1. Services to Support Refugees Who Have Survived Torture & Trauma PRIMARY CARE WORKSHOP Presented by Francesca Faggioli, Clinical Psychologist

2. Topics: Vision Mission Team RTR Core Services Who is a refugee? Intake procedure Intake criteria Stakeholders in NZ and internationally Refugees in NZ Triple challenge Refugee choice? Common presenting issues Mental health definition Mental health conditions Principals of treatment Communicating effectively Strengths of refugees Questions and conclusion

3. Vision Refugees, who have experienced torture and trauma, and their families, settle successfully in Aotearoa New Zealand.

4. Mission Provide specialised mental health services for refugees who have experienced trauma and/or torture Provide support and capacity building for their families and communities

5. Team Clinical Clinical Manager 6 Counsellor/Advocates Social Worker Psychiatrist (DHB secondment) Non Clinical General Manager Administration/Finance Programmes and Services Coordinator

6. RTR Charitable Trust established in 1997 as Wellington Refugee as Survivors Trust. In 2012 changed name to Refugee Trauma Recovery. Specialised mental health service for refugees Clinical and advocacy role Range of community services and programmes: Home safety, Rainbow, Capoeira, FICT, Art project, 4 published books of short stories, Safety and Wellbeing day, new projects coming………. Training for all health and social service professional who have refugees as patients/clients.

7. Core Services Clinical Non-clinical Screening Assessment Treatment Community care coordination Onward referral Consultation and Liaison Training and education Community based programmes and projects

8. Who is a Refugee? ‘A refugee is: any person who, owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his/her nationality and is unable, or owing to such fear, is unwilling to avail himself/herself of the protection of that country.’ United Nations Convention Relating to the Status of Refugees

9. Intake procedure Referrals from different sources (plus self-referral) Referral by RTR website If referral meets intake criteria, triaged and waitlisted Where referrals do not indicate a history of trauma and torture, the service will go back to the referrer and collect more information Statistical data: about 1/3 of refugees coming to NZ are resettled in WLG, of which about 1/3 are referred to RTR

10. Intake criteria Arrived in NZ under Immigration NZ’s refugee quota programme. Convention refugees, arrived as asylum seeker. Arrived in NZ under Immigration NZ’s Refugee Family Support Category (Family reunification). Severe symptoms due to trauma and torture Multiple trauma and multiple losses

11. RTR does not take in: Acute mental health issues including psychotic illness. People in acute, critical conditions and at high risk of self-harm and harm to others will be referred to crisis intervention teams. Alcohol and drug problems. Domestic violence and other marital issues unless they are clearly the consequence of torture and trauma and not an acute presentation.

12. RTR works closely with: Public health Interpreting New Zealand Red Cross including Pathways to employment Union and other primary health providers English Language Partners ChangeMakers Family Reunification Trust Community Law Centres Multicultural Learning and Support Service

14. Refugees in New Zealand ▪ New Zealand accepts 750 quota refugees each year ▪ From July 2016 to June 2018 an extra 600 Syrian refugees will arrive, most in Wellington region. ▪ From January to June 2016 the 3 intakes from the 2015-16 quota will include 150 Syrians and most will be settled in the Wellington Region ▪ Up to 300 RFSC (family reunification)arrive as migrants ▪ About 300 Asylum Seekers arrive in NZ each year. 25%-30% given refugee status.

15. Triple challenge Trauma and Torture History Resettlement issues Refugee journey

16. Refugee choice? The moment everything changed for the refugee was when they had to choose between the two greatest fears of a human being: death or loneliness.

17. Common presenting issues: Body aches and pains Headaches / dizziness Heart palpitations Heighten state of arousal Hypertension Breathing difficulties Sleeping problems and recurrent nightmares Tremors, numbness, weakness, fainting, sweating Digestive problems/poor appetite Recurrent intrusive memories and suicidal thoughts Panic attacks Feeling fearful, nervous or restless High terror alert Frequent sadness, crying, depression, feeling bad Withdrawal from social contact or other activities, social phobia Avoidance of situations that conjure up painful memories Loss of memory and concentration Guilt, shame Anger

18. Mental Health Definition ‘Mental health is defined as a state of wellbeing in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to her or his community.’ ( W.H.O.) Mental health problems may not be the first one to present with or mentioned to health professionals

19. Mental Health Conditions Post Traumatic Stress Disorder (often complex type) Severe Depression High Anxiety Panic Attacks Adjustment Disorders Traumatic bereavement Complex Grief Somatisation and/or Chronic Pain Head Injury Other

20. Principals of Treatment Integrated systemic and psychosocial approach Human Rights commitments (e.g.. effective communication, availability of trained Interpreters; right to rehabilitation) Validation and respect of resilience and strengths Mutual collaboration and cooperation Culturally tailored interventions Wide range of treatment modalities

21. Communicating Effectively Important for rapport building, clinical safety and culturally competent assessment/treatment RTR provides interpreters for all counselling sessions by Interpreting New Zealand Service

22. Strengths of Refugees Resilience Courage Determination Endurance and tenacity Creativity Different cultural knowledge/wisdom Diverse experience Often multilingual Knowledge and experience of survival and beyond

23. Questions ?

24. Thank you for your attention Handouts: - RTR brochure - Annual report - Clinical Managers business card