A Refugee Rose of competencies and capabilities for mental healthcare of refugees

Abstract

In this paper, I set out the challenges of care for refugees and suggest approaches to assessment and intervention. I discuss clinical interventions that can address the immediate concern of the clinician in a bio-psycho-social framework, and the value of considering eco-social and structural influences that can hinder recovery and perpetuate inequalities. Refugees face multiple adversities before, during and after escaping from life-threatening situations, political violence, torture and persecution. They present with complex health needs and encounter hostility from host countries and public services, which see their needs as an additional demand on the public purse. Regrettably, existing care practice and training of professionals do not often include skills for working across cultures, including cultural formulations and fair assessment, cultural adaptation of interventions, cultural competence and cultural consultation methods, including clinical ethnography and exploration of cultural identity and explanatory models. There are little data on effective and kind models of interpretation and translation. Care systems are rarely designed to fully address the needs of refugees. Health practitioners are not trained to address structural and institutional racism and discrimination, which leads to exclusion of the most marginalised, with little attention to social justice and fair processes as part of appropriate healthcare.

Mental health among older Bhutanese with a refugee life experience: A mixed-methods latent class analysis study.

“…Focus has been placed on developing and validating quantitative assessments that screen for mental health problems among refugees to facilitate referral to clinical care (Magwood et al, 2022). Although policies and best practices around quantitative screening are important, it is also critical to include and integrate more qualitative assessments of individuals and their mental health care needs (Bhui, 2022; Christensen & Ahsan, 2022; Lely & Kleber, 2022).…”

Mental health responses in countries hosting refugees from Ukraine

“…23 The range of necessary competencies has been articulated in an article in the BJPsych Open Refugee and Asylum Mental Health Thematic Series. 24 Clinicians, systems leaders and policy makers will need multiple competencies in the following areas:…”

“…23 The range of necessary competencies has been articulated in an article in the BJPsych Open Refugee and Asylum Mental Health Thematic Series. 24 Clinicians, systems leaders and policy makers will need multiple competencies in the following areas: narrative methods and cultural psychiatric critiques and assessment methods assessment of symptoms out of cultural context trauma studies and social and neuroscience perspectives on recovery and therapeutics migration studies, legal and social perspectives on protecting health and recovery liaison, medical and public health actions cultural adaptation of existing therapeutics and outcome measures and policy. …”

Author's Reply. RE: Reconceptualising the treatment gap for common mental disorders: a fork in the road for global mental health?

“…2 Maintaining political neutrality while governments and private interests create worsening conditions for mental health – despite clear evidence on the social determinants of mental health and the actions necessary to reduce mental health inequalities 3 – is to support the status quo. For individual practitioners, who see the pernicious effects of the social, political and commercial determinants of mental health in their clinics every day, there is an opportunity to empower patients by developing formulations of their distress that acknowledge the links between their individual experiences and the structural forces that shape their lives, as described by Bhui 4 and others, and as reflected in traditions of social medicine that are practiced in Latin America and other Southern countries, which aim to centre the complex societal structures that drive poor health. 5 Within the global North, many mental health practitioners already think more broadly than psychiatric care in terms of how to meet patients’ needs, by referring to social workers, non-governmental organisations, occupational therapists and other professionals to address housing needs and provide advice on rights and benefits, access to food banks, etc.…”