Addressing mental health problems in migrants, refugees

In sharp contrast to Aristotle who defined us as “rational animals,” human beings are very much creatures of feelings, moods and emotions.    

But if moods and feelings are difficult enough to handle in times of peace and plenty, dealing with them in times of war, persecution and forced displacement is almost impossible.

This is the question posed by migrants and refugees as they challenge the societies of today.

Refugees, asylum seekers and irregular migrants need our protection and support.Migrants and refugees are often exposed to various forms of psychological stress and trauma which affect their mental health and well-being.

The greatest form of stress is the fear that they will be arrested, imprisoned and killed by a hostile government and its minions. Another kind of stress is being resented in the host country, and continually looked at with suspicion, if not hatred.

Such hostility and resentment are present during their migration journey too, and during their settlement and integration in the host country.

Accordingly, depression, anxiety, and post-traumatic stress disorder (PTSD) tend to be higher among migrants and refugees exposed to adversity, than among the host populations.

Many migrants and refugees lack access to mental health services or experience barriers to accessing these.They also face disruptions in continuous care as they are often moved around.

What kinds of stress do migrants and refugees face?

Pre-migration: Lack of livelihoods and opportunities for education and development, exposure to armed conflict, violence, poverty and/or persecution — these are some of the reasons which compel people to migrate.

Migration travel: Exposure to challenging and life-threatening conditions including violence and detention, and the lack of services to cover their basic needs.

We know that passage to a new land is usually in the control of ruthless gangs, who either overload boats, or dump their passengers in unfriendly places — thus risking life and limb.  In times of hectic change, there are always evil men ready to prey on the vulnerable.

Post-migration: Reception in the host country is usually cautious, if not unfriendly — another source of tension.

Often there are barriers to health care and other basic services, as well as poor living conditions, separation from family members, possible uncertainty regarding work permits and legal status, and in some cases immigration detention.

The difficulties regarding integration and settlement are even worse.

There are usually poor living or working conditions, unemployment, difficulties regarding language and assimilation; challenges to cultural, religious, and gender identities; changing policies in host countries; racism and exclusion,  social isolation and possible deportation.

Children who have been separated from migrating parents are at even greater risk of developing depression, anxiety, suicidal feelings, conduct disorder, and drug addiction.

Protective factors for mental health

All of the above-mentioned stressful conditions can increase the risk of mental breakdown.

For example, unemployment, poor socio-economic conditions, and lack of social integration among migrants and refugees are risk factors for conditions such as depression.

While stress can exacerbate pre-existing social and mental health problems, it can be buffered by protective factors such as access to employment and services, social support, proficiency in the language of the host country, and family reunion.

Among resettled refugee children, protective factors include better socio-economic status, access to education, a perceived sense of safety, living alongside people of the same ethnic origin, and good parental mental health.

Responding to the social needs of migrants

One way of doing this is by organizing inclusive and accessible prevention programs; by strengthening mental health as part of general health services; and by ensuring timely diagnosis and treatment.

Migrants and refugees contribute positively to society, but they cannot reach their full potential unless they are respected and treated fairly.

For this, clear information must be given on mental health care, how much one is entitled to, and how to receive services (e.g. through community outreach, schools, religious or cultural settings), especially to unaccompanied minors, persons with disabilities, and persons who identify as LGBTQ.

When providing mental health care, one important consideration is the length of stay of the migrant in the host country.

The recognition of skills and qualifications acquired pre-migration can also help their integration into the employment sector. Activities and events that promote the social inclusion of migrants and refugees include community forums or mentorship programs.

However, the social integration that fosters sound mental health also depends a lot on the attitudes of the host societies.

One has to handle the atavistic resentment, subliminal and not often articulated, of people who “look different” from us, who “speak a funny language, eat strange foods,” and who will one day “want to marry our daughters.”

Racial stereotyping goes deep and frequently manifests itself in irrational ways. Most countries still haven’t learned how to deal with multiculturalism.

Migration seeks to address two objectives: economic well-being and social integration. If it succeeds in the first, it usually takes much longer for the second.And mental health problems are related to both.

The present scenario

Traditionally most countries have a hegemonistic majority whose norms and values the minorities have to follow. But as the diversity in society increases, arguments about the common good bring disagreement, and support for it also weakens.

Many countries in Europe are discomfited with the growing demands by migrant Muslims for their own Islamic code, dress and eating habits. The tensions over the women’s veil are just one symptom of this.

There is another factor in economic migration today: feminization.

Almost half the world’s migrants today are women, and usually, they are at the very bottom of the labor market — as domestic servants, or as sex workers, work which exposes them to every kind of hazard at the hands of brutal employers and careless government officials.

But wives and mothers who work abroad also contribute to family dysfunction in their home countries, where men are resentful of their economic independence.

Not enough attention has been given to this, another source of emotional tension in migrant families.

Is migration here to stay?

People commonly expect governments to control migration. In fact, most governments just cannot.  The greater the physical barriers they build, the greater the visa controls, and the more devious the illegal migrant networks become.

Because the demand for work is two-sided: a growing labor force that demands work, often any work; and an industry that finds cheap labor a profitable resource, and one to which it is hardly accountable.

Maybe we should revise our definition of countries, considering them not as nations but as markets.

The nation-state is hegemonistic and controlling.But the marketplace generally adjusts to all kinds of workers, because even slogging in a foreign “sweatshop” pays more than what one gets at home.

Ah, but who will regulate the market?

With due respect to Tom Friedman, the world is flat only on a paper map.In real life, there are ups and downs, knolls and fissures, barriers and detours.  The only constant seems to be the seepage of migrant workers across increasingly porous borders.

And all too often the economic success of these migrants comes at the prohibitive cost of mental and emotional breakdowns.

*The views expressed in this article are those of the author and do not necessarily reflect the official editorial position of UCA News.