Delivering Psychological Services to Refugees Resettled in the United States

Approximately 25 million refugees have fled their homelands internationally, and about 3 million have been resettled in the United States. The mental health needs of a population that has fled oppression, violence, and instability are diverse. This chapter seeks to provide a holistic overview of these needs. The introduction covers what defines the status of a refugee, current resettlement policies, and pre- and post-migration experiences and concerns among refugees, including barriers to basic services. Effective mental health treatment options and areas of competence for mental health professionals working with these individuals are discussed, along with future considerations for best meeting the mental health needs of refugees.

Out of the Shadows

Sexual minority and gender-diverse (SM/GD) persons experience depression, anxiety, suicidality, and substance use issues at a disproportionate rate when compared with heterosexuals. Stigma, minority stress, and prejudicial social attitudes and institutional policies are viewed as the reason for this. The disparities in access to health care for SM/GD persons is significant and is perceived as due to lack of access to competent care as well as mistrust of health care professionals on the part of SM/GD persons. SM/GD teens and elders, as well as individuals with low socioeconomic status, those living in rural areas, and those with disabilities, are particularly vulnerable. Recommendations for changes in health care policy, as well as strategies for improving the cultural competence of health care providers and evidence-based treatments, are discussed. Additionally, further research, standardizing health care training to include SM/GD persons, prevention, and inter-organizational advocacy are recommended.

Ethics Issues and Challenges When Bringing Psychotherapy to the Underserved

Providing effective clinical services to underserved communities brings with it a number of ethics challenges that, if not given sufficient attention, can result in potentially well-intentioned mental health clinicians causing harm and placing themselves at risk of professional sanctions. The need to possess sufficient clinical and multicultural competence relevant to the individual in question to be able to provide clinically effective treatments, addressing language differences, and appropriately utilizing interpreters are each discussed. Knowledge of local laws and regulations when providing clinical services in underserved communities is addressed. Additionally, the practice of tele-mental health and appropriately addressing fee issues for all types of professional services provided are discussed. The need to proactively address the potential for the development of vicarious traumatization and effectively practicing self-care on an ongoing basis are emphasized for all mental health clinicians who provide treatment services to the underserved.

Psychotherapy for Developmental Disabilities

Psychological disorders commonly co-occur in individuals with developmental disabilities, yet mental health disorders are under-identified and mental health services are underutilized for this group. Within the larger population of individuals with developmental disabilities, this chapter focuses on individuals with intellectual disability (ID) and autism spectrum disorder (ASD). The authors review defining characteristics of ID and ASD and then describe common psychological disorders for each group, including anxiety, depression, and behavioral dysregulation disorders. A selective review is provided of evidence-based interventions, such as cognitive behavioral therapy, that address mental health concerns for both groups. Barriers to access and utilization of services are identified and potential solutions are offered to these barriers. The authors identify the important role of stigmatizing attitudes toward individuals with developmental disabilities as contributing to poor experiences with mental health providers. The intersectionality of developmental disability and mental illness is highlighted as contributing to barriers to access to mental health treatment.

Delivering Mental Health Assistance in the Wake of Natural and Manmade Disasters

Disasters, both natural and manmade, seem to be occurring with increasing frequency in the United States and around the world. A single incident may affect many thousands of people. Collectively, many millions feel the impact of disaster every year. Addressing the psychological elements of such events has become recognized as a vital component of preparation, immediate response, and long-term recovery. This chapter reviews the major psychological aspects of disasters and disaster mental health (DMH) and highlights the importance of psychosocial assistance to survivors, responders, and others. DMH is designed to comfort and stabilize those affected, to promote effective coping, and to help maintain and restore inherent functioning. Factors that inhibit greater provision and utilization of these services are discussed, as is the importance of responding appropriately within the cultural environment of affected populations.

Delivering Mental Health Services to Children and Adolescents

Although one out of every five to seven children and adolescents has elevated psychological symptoms or a diagnosable condition warranting treatment, most will not access mental health services. Children from ethnic, linguistic, or cultural minority communities are at greatest risk for being underserved. Many communities lack professionals who are trained to work with this population. Yet effective and efficacious treatment options are available for children and adolescents who present with a range of conditions. Clinicians must consider developmental level, socioecological context, and culture when selecting and delivering evidence-based treatment approaches. Future steps include the use of remote technologies and creative co-location of services to improve access, the use of coordinated services to improve quality of life, and robust specialty training to provide the professional competencies necessary to reach this underserved population.

Delivering Psychological Services to Religious and Spiritual Clients

Spiritual and religious beliefs and practices in the United States are becoming increasingly diverse. This chapter reviews some of the fundamental problems and obstacles to providing culturally competent and compassionate mental health care to religious and spiritual clients, highlights the recent progress that has been made toward better serving the mental health needs of these clients, and provides a summary of best practices and future directions. Although religious and spiritual individuals continue to be underserved, there is increasing consensus among mental health professionals that religion and spirituality represent important cultural and clinical dimensions associated with treatment outcomes. As such, the field continues to work toward narrowing the gap in service delivery for religious and spiritual individuals seeking psychotherapy.

Serving the Underserved

Eliminating disparities in racial/ethnic mental health care is an ethical mandate and a tall order for the field of psychotherapy. There are significant obstacles that pose challenges, and at the same time point out directions for the field to address. This chapter provides arguments and narratives illustrating that increasing racial/ethnic parity requires all practicing psychotherapists and those in training to devote themselves to personal and professional multicultural identity/competence development, continuous knowledge renewal, and expansion and improvement of interventions in and outside of counseling rooms. Some of the possible and concrete paths toward meeting such demands are discussed to aid practitioners in their pursuit of the course of racial /ethnic mental health care parity.

From Exploratory to Experimental

The research findings to date are clear: Health disparities exist and are persistent. This chapter explores current research strategies and considers additional, less often employed methodologies in the area of mental health disparities. In particular, previous correlational and survey studies examining barriers to treatment are reviewed. In addition to understanding barriers to treatment, however, we need to focus on what works for underserved populations. Additional experimental studies of treatment modalities (e.g., telehealth), the impact of integrated care and geographic access, and the use of culture- and language-sensitive programs seem timely. Additional qualitative studies of individual experiences within various underserved populations will also help us devise innovative treatment approaches. By matching method to need, we will be able to find new ways to help underserved populations decide to seek help, access the care they need, and receive the best psychotherapeutic treatments available.

Psychotherapy with the Underserved Older Adult Population

The older adult population is steadily growing in number, and by 2050, over 20% of the U.S. population is expected to be over the age of 65. Ageism may affect both patients and providers and may limit access to mental health services. This chapter reviews the prevalence of major mental health conditions in older adults, empirically supported treatments for these conditions, and how best to tailor interventions for use with older patients. The authors suggest that psychoeducational training, increasing availability of specialty training programs for providers, intergenerational programs to promote empathy from as early as primary school to hospital staff training, and shifts in policy may boost interactions with older persons in health care settings and decrease avoidance of assessment and treatment for mental health conditions.