Mental Health First Aid comes to refugee service providers

November 3, 2017

Ahmed al-Zubidi, a caseworker with refugee resettlement at Catholic Charities, knows when his clients are suffering, even if they don’t want to tell him. They isolate themselves, unable to leave or even clean their homes. But when he suggests they talk to a mental health specialist, many recoil.

“The feeling may be that the community will judge them, or they feel shame to say, ‘I have this problem,’” he said this week during a Refugee Mental Health First Aid course, offered by the Multnomah County Health Department in partnership with the federal Office of Refugee Resettlement.

One client went to see a counselor, but denied having any anxiety or depression, al-Zubidi told the group.  “After two sessions he didn’t continue,” he said. “Because he pretends he doesn’t have these problems, the doctor says, ‘we can’t help.’”

Al-Zubidi offered the example during the free workshop, which focused on how to help refugees better their manage mental health -- and identify the risk factors and warning signs around depression, anxiety, trauma and other issues that can affect refugees differently. He was joined caseworkers, experts, community members and Multnomah County staff.

Eugene Sadiki monitors patients with tuberculosis and visits local shelters to screen guests as part of Multnomah County’s Communicable Disease Services team. He said he regularly sees symptoms of depression and anxiety in his clients. 

Esther Lugalia works in facilities at Multnomah County’s Department of Assets. In her free time she volunteers with the African Women’s Coalition. She also sees it. “Even me, being from Kenya, we have so much stigma around mental health and when I saw this training I’m like, ‘We need this big time,’” she said. “People don’t want to talk about it, so I want to learn ways to address it.” 

Some immigrant communities experience many of the same traumas as refugees, and those who live without legal immigration status have experienced continued stress on a low-boil for months. Terese Rios Campos is a community health worker with the County who organizes outreach and education for Spanish-speaking communities in Wood Village. Rios lives within blocks of hundreds of clients she serves, and Spanish-speaking residents often turn to her for help.

Parangkush Subedi, a health program analyst with the Division of Refugee Health at the Department of Health and Human Service

When news of immigration raids hit the community, she began coordinating gatherings where people could share stories, ask questions and learn how to protect their families. The Wood Village Baptist Church hosted immigration lawyers who spoke to families about crafting emergency deportation plans. In those plans they in decided who would care for children if, one day, they don’t come home.

“There was a lot of crying,” Rios said. “There’s a lack of hope because immigration was out there several times. They continue to be fearful.”

Participants learned about risk factors that may be specific to refugee clients, including gender.

“Refugee women tend to have a higher level of accumulated trauma than men,” said trainer Parangkush Subedi, a health program analyst with the Division of Refugee Health at the Department of Health and Human Services in Washington D.C. “It is the women of the family who witness their husbands being arrested and tortured, or killed, or they’re raped.”

Education level can be another risk factor, for those who come with advanced degrees from licensed professions. Subedi earned his master’s in microbiology before coming to the United States as a refugee. He took a job stocking the mini-bar in rooms at an Atlanta hotel. Then he pumped gas. 

“If they were high in education, they were a lawyer or a doctor or a professor, then suddenly they have to start all over again,” he said, “This makes people highly stressed.”

Subedi suggested informal settings and casual seating that’s not directly face-to-face could help clients feel more comfortable when they talk about mental health.

“Sometimes refugees don’t want to talk in a formal setting,” he said. “They can get flashbacks of incidents. They can get retraumatized.”

Subedi recommended that when providers want to talk about mental health, they should begin by earning trust. Begin with casual conversation in a comfortable setting of the client’s choice — perhaps it’s a coffee shop, a park, the person’s own home.  “But don’t start right off. Create a foundation,” he said. “When you meet someone, create a foundation before you jump to the real topic.”

Charlene McGee, refugee health coordinator for Multnomah County, said the workshop generated so much interest the added additional days both in Portland and Salem, an area resettling an increasing number of refugees. More than 100 participants, from social and health services, programs such as the Boys and Girls Club, and City of Portland

“There was an overwhelming response,” she said. “It was a busy week, but it was one of these weeks that I could say, ‘you know, I’m doing the right job.’”

That response spurred McGee to begin planning a broader series of health and social service workshops in 2018 for refugee service providers.

“This is a unique population that requires special skills and understanding. It’s a specialized way of delivering care. How we look to customize the care we give to refugees, the same as we do for the homeless population and foster youth? It’s about really striving to move away from that one-size-fits-all model, and looking at how we give that customized care.”