Refugee Mental Health:
Successful Referrals and Expected
Outcomes
Sr. Stephanie Spandl, MSW, LICSW
Ninth Annual
Local Public Health and Resettlement Agency Forum
Assessing Need for Referral
Assessing Need for Referral
1.
2.
3.
4.
5.
6.
Appearance – how they look
Behavior – how they act
Cognitions – how they think
Em otions – how they feel
Functioning – how they m anaging day-to-day life
Special considerations, such as history of torture,
sex ual abuse, dom estic abuse, alcohol/ drug use,
unaccom panied m inor, single parent of m ultiple
children, post-partum
Mental Health Trends in Refugees
Depression
Mental Health Trends in Refugees
Anxiety
Mental Health Trends in Refugees
PTSD
Mental Health Trends in Refugees
Somatic Disorder
(Pain, Digestive
issues, headaches)
Mental Health Trends in Refugees
Mental Health Trends in Refugees
Dissociation
Mental Health Trends in Refugees
Chemical
Dependency
Successful Referrals
Research services
Expertise/experience working with refugees?
Willingness and ability to adapt traditional
therapy?
Comfort working with interpreters?
Flexibility regarding missed appointments?
Willingness to do home visits?
Willingness to help schedule transportation
and link to case management services?
Successful Referrals
A warm hand-off
Make the first appt. for the client
Bring the client to meet the provider the first time
Make sure transportation, etc. arranged
Ways to Explain Therapy
Mental Health as a Continuum
Refugee experience and resettlement as
stressful - normalize some symptoms – illness
has to do with intensity, duration and effect
on functioning
Not just sane/crazy
Ways to Explain Therapy
Aug 12
Mild illness
Severe
Illness
Moderate
Illness
May 15
Healthy
cold
Flu
Digestive
Aug 12
Mild illness
High BP
Diabetes
Heart
Disease
Stroke
Cancer
Dead
Severe
Illness
Moderate
Illness
May 15
Healthy
Sadness
Worry
Not
sleeping
Panic
Attacks
Depression
PTSD
Psychosis
Actively
Suicidal
Dead
Ways to Explain Therapy
Someone to help you feel better – a doctor of
the heart/feelings/mind.
Ways to Explain Therapy
Explore who they talked to in past and
present– family, friends,
Ways to Explain Therapy
Religious leaders…note how
resettlement has separated them from
traditional support system.
Ways to Explain Therapy
Therapist is someone to listen to their stories so the
sadness and worries are less heavy, to help them
figure out their problems and find resources/solutions
– to make sure they are not alone
Sometimes problems are too heavy for family and
friends and they need another person to help lighten
the burden
What Happens During Therapy?
Assessment
Lots of questions to understand how they are
feeling and their life experiences.
Establish a therapeutic relationship/trust
Start with what is most important to the client
Be useful – help find solutions to practical issues
Be flexible – missed appts., home visits if
necessary
Ask permission to
collaborate with others
such as primary care
physician, case managers.
Therapeutic Interventions
Relaxation techniques
Deep breathing
Guided imagery
Muscle relaxation
Stretching/yoga/exercise
Somatic Interventions – regulating the
nervous system and the fight, flight, freeze
responses
Attention to body sensations and movements
Reworking the traumatic memory via the
body/mind connection
Somatic touch
Therapeutic Interventions
Narrative Therapy
Telling the story and highlighting moments of
strength, hope, kindness and intelligence even in
the trauma – refocusing the narrative
Did you outwit captors?
Who was kind to you?
How did you survive?
When/how did you make it to safety?
Cognitive Behavioral Therapy
Working to change your thoughts so that you
change your behavior to something more positive
Treatment Groups
Reduces isolation
Community support in healing
Therapeutic Interventions
Solution Focused Therapy
Miracle question – what would life be like if you
felt good or your problems were gone?
Look for exceptions – examples of times when
they were or are closer to their goal
Affirm and focus on strengths and build on them
Supportive Therapy
Supportive listening
Emotional support
Advice/guidance
Problem-solving
Expected Outcomes
Reduction in symptoms
Increased functioning
In the home – caring for children/family
In the community
In the workplace
Improved relationships
Varies
by
Client
Increased capacity for pleasure
Length of Therapy:
For clients with greater level of functioning to start with who
actively engage and try some of the suggestions – 6 mo – 1
year
For clients whose illness is very deep, who have ongoing
stressors at home (such as abuse) or not much support
system or who are not willing/able to try new things to get
better, it can take several years or more. Some people
make progress and then come less frequently for
maintenance.
Health Insurance/County Benefits
Medical Assistance covers 20-22 visits with no
questions
Private insurance – health equity
More sessions require a request based on a
treatment plan
Therapy sessions qualify for medical
transportation
County MFIP work participation waivers for
mental health issues – doctor or therapist
must fill out medical opinion form –
eventually apply SSI if severe and longlasting
Doctor, psychiatrist or psychologist can fill out
citizenship test waiver for mental health
reasons.
Prevention
Reminder
Therapy does not need to wait until you are
very sick.
Therapy can help when there are smaller
problems or stressors and help prevent more
serious mental health issues.