News

Support for refugees is generally considered to include things that meet basic needs like food, water, shelter and health care. But what about refugees’ mental health?

Cox’s Bazar, a district in southeast Bangladesh, is home to what the United Nations has named the world’s largest refugee settlement. In Cox’s Bazar and around the world, aid organizations have long provided programming and assistance to displaced populations. But more recently, those interventions have expanded to include efforts to improve residents’ mental well-being. The good news is that these programs can make a significant difference in the lives of residents – but only if they work.

Amanda Nguyen, assistant professor in the University of Virginia’s School of Education and Human Development, led a project last spring that reviewed current research on the effectiveness of psychosocial support interventions on displaced people around the world. Often closely connected to mental health support, psychosocial supports are activities aimed at strengthening social connectedness, social supports, coping skills, and the like to support and improve well-being. The review, conducted in partnership with Batten School of Leadership and Public Policy faculty members Kirsten Gelsdorf, professor of practice of public policy, and Lucy Bassett, associate professor of practice of public policy, found that early research shows positive impacts of these programs. But more research is needed.

“Not long ago, there was very little focus on mental health in conflict-affected populations,” Nguyen said. “Now that it is increasing, good intentions are not enough. We need to know if what we’re doing, with the limited available funds, is helping people.”

Read more at News.Virginia.edu.

The ongoing COVID-19 pandemic has opened conversations about improving behavioral health across the nation, and the importance of creating robust, communicative systems of care. In Hawaii, the state’s unique geography and cultural demographics have led to the development of a diverse network of behavioral health services. State of Reform spoke with some of the organizations offering these services about improving access to behavioral health care in the state.

In Hawaii, people experiencing mental health crises or are seeking mental health and substance use disorder services can utilize Hawaii CARES, which offers a free 24/7, statewide call center. Hawaii CARES also works with partners in the criminal justice system and homelessness sector to provide access to behavioral health services for underserved communities.

One of the barriers to behavioral health care, according to Hawaii CARES Clinical Director Dr. Leocadia Conlon, is the amount of time it may take for a person to gain admission into a substance use disorder treatment facility program. To help mitigate this problem, Hawaii CARES refers callers to a bed stabilization program, where people can stay while waiting to enter a facility. Bed stabilization programs are also available to help individuals in mental health crises avoid hospitalization.

Hawaii CARES can refer clients to services under the Department of Health by dispatching a crisis mobile outreach, where a crisis therapist will meet a client in the community and try to help them resolve the crisis in the “least restrictive setting.”

All of these programs require constant communication with different agencies around the state. Dr. Conlon explained that this communication and collaboration are necessary to maintain programs that can best serve the complex behavioral health needs of the community.

Read more at StateofReform.com.

The following blog was authored by Fulvia Camargo; Drew Hickman, BS; Shayla Anderson, MPH, MCHES; Mary Roary; PhD, MBA at the SAMHSA Office of Behavioral Health Equity (OBHE).

Migrants experience difficult conditions in their attempts to enter the United States whether at an air, land, or sea port of entry. This includes parents and children that have fled their home countries due to extreme poverty, violence, and other unbearable conditions for a chance to be given safe refuge in the United States. The experience of seeking refuge or migrating to a new country places children, adolescents, and their parents (or other caregivers) in extreme conditions that may place a strain on their mental and physical health, both at the time of migration and in some cases, for many years ahead.

Effects to Children

Children may experience challenges including struggles with regulating their emotions, completing tasks, misplacing items, and being organized. The prefrontal cortex of the brain does not finish developing until the mid to late 20s. This may result in children having less control of their emotional impulses making it difficult to regulate fear and other emotions. At this developmental stage, it may lead to children being constantly in fear when they are triggered, or when events remind them of their past. Trauma experienced early in life can lead to Post-Traumatic Stress Disorder (PTSD), depression, anxiety, antisocial behaviors, and alcohol and substance use disorders. PTSD may present as difficulty regulating emotions and behaviors, which could lead to difficulty with fear, shame, rage, and potentially substance use. Children may experience difficulty concentrating, learning problems, dissociation, and low self-esteem. Children can suffer from Reactive Attachment Disorder (RAD), a stressor and trauma-related condition of early childhood caused by social neglect and maltreatment. Children that have an attachment disorder may experience emotional attachment difficulty, decreased ability to experience positive emotions, and cannot seek or accept physical or emotional closeness.

