Living in peace? Refocusing on dignity and healing for refugees.
Why Petra Dankova, Voice of Faith speaker 2016, thinks, that we need to get better at attending to the hearts and the souls, better at supporting the mental health and psychosocial well-being of (not just) the newcomers. Research shows that mental health of asylum seekers continues to deteriorate in exile, especially when they live in detention or large camps. But is this a fact we have to live with or can we do something to counter this horrible dynamic?
The end of July 2016 was an anxious time in Bavaria, a German region that has just recently become my new home. In a span of one week, three times a young man attacked strangers in public – one with an ax, one with a gun, one with a home-made bomb. Every time, there were speculations of whether the attacker “ran amok” or whether it was a terrorist attack. Each of the three young men had a history of mental health problems or even attempted suicide. And while some politician asserted that the control over asylum-seekers must be tightened and while many people stepped up to say that acts of individuals must not sway our resolve to be a welcoming place for those in need, I thought: we need to get better at attending to the hearts and the souls, better at supporting the mental health and psychosocial well-being of (not just) the newcomers.
This is a theme that claims my attention not only because of these latest extreme cases of violence. I also see my Syrian friends a year after they arrived in Germany, some of them descending into depression as their lives continue to hit new barriers. “Everything is a problem,” Mohammed tells me, “people always remind us that we are refugees.”
It is even worse for those who must stay in the large governmental housing facilities for asylum seekers. There, desperation, outbursts of rage, alcohol abuse and domestic violence makes itself at home with those who live in cramped rooms and constantly worry about whether they will be allowed to stay in Germany. All these phenomena are well-documented. Research shows that mental health of asylum seekers continues to deteriorate in exile, especially when they live in detention or large camps. But is this a fact we have to live with or can we do something to counter this horrible dynamic?
Some years back, I worked with the Jesuit Refugee Service in the remote refugee camps of the Horn of Africa. When I told people that I focused on psychosocial assistance to refugees, many looked at me in disbelief. If mental health is so often seen as a luxury in Western Europe or the United States, which sane person would offer such services in a refugee camp? Is not talking about feelings an extravagant – or misguided – pastime when a war is raging just beyond the horizon and children are dying of preventable diseases?
In my explanations at that time I often focused on the pragmatic reasons of why such help “made sense:” The experience of becoming a refugee involves incredible pressure on the personal, family and communal resources of people. Whether before and during the flight, or after arrival in the new environment, people experience violence, death of loved ones, destruction of dreams and constant uncertainty. These pressures impact mental health and can result in post-traumatic stress, depression or anxiety. They also disconnect people from their usual ways of coping with stress – by taking them away from family, trusted community leaders or religious practices that have until then provided a sense of peace and meaning.
A depressed person has immense difficulties keeping their important refugee status determination appointments. An anxious person easily becomes involved in a fight at a food distribution center. A traumatized person might come to a medical clinic repeatedly complaining of stomach pains that the doctor cannot trace to a physical problem – because they are really an incarnation of a psychological problem. In other words, a person with an impaired mental health is unable to take advantage of the life saving services that a camp offers and even seems to disrupt services for others. Disregarding mental health can get expensive! Investing in mental health can pay off in the chronically underfunded refugee assistance operations.
The next question, of course, is what can we do to help? Is not therapy and medication the treatment for mental health concerns? But when we think of this solution, we hit so many barriers: many more people seem to be affected by mental health issues than can be treated by available professionals; there is often a language barrier between clients and service-providers in the host countries; people may be reluctant to access mental health services and be labeled as “crazy.” So is mental health for asylum seekers and refugees even distantly plausible?
Luckily, what we can learn from a variety of emergencies around the world is that most people do not need a psychiatrist or a psychologist. Most people need something much more basic, something that with a bit of concerted effort and empathy can be offered anywhere in the world: A psychosocial intervention might mean that a person received information about where they are and what they can expect in the first days of their stay so they can feel a level of predictability return to their lives. A psychosocial intervention might mean that living quarters offer people a sense of privacy and safety. A psychosocial intervention might mean making music together or having a safe place to play for children. A psychosocial intervention might mean that someone is available to listen to a story – and to hear the pain, the loss and maybe the hope that a person still has. That listener might be a psychologist. It might also be a properly trained and supervised volunteer.
The IASC Standing Committee on Mental Health and Psychosocial Services has developed a pyramid that illustrates the desired balance between the various interventions for improvement of mental health of those caught up in emergencies.