to 45 (high) points. Linear regression analysis was used to test associations of sociodemographic and psychopathological variables with self-stigma subscales.Results: On average, self-stigma ratings ranged from 16.5 (SD = 6.6) points on Application to self to 28.3 (SD = 7.5) points on Stereotype awareness. Results showed higher scores on Application to self for individuals who were younger (t = 2.65, p = 0.009) and single (F = 5.70, p = 0.004). Regression analyses yielded statistically significant associations between having multiple comorbidities and a higher Application to self stigma (β = 0.18, p = 0.044), controlling for sociodemographic covariates.Discussion: Mental health self-stigma was increased among Syrian refugees in Germany. Correlates of increased self-stigma could inform efforts to improve access to mental health care among Syrian refugees with mental ill-health. Longitudinal studies following an intersectional approach by concurrently examining multiple forms of public and internalized stigma could provide helpful insights for developing tailored stigma reduction efforts in this context.


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
D C Fuhr ◽  
C Ataturk ◽  
M McGrath ◽  
Z Ilkkursun ◽  
A Woodward ◽  
...  

Abstract Introduction Turkey hosts the highest number of Syrian refugees in Europe. Refugees are often vulnerable to situational forms of psychosocial distress as a consequence of exposure to war and violence which may result in more profound mental health problems if no treatment is sought. The aim of this study is to report evidence on mental health and psychosocial support (MHPSS) needs, access and barriers to MHPSS care among Syrians refugees living in Istanbul, Turkey. Methods A cross-sectional survey was conducted among Syrian refugees aged 18 years or over in Istanbul (Sultanbeyli) between February and May 2018. Data among 1’678 Syrian refugees were collected on mental health outcomes using the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5) and the Hopkins Symptoms Checklist (HSCL-25) for depression and anxiety. We also collected data on health care utilization, barriers to seeking and continuing care as well as knowledge and attitudes towards mental health. Descriptive analyses were used. Results The prevalence of PTSD, depression and anxiety was 19.6%, 34.7% and 36.1% respectively. The treatment gap was 89% for PTSD, 90% for anxiety and 88% for depression. 249 respondents (15%) screened positive for either PTSD, depression or anxiety in our survey and self-reported emotional/behavioural problems since arriving in Sultanbeyli. Several structural and attitudinal barriers for not seeking care were reported. Conclusions To overcome the treatment gap, mental health care programmes need to be more responsive to the needs of Syrian refugees. Barriers to seeking and continuing care can be overcome by providing MHPSS services in the community which facilitate access to care. Community-based programmes of care should be supported by activities which increase awareness about mental health issues and tackle negative attitudes towards mental illness. Key messages This study provides the first nationally representative data on the mental health of Syrian refugees in Turkey, and shows that refugees have high mental health needs. Syrian refugees do not seek mental health care despite availability of mental health services in the community.


2017 ◽  
Vol 41 (S1) ◽  
pp. S620-S620
Author(s):  
K. Bazaid

War is the most serious of all threats to health (World Health Organization, 1982) and can have severe and lasting impacts on mental health. Forced displacement and migration generate risks to mental well-being, which can result in psychiatric illness. Yet, the majority of refugees do not develop psychopathology. Rather, they demonstrate resilience in the face of tremendous adversity. The influx of Syrian refugees to Canada poses challenges to the health care system. We will present our experience to date in the Ottawa region, including a multisector collaborative effort to provide settlement and health services to newly arriving refugees from the Middle East and elsewhere. The workshop will be brought to life by engaging with clinical cases and public health scenarios that present real world clinical challenges to the provision of mental health care for refugees.Objectives(1) Understand the predicament of refugees including risks to mental health, coping strategies and mental health consequences, (2) know the evidence for the emergence of mental illness in refugees and the effectiveness of multi-level interventions, (3) become familiar with published guidelines and gain a working knowledge of assessment and management of psychiatric conditions in refugee populations and cultural idioms of distress.How will the participants receive feedback about their learning? Participants will have direct feedback through answers to questions. The authors welcome subsequent communication by email. Presenters can give attendants handouts on pertinent and concise information linked to the workshop.Disclosure of interestThe authors have not supplied their declaration of competing interest.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  

