Helping Refugees Heal: Pathways to Wellness
While working as a social worker at a refugee resettlement agency, Beth Farmer saw that mental health support was a major gap in the services accessible to refugees.
“When you’re driving a client to a job interview, and they’re crying and telling you that they lived in the woods for three years, sucking water from mud, and that their newborn baby and wife were killed in front of their eyes — of course, you start to think that this person needs some extra support,” she said (in an understatement).
Even after fleeing unimaginable circumstances like terror, murder, rape, or torture, refugees face extraordinary challenges. There are about 15.4 million refugees worldwide (not including 27.5 million internally displaced people); and less than 1 percent eventually qualify for resettlement with the UN after a rigorous application process.
Refugees who do make it to the United States are immediately under pressure to quickly gain economic self-sufficiency.
“The economic pressures are tremendous,” Farmer said. “After eight months, the support and the Medicaid stop.
“This is a population that has been heavily, heavily traumatized, and they’re being asked to do a lot in a very short amount of time. That tends to increase stress, and trigger anxiety and depression symptoms.”
Finding employment as soon as possible is key for resettled refugees. But compounding the challenge of finding a job—difficult for almost anyone in today’s economy—are the effects of post-traumatic stress disorder (PTSD) and depression.
While King County had long offered mental health services covered by Medicaid, government and community entities had no way to engage refugees about mental health services and provide help. As a result, most refugees had little knowledge of those services and how to access them.
To address these barriers, Farmer created Pathways to Wellness, based in King County, Washington, in partnership with Public Health of King County, Lutheran Community Services Northwest, and a network of licensed mental health agencies. Pathways has pioneered an evidenced-based tool to help detect mental illness in refugees and connect them to care. Through a key partnership with Public Health of King County, it is able to screen every refugee that arrives in the county for mental health issues, and refer those with significant symptoms to Medicaid-supported services.
The tool is a 10-minute questionnaire that was developed with the help of licensed medical practitioners. It allows any public health worker to screen refugees with different linguistic and cultural backgrounds that include Iraqi, Bhutanese, Burmese, and Karen populations.
Because all refugees must undergo a general health screening by Public Health when they arrive in the country, the Pathways tool is applied to all of them. It is easily integrated with a physical health screening and deployed in a non-stigmatizing environment, while making efficient use of medical providers’ limited time and resources.
The tool provides an early intervention so that refugees can access mental health resources before pressures mount and their Medicaid runs out. This makes the Pathways’ model a strong example of how common sense can solve a problem and unlock existing resources so that a system functions more efficiently.
Partnerships with culturally-specific resources, such as Asian Counseling and Referral Services, as well as continued engagement with local refugee communities, have also been key to Pathways’ effectiveness. The tool was developed using professional translators and multiple focus groups to ensure that it employs culturally sensitive, effective communication.
“We tend to talk about mental health in the United States through very Western-based concepts,” Farmer said. “But directly translated words often have different meanings in different cultures. So we spend a lot of time making sure we were asking the right questions in the right way.”
Thanks to the Pathways program, 70 percent of the refugees that have screened positive for significant mental illness symptoms are seeking services in King County. Refugee communities’ high level of participation reflects the importance of culturally sensitive engagement when it comes to mental health.
“We conducted some qualitative interviewing of individuals that had gone through the program, and they said they felt surprised that we knew which questions to ask them,” Farmer said. “They felt relieved that someone was actually asking them how they were doing.”
The tool and referral service have also saved lives.
“We’ve found people that have had recent suicide attempts that no one knew about,” Farmer said. “We’ve found people that had been on medication in their home country, but had run out and hadn’t told anyone because they were ashamed.
“There have been people who’ve said, ‘Yes, I’ve been in the hospital for PTSD before.’ One man hadn’t slept more than two hours a night for eight years.”
Refugee organizations are seeking to learn from Pathway’s approach because of the effectiveness of its methodology for developing culturally-tailored mental health screening tools. Even non-refugee organizations that engage with immigrant and foreign-born aging populations are discussing how to partner with Pathways to adopt or adapt its screening method for mental health.
“Organizations are starting to say, ‘Maybe one size doesn’t fit all,” Farmer said. “We need to have a variety of approaches to mental health that will work for our increasingly diverse American population.”
Pathways to Wellness was selected as a finalist in the Making More Health: Achieving Individual, Family And Community Well-Being competition. Read about more solutions transforming the field of health on the competition page and vote for your favorite entry! Don’t wait — voting ends tomorrow, November 30, 2011.