Trauma-related immigrants face barriers to mental health care.

As a young boy living in Zaire at the time, Bertin Bahige saw refugees fleeing the Rwandan genocide in 1994 crossing the river that forms the border between the two Central African countries.

“I didn’t know it would be me a few years later,” Bahige said.

Bahige’s harrowing journey as a refugee began in 1997 when war broke out in his home country, the Democratic Republic of Congo, when he was abducted and forced to become a child soldier. In the year In 2004, Baltimore to A.A Refugee resettlement program.

Bahige, now 42, says he grew up “buckling up and toughening up,” and adapted that philosophy to America, where he worked several jobs until he got to university, where he took classes at a community college. At Wyoming Scholarship. He is now an elementary school principal in Gillette, Wyoming, and his coping strategy is to keep himself busy then and now.

“Looking back, I don’t think I even got over the injury I did,” he said.

Immigrants have been entering the U.S. in large numbers since this year’s resettlement census. 40-year low under President Donald Trump. These newcomers are just like the immigrants before them. It is 10 times more than the total population To have post-traumatic stress disorder, depression and anxiety. Many, like the Bahige, have fled their homelands due to violence or persecution. After that, they have to deal with the mental problem of integrating into new environments, like Wyoming is from Central Africa.

This Bahige is concerned about the safety of the new generation of refugees.

“The type of system a person lived in may be completely different from the new life and system they are in now,” says Bahige.

While their need for mental health services is greater than that of the general population, immigrants are less likely to receive such care. Part of the shortage stems from societal differences. But the big reason is general Lack of mental health providers In the US, and immigrants face myriad barriers and barriers to accessing mental health care.

In rural areas like the northern Rocky Mountains or urban areas like Atlanta, refugees can face months of care, and a lack of clinics that understand the culture of the people they serve.

From 1975 About 3.5 million refugees They entered the United States. Annual admissions under the Trump administration have dropped from 85,000 in 2016 to 11,814 in 2020, according to the State Department.

President Joe Biden will raise 125,000 for the 2022 federal budget year. This will end on September 30. At the beginning of August, less than 18,000 have arrived, so this ceiling cannot be reached, but the number of people accepted is increasing every month.

Immigrants receive a mental health screening along with a comprehensive medical evaluation within 90 days of arrival. But the effectiveness of that effort depends largely on the ability to navigate complex cultural and linguistic issues, said Dr. Ranit Mishori, professor of family medicine at Georgetown University and senior medical adviser to Physicians for Human Rights.

Despite the high number of refugees, not all displaced people seek mental health services, Mishori said.

For refugees facing stress and crisis, resettlement agencies such as the International Rescue Committee provide support.

“Some people come in and ask for services right away, and some don’t need it for a few years until they feel completely safe and their bodies adjust, and the risk response starts to dissipate a little bit,” McKinley Gwinner said. IRC Mental Health Explorer in Missoula, Montana.

Unlike Bahige’s adopted state of Wyoming, which does not have a refugee resettlement service, IRC Missoula has resettled refugees from the Democratic Republic of the Congo, Syria, Myanmar, Iraq, Afghanistan, Eritrea and Ukraine in Montana. A major challenge in accessing mental health services in rural areas is that there are very few providers who speak the language of those countries.

Translation services are abundant in Clarkston, Atlanta, where there are many immigrants from Myanmar, the Democratic Republic of the Congo, and Syria. Five mental health clinics in Atlanta and Georgia State University’s Defense Research Center will work with IRC caseworkers in the IRC’s new program. The clinics assess the mental health needs of immigrants as caseworkers help with housing, employment, education and other issues.

Seeking mental health care from a professional can be a strange idea for many immigrants, said Fardouus Ahmed, a former immigrant mental health clinician at the University of Colorado School of Medicine.

For immigrants in need of mental health care, stigma can be a barrier to treatment. Some immigrants fear they could be deported if U.S. officials find out they’re struggling with mental health, and some single mothers worry they’ll lose their children for the same reason, Ahmed said.

“Some people think that seeking services means they’re ‘crazy,'” she says. “It’s important to understand how different cultures view and perceive mental health services.”

Long wait times, lack of cultural and linguistic resources, and societal differences have led some health professionals to suggest alternative ways to address the mental health needs of immigrants.

Dr. Susan Song, a professor of psychiatry at George Washington University, said expanding the scope beyond individual therapy to include peer intervention can rebuild dignity and hope.

Spending time with someone who shares the same language or knowing how to use the bus to get to the grocery store is “incredibly healing and gives someone a sense of belonging,” Song said.

In Clarkston, the Prevention Research Center will soon launch an opportunity for immigrants to play a direct role in caring for the community’s mental health needs. The center plans to train six to eight refugees.Sleep therapists” advises other women and mothers through a method called Narrative Exposure Therapy to address complex and multiple traumas.

The therapy, in which patients create a chronological narrative of their lives with the help of a therapist, focuses on traumatic experiences over a person’s lifetime.

Jonathan Orr, coordinator of the Clinical Mental Health Counseling Program at Georgia State University’s Counseling and Psychological Services, said the therapy can be adapted to traditional ways and implemented in underserved communities.

The American Psychological Association It is only recommended conditionally Narrative exposure therapy for adult PTSD patients suggests that further research is needed.

But the method worked for Mohamed Alou, a 25-year-old Kurdish immigrant living in Sennelville, Georgia, who entered the U.S. from Syria in 2016.

Alo was attending Georgia State while working full-time to support himself when the Covid-19 pandemic began. While the decline during the outbreak gave him time to reflect, Syria lacked the tools to process its past, including the threat of flight and violence.

As his busy schedule resumed, he felt unable to cope with his newfound stress and lack of concentration. Narrative says that exposure therapy helped him deal with that anxiety.

Regardless of treatment options, mental health is not necessarily a priority when an immigrant enters the United States. “When one lives a life of survival, vulnerability is the last thing you express,” Bahige said.

But Bahige sees the settlement as an opportunity for the refugees to address their mental health needs.

He said it is important to help immigrants succeed and thrive in all areas of life they are trying to create if they are to take care of their mental health. Changing that mindset can be empowering, and it’s something I’m still learning.