Abstract Over the past decade, the global population of forcibly displaced people reaching a record high by growing to over 70 million in 2018. The largest group of refugees worldwide currently are the Syrians, and most of them have fled to countries neighboring Syria (e.g., Turkey, Jordan and Lebanon), whereas smaller but significant numbers of refugees fled to European countries. Over 50% of Syrian refugees are children, in many cases unaccompanied by their family. Increased rates of common mental disorders, including anxiety, depression, and posttraumatic stress disorder (PTSD) have been documented in various refugee populations. Much less is known about the prevalence of other common mental health problems, such as substance use. In order to effectively address the mental health needs of Syrian refugees, increasing knowledge about self-identified problems and cultural idioms of distress within the Syrian community is imperative. This may also facilitate the development of effective mental health awareness programs within refugee communities. Further, the refugee crisis imposes highly challenging demands on health systems in Europe and the Middle East. Within the Middle East, there is a great lack of mental health workforce, and limited availability of evidence-based interventions. Within Europe, specialized mental health care services for refugee populations are available, yet the number of Arabic-speaking professionals is very limited. Other barriers to seeking and continuing mental health care for refugees include the use of interpreters, lack of culturally adapted interventions for a range of mental health problems, and stigma within refugee communities. Learning from evidence from low- and middle-income settings, task-sharing interventions delivered by non-professional helpers in the community instead of within specialized mental health care facilitate access to care. Within European settings, they can be successfully integrated within stepped care models used as a public mental health care strategy to reduce costs and increase mental health care use and continuation for refugee populations. In order to address the mental health needs of Syrian refugees, increasing knowledge about self-identified problems and cultural idioms of distress within the Syrian community is imperative. In addition, scalable task-sharing interventions addressing these problems should be developed and evaluated. This international workshop will focus on 1) self-identified problems and idioms of distress within the Syrian refugee community to inform the development of targeted psychosocial interventions; and 2) the effects of novel scalable psychosocial interventions to address common mental disorders across the health systems within Europe (Turkey and the Netherlands) and the Middle East (Jordan). The presenters are Naser Morina (Switzerland), Jutta Lindert (Germany), Richard Bryant (Australia), Dr. Ceren Acarturk (Turkey) and Marit Sijbrandij (the Netherlands). Key messages Scalable psychosocial interventions can successfully be implemented across refugee settings in the Netherlands, Turkey, the Netherlands and Jordan to address common mental disorders. To address major mental health concerns within refugee communities, culturally concepts of distress and general wellbeing indicators should be considered.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
N Morina ◽  
A Drescher ◽  
A Akhtar ◽  
J Spaaij ◽  
N Kiselev

Abstract Background Syrian refugees have high levels of mental disorders. They face multiple stressors before, during and after migration which affect their psychosocial wellbeing. Stressors after flight may vary due to different geographic, economic, cultural, socio-political contexts. Previous studies demonstrate that displacement-related factors are as likely as war exposure to contribute to distress after migration and hence, are pivotal to include in public health policy. Assessments in mental health care are mainly through nomothetic measurements, often developed in western countries. A growing body of literature recognizes the importance of clients' own perspective, especially in cross-cultural settings. The aim of this multi-country study was to describe and compare self-reported problems of Syrian refugees between Jordan, Turkey and Switzerland. Methods Using the semi-structured client-generated outcome measurement PSYCHLOPS enabled to identify and compare problems in various study settings: camp-based in Jordan (N = 61), community-based in Turkey (N = 46) and Switzerland (N = 57), respectively. Questionnaires were analyzed following thematic analysis. The developed coding framework allowed to qualitatively illustrate the meaning and quantitatively compare the frequency of codes. Results Almost all the emerged themes are related to post-migration stressors. Over half of the participants reported practical problems with an emphasis on financial, employment, government regulations, followed by psychological and physical health problems. For participants in Turkey, finances are of much more concern than in Jordan and Switzerland, whereas in Switzerland, problems with government regulations stand out. Conclusions This study underlines the importance of displacement-related factors with special regard to local key factors on psychosocial wellbeing. Consequently, when planning mental health care services and preventive measures such factors must be considered and addressed.


2021 ◽  
pp. 002076402199521
Author(s):  
Kerem Böge ◽  
Eric Hahn ◽  
Judith Strasser ◽  
Stephanie Schweininger ◽  
Malek Bajbouj ◽  
...  

Background and Aim: The Kurdish Region of Iraq (KRI) is home to Kurds, internally displaced persons, and Syrian refugees. In the last decades, its inhabitants have witnessed a great deal of political instability, which has led to increased rates of psychological distress. Mental illness contrasts with limited access to and availability of mental health services – and so the treatment gap remains high. This study aims to investigate the perspectives, perceptions, and expectations of Syrian refugees, internally displaced persons and KRI host community members concerning mental health care in the governorate of Duhok. Attitudes and perspectives regarding psychotherapy, such as satisfaction with services, effects of therapy, bias toward therapy, and stigma, are explored. Methods: One hundred one participants were recruited from hospitals, clinical settings, and institutions from the governorate of Duhok in the KRI. Participants received the Patient Satisfaction Questionnaire (PSQ) and were asked to evaluate services through four subscales: patient satisfaction, effects of therapy, bias toward therapy, and stigma. Results: Results revealed overall high satisfaction with services and effects of therapy. In contrast, both bias and stigma subscales were rated more ambivalently. Conclusion: Patient satisfaction is key for assessing health care quality, understanding attitudes toward therapy, and help-seeking behavior. Results offer insight for stakeholders in the psychosocial field allowing for a better understanding and improvement of availability and access to quality-driven mental health care services


1996 ◽  
Vol 24 (3) ◽  
pp. 274-275
Author(s):  
O. Lawrence ◽  
J.D. Gostin

In the summer of 1979, a group of experts on law, medicine, and ethics assembled in Siracusa, Sicily, under the auspices of the International Commission of Jurists and the International Institute of Higher Studies in Criminal Science, to draft guidelines on the rights of persons with mental illness. Sitting across the table from me was a quiet, proud man of distinctive intelligence, William J. Curran, Frances Glessner Lee Professor of Legal Medicine at Harvard University. Professor Curran was one of the principal drafters of those guidelines. Many years later in 1991, after several subsequent re-drafts by United Nations (U.N.) Rapporteur Erica-Irene Daes, the text was adopted by the U.N. General Assembly as the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. This was the kind of remarkable achievement in the field of law and medicine that Professor Curran repeated throughout his distinguished career.


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