1. The Emotional Health and Well Being of Resettled Refugees Considerations for U.S.-based Mental Health Practitioners

2. Contextual Considerations Layered and not single dimensional Respect of fully human status not defined by history or a single incident Assessment must be holistic Treatment must be client- centered and targeted to layered assessment

3. A Good Treatment Plan Is Built From A Good Assessment

4. Broader Context Fleeing  What situation has brought them here? Violence, religious persecution, ethnic cleansing, the combination of all three? Example – Mental health impact of soldiers coming into town raping and pillaging vs. mental health impact of systematic oppression (frozen out of jobs, education) because of your religion and practicing your religion for decades in secret because of fear of jail

5. Encampment or Undocumented  Were they encamped? If so, for how long and under what conditions?  Example – Mental health impact of not being allowed to work for 30 years; lack of micro-nutrient rich foods; lack of social justice system.  Were they illegal in another county?  Example – Mental health impact of little access to medical care, employment, education; high incident of bribery, being forced into unsafe working and housing situations; round-ups by authorities.

6. Resettlement  Come in debt  30-90 days with casework consists of meeting basic needs  Cash and medical assistance is 8 months (until 18 if minor)  @$300 for RCA  @$550 for family of 4 if TANF  Did they leave people behind? Are there continuing obligations and connections to them? What is the current situation in their country of origin?  Example – Continuing to receive news constantly from home regarding deprivation or bombings; paying for parents housing or medical care; left children behind.

7. Common Challenges History Systems are difficult to navigate Mismatch of skills and education If encamped, often little history of education or employment (what works as survival in one setting does not work in another) Lack of English – impacts ability to adequately understand or communicate needs Transportation Short and pressured with little if any safety net adaptation Little IF ANY social capital – impacts ability to find emergency assistance, care for children, employment Separation from traditional support Reaching U.S. does not always translate to “safety.” Refugees often cite resettlement as MORE stressful than trauma events.

8. Individual Considerations What has the individual experienced – not just the group Individual attributes – resiliency, pre-morbid functioning, role and responsibility in the family, education, class, etc. Where are they in the resettlement process? – First 30 days versus 30 years What are their primary concerns? How are they functioning? What symptoms are they having? Know the landscape and ask the individual!

9. Considering Differences The meaning of “ mental health ” Experience/Framework for what “mental health” looks like “I” vs. “We” – How this plays out in assessment and treatment (individual agency versus family support) Causality Solutions

10. Perception of “normal”  What “ should be ”  How it is expressed  What is the cultural norm What is considered “ important. ”  Loss of ‘ role ’  Loss of ritual/ceremony  Loss of place  Injustice  Existential meaning

11. Considerations for Practitioners  Trauma history does not necessarily dictate trauma-treatment  Chronic vs. acute symptoms  Current concerns vs. current symptoms  And more….  Build trust and relationship over time – it’s OK to go slow  Don’t assume knowledge on part of client – about systems, culture, shared understanding of what happens next  Have established and clearly communicated boundaries that are communicated KINDLY - Professionalized helping relationship is not present in many cultures  Be humble enough to do what works  See your own work as layered

12. “…..there is no substitute for deep, empathic, open-minded listening to people. It is, of course, very important to have some knowledge of the culture, values, attitudes, even gestures of people from cultures different from ours. But even with this very useful knowledge, when we work directly with people, we must listen to them with a minimum of assumptions, with genuine interest, caring and curiosity, as well as a desire to truly know their thinking and feelings. We need to balance the truth that people are very much products of their cultures with the truth that, at the core, we are all equally human.” --- Bernard Kempler, PhD

13. Further questions… Beth Farmer, MSW International Counseling and Community Services 206-816-3252 bfarmer@lcsnw.org