This Mental Health Awareness Month, RAICES is calling attention to the fact that migrant justice in the U.S. hinges upon equitable access to culturally competent, trauma informed mental and behavioral health services.
Displacement and migration can inflict significant trauma, and the process of resettlement in a new home and community, away from one’s natural support systems, adds additional layers of stress. Refugees statistically reflect higher than average rates of depression and suicidal ideation, but cultural differences and language barriers often make it difficult for people to receive support.
In the wake of COVID-19, RAICES quickly recognized the increasing need for mental and behavioral health services to support our refugee community members. Many refugees have been detained and/or delayed access to reception and placement services in the U.S. due to pandemic health protocols and restrictions. Fears of contracting COVID-19 in addition to job loss, reduced social support, the breakdown of public services, and the pivot to virtual learning for school-aged children, exacerbated stressors for immigrants.
In response to these challenges, RAICES launched a trauma-informed, culturally-competent mental and behavioral health diagnostic and treatment services program for refugees in 2021 with initial funding from the Center for Disaster Philanthropy (CDP), The Gunzenhauser-Chapin Fund of the Piedmont Trust Company, and The Philadelphia Foundation. By building out our mental health service capacity, RAICES has been able to provide 36 clients with access to sustained mental and behavioral health services in the initial year of this program.
In September 2020, we invited health and human services consultant Sasha Verbillis-Kolp to train staff on culturally competent care and addressing trauma and emotional health and wellbeing for newcomers to the U.S. With her support, RAICES codified our standard operating procedures and workflow development, facilitating case manager to clinician collaborations and centering our clients’ agency in accordance with trauma-informed best practices. In February 2021, Lynsey Tucker, LCSW, joined our team as a Mental Health Clinician, significantly expanding our staff capacity to support mental health services. Tucker specializes in treatment for trauma-related issues and has a decade of experience working in mental health and substance use recovery with houseless and veteran clients living with severe and persistent behavioral health conditions. She operates under a guiding framework of being person-centered, trauma-informed, and recovery-oriented, and conceptualizes treatment through interpersonal neurobiology and mind-body orientations.
Following the United Nations High Commissioner for Refugees (UNHCR) Operational Guidance on Mental Health and Psychosocial Support, RAICES does not refer clients to mental health services until their most basic needs (e.g. food, shelter) have been met, as it would be difficult for someone in acute crisis to engage in counseling. Once basic needs have been secured, a case manager requests consent from a client for referral to a clinician based upon culturally-competent assessments. We established both telemental health and in-person treatment options, and provided language translation and interpretation needs, including Pashto, Dari, Arabic, Swahili, and Tigrinya. Clients typically receive 3-6 months of care, after which the client and provider decide together whether continued care or referral to another service may better meet individual needs.
Our service providers have honed a sustainable and scalable service model to best support refugee populations, taking into account the various and unique obstacles our clients face. With our clients who are actively working to establish employment, as well as in-home care or child-care and education plans, we focus on stabilizing security needs first before reengaging in an in-depth clinical intervention when viable.
RAICES has made the experience of emotional validation accessible to clients reflecting signs of severe trauma and stress-related disorders, including post-traumatic stress, adjustment, major depressive, and generalized anxiety disorders. Those of all ages who have faced displacement at minimum in the midst of a global pandemic and international conflict can now feel seen and heard, in addition to feeling understood and accepted through trauma-informed, culturally-competent mental and behavioral health diagnostic and treatment services. These services allow for better emotional regulation and reduced proclivity to major depressive and anxiety conditions, improving the chances for successful resettlement in the U.S.
For example, a recent arrival from Afghanistan has struggled with memory loss and lack of focus, which is not uncommon for individuals under extreme stress. He arrived in the U.S. with three school-aged children and his wife, who is pregnant and also going blind –– thereby limiting his ability to secure employment due to at-home care demands, especially with the delays in school enrollment. Despite his desire to engage in counseling services, he had a hard time switching into clinical intervention, as he did not have essential security needs in place. However, RAICES established and refined a client-centered, culturally-competent standard of mental and behavioral health diagnostic and treatment services that is structured to recognize when such services could in fact hinder rather than benefit.
While a huge boost to our capacity, this process was not without challenges. Digital barriers and faulty wifi made it difficult to scale our telemental health reach, and we often resorted to socially-distanced, in-person services. Likewise, sessions with interpreters required more time, which limited our clinician caseload capacity, and third party translators still left a barrier to interpersonal trust-building between clinicians and clients.
Of the people we served through our mental health services in our pilot period:
- 67% are Afghan humanitarian parolees and Special Immigrant Visa holders,
- 19 % are Iraqi Special Immigrant Visa holders,
- 11% are refugees from the Democratic Republic of Congo and Eritrea,
- 4% are a Victim of a Severe Form of Trafficking (VOT) from Mexico,
- 67% are adults, and
- 33% are minors.
The mental health of youth and adolescents has been most heavily influenced by extensive waitlists for school enrollment, noting a desperation for the community-building and structure of a classroom.
Despite challenges, the program has proven to be transformative. One client who left Afghanistan when the U.S. withdrew in August 2021 arrived with her husband, a former employee of the U.S. Embassy in Afghanistan, and her child — leaving behind what she knew to be a full and happy life in Kabul with close family ties and a career as a kindergarten teacher. Upon their arrival, they experienced an extended period of detention on a military base with limited belongings and strict COVID-19 health protocols. She became consumed with feelings of uncertainty and insecurity –– constantly in tears, unable to focus or retain information, exerting control by undereating or overeating.
Following her husband’s request for a referral, RAICES took a bottom-up approach to intervention, providing her with the space to build and experience safety and stabilization before exploring dysregulated feelings. This approach affirms an individual’s behaviors as valid and applies both feeling and logic to process past trauma. Over the last several months, her depressive criteria has gone from from severe to mild. She is now enrolled in an immersive English Language Learners program and expressing more hope about her and her family’s future in the U.S.
Refugee Resettlement Expansion
The development of this program prepared RAICES to expand our trauma-informed, culturally-competent services for Afghan community members following the U.S. withdrawal of troops from Afghanistan in August 2021 — and to advocate for their needs.
In just over a year, we have strengthened our holistic approach to reception and placement, and reaffirmed RAICES’ position as a qualified resettlement agency in Texas. We expanded our resettlement capacity in San Antonio by 50 percent to approximately 400 individuals annually and will welcome 370 Afghan humanitarian parolees between 2021 and 2022. RAICES also received funding from the Preferred Communities federal grant program to enhance services for newly-arrived refugees and ensure pathways to self-sufficiency. As part of the scope of work, we are providing existing and new community partners with training in trauma-informed counseling.
Looking ahead, RAICES intends to extend the reach of our mental and behavioral health diagnostic and treatment services, including the creation of additional engagement methodologies throughout the resettlement cycle and an increased capacity for additional clients. As COVID-19 protocols are lifted, we anticipate being able to expand the number of clients served at one time through centralized in-person counseling, rather than scattered-site delivery of service, and the potential of an additional clinician, as necessary.
How You Can Help
In order to support the successful matriculation of immigrants and refugees in U.S. society, a holistic approach to care must include expansive mental health services that prioritize the needs of the whole person and are informed by individuals’ lived experiences. Otherwise, the needs will persist and deepen due to lack of access, cultural differences, and language barriers. But such culturally competent, trauma informed care is only possible through philanthropic support of community members like you. Please consider making a contribution today.