Until recently, screening for emotional distress in newly arrived refugees was not a standard practice due to multiple barriers, one being the absence of a valid screening instrument for multiple refugee populations. The Refugee Health Screener-15 (RHS-15) was empirically developed to be a valid, efficient and effective screener for common mental disorders in refugees.
The Virginia Department of Health – Newcomer Health Program (VDH-NHP) and DBHDS-OCLC have begun working to build the supports necessary to administer the screening as a part of the initial refugee health screening program for newly arrived refugees. Refugee health programs in four areas of the state have begun to administer the screening and work in collaboration with area resettlement agencies and behavioral health providers to develop a process for seamless referrals for individuals presenting with high levels of distress. The VDH-NHP and DBHDS OCLC provide technical assistance, linkages to public behavioral health providers, and some interpreter assistance to support the early stages of implementation.
To screen and identify refugees in need of mental health treatment, provide education about mental health issues, discuss expected stress responses, improve adjustment and provide information about or linkage with mental health resources.
Clinical depression is a disorder that affects millions of people worldwide. Refugee experiences, long distance journeys and resettlement in a new country are life-changing events that can predispose refugees to mental health issues. It is estimated that the prevalence of major depression, anxiety, panic attacks and post-traumatic stress disorder (PTSD) is very high in many refugee populations. In studies with representative samples using self-rated scales, the prevalence of PTSD ranged from 9-86%. , , Risk factors that may predispose refugees and asylum seekers to psychiatric symptoms and disorders include: exposure to war, state-sponsored violence and oppression, including torture, internment in refugee camps, human trafficking, physical displacement outside one's home country, loss of family members and prolonged separation, the stress of adapting to a new culture, low socioeconomic status, and unemployment.
The overall prevalence of major mental illness among refugees is likely similar to that in western populations. Upon arrival, a small number of refugees with major mental illness may present with symptoms such as suicidal or homicidal ideation or severe limitations in ability to function and may require immediate attention. This group may include refugees with schizophrenia, bipolar disorder, major depression, traumatic brain injury or PTSD (post-traumatic stress disorder), and need immediate psychiatric evaluation and treatment.
A majority of refugees may not be in need of clinical mental health services, but should have access to a basic mental health screening since all of them have suffered directly or indirectly as a result of crisis, trauma or loss. The Refugee Health Screener – 15 (RHS-15) is a tool developed to detect the range of emotional distress common across refugee groups.
As of 2015, the RHS-15 is available in Amharic, Arabic, Burmese, Karen, Farsi, French, Nepali, Russian, Somali, Cuban Spanish, Swahili, Tigrinya, English, and other languages.
WEBINAR -ADMINISTERING AND IMPLEMENTING THE RHS-15 IN YOUR COMMUNITY
PATHWAYS MATERIALS REQUEST FORM
WHY REFUGEE MENTAL HEALTH?
Researchers have shown that the most common mental health diagnoses associated with refugee populations include post-traumatic stress disorder (PTSD), major depression, generalized anxiety, panic attacks, and adjustment disorder. The incidence of diagnoses varies within various populations and their experiences.
A range of studies has shown rates of PTSD and major depression in settled refugees to range from 10-40% and 5-15%, respectively. Children and adolescents often have higher levels of these disorders with various investigations revealing rates of PTSD from 50-90% and major depression from 6-40%. Risk factors for the development of mental health problems include the number of traumas, delayed asylum application process, detention, and the loss of culture and support systems. (Refugee Technical Assistance Center: Mental Health; UNHCR, 2014; World Health Organization; Keller, A., and Stewart, A., 2011)