Becoming displaced can be a significant source of psychological distress. This, along with a number of factors associated with the resettlement process, such as finding employment, learning a new language, or navigating a new system of public benefits can cause short- or long-term mental health concerns in refugee populations.
According to the American Psychiatric Association, roughly 1 in 3 refugees and asylees experience high rates of post-traumatic stress disorder (PTSD), depression, or anxiety. Over the past five years, mental health services have been increasingly incorporated into the IRC in NJ’s programming to respond to these needs. A combination of intakes and assessments, group therapy and wellness sessions, counseling services, and referrals for individualized therapy and medication are offered.
Two programs at the IRC in NJ that currently incorporate these mental health services are the Intensive Case Management (ICM) program in the Resettlement Department and the Mental Health and Psychosocial Support (MHPSS) program within the Health and Wellness Department.
The Intensive Case Management program is dedicated to providing care past the initial 90-day resettlement period to clients with presenting needs. These services are available to refugees experiencing mental health concerns, physical disabilities, or medical conditions; survivors of domestic violence and gender-based violence; single-headed refugee households; refugees who identify as lesbian, gay, bisexual, transgender, or queer; or those facing any additional barriers.
Nathalie Leonardo, the Intensive Case Management Supervisor at the IRC in NJ, explains that there is a big emphasis on self-sufficiency within this program, with an emphasis on teaching clients how certain systems work. Her day to day involves “reviewing and responding to calls and messages from clients, determining the varying levels of needs and prioritizing what is most urgent, meeting in-person and remotely with clients to discuss their more pressing needs, and determining next steps within their service plan.” She also supervises a team of caseworkers that provide case management services and ensures that the program is adequately addressing and adapting to clients’ changing needs.
The Health and Wellness department is one of the newest departments at the IRC in NJ, increasing capacity to serve more clients and address their physical and mental health needs. Monica Indart, the Clinical Supervisor at the IRC in NJ, came to the IRC with a breadth of knowledge after over 20 years of experience providing trauma-informed psychotherapy to asylum seekers and working overseas in war conflict areas, including Palestine and Turkey during the Syrian conflict. She started as a consultant with the IRC and is now supervising a pilot externship program for Masters of Social Work students while also providing individualized counseling to clients with more urgent mental health needs.
Many refugee individuals and families struggle to access mental health services. Cultural and linguistic barriers are not always accommodated by providers. This, accompanied by misinformation both on the provider's and patient’s side, severely impacts one’s access to care. These unique challenges are characteristic to the service delivery of mental health care providers and negatively impact refugees and migrants.
One challenge that Monica has experienced with her new externship program has been bridging the gap between what students learn in school versus what provides thebest support to clients. Evidence-based practices, or practices based on the best available scientific evidence, are emphasized in most MSW programs. These practices often do not perceive community-based experiences, rather centering the individual’s background in the provision of services. Western psychology has traditionally focused on addressing thought patterns and prioritizes healing the mind whereas Eastern practices view the body and mind as one, often incorporating spirituality. According to Monica,
“Most of our clients come from a collective-based culture, and stress is experienced more in the corporeal than cognitively.”
Monica's extensive international experience has revealed to her that Western methodologies, which focus on cognitive behavior therapy, are not always the best fit for clients.
Nathalie voices a similar challenge in case notes and service plans being targeted toward individuals but not always in consideration of the family unit as a whole. While individualized care is a tenet of IRC programming, there are certain situations where it may be more useful to provide services to the entire family. Another challenge that has come up in connecting clients to care has involved external service providers and misunderstandings about services available for refugees. Medical providers may not be informed on how to support migrants, especially those who may be survivors of torture or trafficking. This could lead to inadequate or limited services in the form of denying tailored support such as interpretation or follow-up, which all patients have a right to receive. Some providers have even denied care to clients, not understanding that they are in fact eligible for the services they are seeking.
Despite the aforementioned challenges, the IRC in NJ has taken the initiative to ensure that health programming is all-encompassing and responsive to individual clients’ needs.
To overcome some of the challenges associated with the dominance of Western ideologies in mental health education and programming, Monica has incorporated Eastern practices into training for MSW students and counseling for clients. Though this tends to be a more systemic problem with how mental health is conceptualized, she makes sure to emphasize how culture dictates all realms of health to the externs in her program and ensures that she takes both body and mind into account when providing individualized services. Through her past experience, Monica has also learned the importance of understanding the courage of leaving when working with these individuals.
Monica explains: so what we try to do within the services we offer is "translate" these messages of the heart and mind into how they are expressed in everyday life, how we can help ease our client's suffering while also helping them manage the challenges of daily life.
Having conversations with all family members, even though case management services are still individualized, is crucial for building trust between clients and their caseworkers. Nathalie explains “We try our best to address needs uniformly as a family in order to spread impact and include family members in precise discussions and details.” A common example of this occurs when connecting clients with housing. Housing preferences and needs are identified during individual sessions and noted on case notes, but the whole family will be involved when finding housing.
In addressing certain gaps in service from healthcare and other providers, Nathalie reflects, “It becomes part of our jobs to teach service providers about eligibility and point out what has been overlooked.” This often involves explaining the lived experiences of refugees and what types of care they are qualified for, based on their status. Thus, increasing accessibility to mental health services is an act of advocacy.
Hopes and Visions for the Future
Nathalie and Monica share their hopes and visions for the future of mental health programming, at the IRC and of other service providers.
Monica hopes to see Mental Health and Psychosocial Support programming integrated into all IRC in NJ programs, not just programs provided by the Health and Wellness Department. Though all programming is trauma-informed and culturally responsive, further embedding the guiding principles of the MHPSS program will help reduce certain stigmas around mental health. It would also ensure that all staff members can identify when clients are in need of mental health services and connect or refer them to the proper care. Moving forward, Nathalie wishes to strengthen advocacy efforts and ensure that service providers are adequately addressing the needs of the populations the IRC supports.
The IRC in NJ is hopeful for the future of mental health access and the ability to help clients feel more empowered in their journeys.