Bridging a Divide at Inaugural Refugee Mental Health Conference

September 8, 2016

Therese Lugano, a community health worker at Mid County Health Center, works with clients from across the globe

Counselors, refugee resettlement staff and public servants came together this week for the state’s first refugee mental health conference, where more than 200 providers met to discuss the challenges of serving refugee clients and methods to bridge what can be a wide cultural divide.

“I left behind my siblings and my mother. There was a lot of pain; also a lot of guilt because I left my mother alone,” Salah Ansary, director of Multicultural Services for Lutheran Community Services NW,  said Thursday during opening remarks at the Kennedy School. “I think it was the right choice. My mother pushed me.”

Ansari left Afghanistan in 1978 and brought his family to the United States two years later. He began working with Lutheran Community Services NW, one of the state’s three refugee resettlement agencies, in 1980 and struggled to raise awareness about, and money for, mental health services.

“It’s so important that we adequately address this,” he said to a standing-room only crowd filled with providers.

Now Lutheran Community Services NW has brought together the people who can, with support from the state of Oregon, CareOregon, Multnomah, Clackamas and Washington counties.

Multnomah County has invested for more than a decade in local nonprofits that employ bilingual and bicultural staff to serve immigrants and refugees. Lutheran’s culturally-specific mental health program, Pathways to Wellness, is one of them.

“The government can’t take care of these needs on our own, and I don’t think anyone would want us to,” said David Hidalgo, the county’s director of Mental Health and Addiction Services. “That’s why I’m hoping we’ll hear from all of you.”

David Hidalgo, left, director of Multnomah County's Mental Health and Addiction Services, chats with Salah Ansary from Lutheran Community Services Northwest

The county dedicates $1.5 million a year to culturally-specific and refugee mental health services. Hidalgo said the county has had to find creative ways to overcome limits of an inflexible system set up to treat U.S.-born residents. It’s a system funded by taxpayer dollars that demands a billing code and diagnosis.

“But what’s needed doesn’t always fit that traditional model,” he said. Refugees, in some cases, are better served through programs that support community development, for example. And before treatment comes a process of outreach and building trust. There’s no billing code for that.

Charlene McGee, a senior health policy analyst who leads county efforts to better serve immigrant and refugee clients, said the refugee community and the organizations who serve them are at a pivotal moment.

“We have successes we can build on and challenges we can work on,” she said. “We can redefine the refugee experience.”

She called on agencies to use and share data that informs policy and shapes community-based intervention. And she imagined what might be achieved by case management that breaks down the silos between housing, and health, employment and education.

“When you look at refugee children who end up in the criminal justice system,” she said, “I wonder what could we have done from Day 1.”