Mental Health Services for Syrian Refugees in Lebanon: Perceptions and Experiences of Professionals and Refugees

Abstract

We applied semi-structured and in-depth interviews to explore the perceptions and experiences of 60 practitioners/policymakers and 25 Syrian participants involved in mental health services for refugees in Lebanon. Refugees were found to view their distress as a normal shared reaction to adversity while professionals perceived it as symptomatic of mental illness. Practitioners viewed Syrian culture as an obstacle to providing care and prioritized educating refugees about mental health conditions. Policymakers invoked the state of crisis to justify short-term interventions, while Syrian refugees requested community interventions and considered resettlement in a third country the only solution to their adverse living conditions. The therapeutic relationship seems threatened by mistrust, since refugees change their narratives as an adaptive mechanism in response to the humanitarian system, which professionals consider manipulative. We discuss the implications of our findings for mental health practice in humanitarian settings.

Prevalence of Depression Symptoms and Associated Sociodemographic and Clinical Correlates Among Syrian Refugees in Lebanon

“…Participants who screened positive on the PHQ-2 and PHQ-9 were selected for further analysis. PHQ-9 score was categorized into no symptoms (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), and severe (20)(21)(22)(23)(24)(25)(26)(27). PHQ-9 categories and average scores, as well as individual PHQ-9 items were summarized by gender and tested for statistical difference using the Pearson's Chi-Square and the independent t-test.…”

“…[Insert Table 4 In Lebanon, many post-migration variables present important obstacles towards adequate health and survival. For example, the high prevalence rates of depression symptoms could be attributed to numerous external factors beyond their exposure to traumatic events, such as the di cult conditions in which Syrian refugees live, the limited opportunities for development, and the many challenges associated with their social integration and acculturation (Kerbage et al, 2020). Additionally, the constant internal and regional socioeconomic and political con icts promote little hope for refugees to settle in a stable context unless they travel to more developed countries, which is a solution Syrian refugees commonly request to overcome their documented adverse living conditions (Kerbage et al, 2020).…”

“…For example, the high prevalence rates of depression symptoms could be attributed to numerous external factors beyond their exposure to traumatic events, such as the di cult conditions in which Syrian refugees live, the limited opportunities for development, and the many challenges associated with their social integration and acculturation (Kerbage et al, 2020). Additionally, the constant internal and regional socioeconomic and political con icts promote little hope for refugees to settle in a stable context unless they travel to more developed countries, which is a solution Syrian refugees commonly request to overcome their documented adverse living conditions (Kerbage et al, 2020). The existing economic di culties in Lebanon, which are now exponentially compounded by the fall of Lebanese pound (Youssef, 2020), and by the colossal explosion that devastated the capital Beirut in August 2020 (Tharoor, 2020), may place Syrian refugees under further instability and vulnerability.…”

“…Rightfully so, ndings have con rmed that besides the existing acute and chronic stressors, the mental health of refugees largely depends on the social, economic, and cultural environments associated with their pre and post-displacement experiences (Porter & Haslam, 2005). However, the status of Syrian refugees in Lebanon is far from being ideal, with potential protective factors being compromised and minimally available (Kerbage et al, 2020). As an example, Syrian refugees have restricted rights in Lebanon, which limit their access to proper healthcare, education, and employment opportunities, due to the lack of a clearly de ned legal and administrative framework under which they can operate (Blanchet, Fouad, & Pherali, 2016;Kerbage et al, 2020).…”

“…However, the status of Syrian refugees in Lebanon is far from being ideal, with potential protective factors being compromised and minimally available (Kerbage et al, 2020). As an example, Syrian refugees have restricted rights in Lebanon, which limit their access to proper healthcare, education, and employment opportunities, due to the lack of a clearly de ned legal and administrative framework under which they can operate (Blanchet, Fouad, & Pherali, 2016;Kerbage et al, 2020). Such systemic precariousness excludes potential opportunities for long-term integration, and places Syrian refugees in Lebanon at increased risk of developing mental health problems (Jayawickreme et al, 2017;Killikelly, Bauer, & Maercker, 2018).…”