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Mental health care barriers for refugees and asylum seekers

DISCUSSION mental health care
I want to tell you the story of a Kurdish refugee woman who was our patient.
She was the mother of five children and they asked for asylum but it was not granted. So they normally would have to go out of Germany. And they got a legal status that is called “Duldung”, in Germany that means “temporary suspension of deportation”. She was very depressed, she could not look after her family anymore, so the eldest daughter, at that time maybe she was 14, she took over the responsibility for the family. The mother was so depressed that she started to try to kill herself. After the first attempted suicide she was in hospital, in a psychiatric hospital but they couldn’t really help her because nobody could talk to her in her language.
Her daughter had to translate for her on admission and there was another interpreted conversation when she was discharged. She got a lot of tablets that she didn’t take because they made her tired. There was another attempt of suicide and psychiatric hospital again, same experiences again. Then they went to an outpatient clinic of a psychiatrist but it was the same experience. It was tablets, no talking, no relief. And then she hid in her house, she didn’t go to any doctor anymore and the daughter tried to keep the family running. We got to know them because the daughter came and she said that she couldn’t cope anymore.
Because the father left the family, the brothers didn’t go to school anymore, and she tried to finish her school but it was very difficult, with all this responsibility. And then we managed to make an appointment for the woman in a special clinic called ”Refugium” in the city of Bremen. There are psychotherapists who treat people in their own language.
Slowly by slowly she recovered and she took over her own responsibilities again. Until now she goes there and is treated in a group with other women and the therapist always tells us that she is a very responsible and a very happy woman now and can manage her duties again and likes to go to the treatment. And in the meantime the family has gotten their permit to stay, the daughter has finished her school and the boys went back to school, finished and are in training. So this is a very typical story but one that ends well, not all do.

Dr. Gisela Penteker is a Family physician and expert on refugee health. As the example she gives in this video illustrates, there are many barriers to mental health care for refugees and asylum seekers.

One barrier is that many health care workers and public officials have not been trained in recognizing signs of trauma. They may not realize that incoherent information given by the asylum applicant or lack of ability to account for certain details often are hints of an underlying trauma, for example torture. As a result, asylum applications are sometimes rejected because the traumatized person is suspected of not telling the truth. For example, an African woman who arrived in Germany described the journey in the boat over the Mediterranean sea as a terrible storm. The official who interviewed her checked the weather during the days she had been on the sea and found them to have been calm days. He therefore concluded that she had not been telling the truth. However, she was just trying to find words for several incidents when she was raped during the journey.

In addition, refugees do not necessarily share information upfront about traumatizing events or mental health problems. Language difficulties and lack of access to an interpreter may also contribute. Another important barrier for access to mental health care for refugees is the fact that the diagnoses and the respective therapies in “western biomedicine” are sometimes not compatible with disease concepts among people from non-western cultural backgrounds. One-to-one psychotherapy with an interpreter is often difficult for patients from a background where the healing power of an entire community is important.

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