Effects to Parents

Parents have a high probability of experiencing PTSD — a condition that may last months or even years. There are stressors that trigger memories of trauma that are accompanied by intense emotional and physical reactions. Parents with PTSD may experience trauma including family separation and physical assault. Parents may also experience a prolonged activation of stress-related disorders; for example, chronic stress is where the body experiences stressors with such intensity that the body remains in a constant state of physiological stimulation. This state can negatively affect all systems of the body including musculoskeletal, cardiovascular, nervous, reproductive, and respiratory.

Migrant parents strive to create a better life for their children and subsequently make the difficult decision to send their children off, unaccompanied, in order for them to cross the border into the United States for a better life. This act can lead to irreparable trauma and increase the risk of anxiety, depression, behavioral difficulties, learning problems, and substance abuse in minors. Under normal circumstances when a child undergoes a traumatic experience, their parents are typically there to help them cope. In the case of an unaccompanied minor refugee, the child will undergo prolonged stress which might lead to changes in genetics and abnormal physiological functioning. After a period of time children are reunited with their closest relatives living in the United States that can be located; for example, grandparents, uncles, aunts, and ideally their own parents. Please find a few resources below for behavioral health providers, teachers/school staff, and workers who may support migrant families at our borders.

Resources to Support Migrant Families

1. Encourage professional counseling or behavioral therapy
   There is a stigma surrounding behavioral and mental health. Some factors that come into play include cost of mental health care and feeling misunderstood. In Hispanic culture a family’s health tends to be valued more than that of the individual members of the family. However, the use of Spanish language materials strategically and coaching in Hispanic values can help improve therapy outcomes.
   
   SAMHSA’s Behavioral Health Treatment Locator can assist with accessing treatment for mental health or substance use disorders. Through this tool, you can identify providers from your area that provide behavioral health services in different languages.
   
   
2. Promote primary care
   Ensuring access to primary care provides an opportunity to establish a medical home for children and parents. Primary care providers can assist with disease prevention, health maintenance, health education, and health counseling. Access to primary care provides an opportunity to identify any developmental or behavioral health issues early and get them appropriately treated. The Health Resources and Services Administration offers the Find a Health Center tool that can assist with locating primary care providers across the U.S. and its territories.
   
   
3. Promote access to education
   Gaining access to educational opportunities can help children and adolescents lead to better performance not only in school but in every part of their lives. Children can feel more connected to their environment by developing strong social skills and friendships. Providing children access to education improves language skills and teaches them how to navigate the new community, which further strengthens social and emotional learning.
   
   There are no federal or state laws that prohibit the admission of undocumented immigrants into U.S. colleges. Only a few states have restrictions on undocumented students attending public colleges and universities. Undocumented students cannot receive federal financial aid for college; however, they can receive scholarships and financial aid in other ways. Prospective students may access resources for higher education obtained through other mechanisms.
   
   
4. Ensure access to resources for families and the behavioral health workforce
   The Administration for Children and Families Office of Refugee Resettlement (ORR) has an Unaccompanied Refugee Minor Children (URM) program. The program offers a range of services including case management by social workers and mental health care for those populations who meet the specific eligibility requirements.
   
   The National Child Traumatic Stress Network was created in 2000 through the Children’s Health Act and focused on increasing access and improving the standard of care for children and families who experience traumatic events. The network provides resources on refugee trauma for the behavioral health workforce and others.
   
   The Centers for Disease Control and Prevention also provides mental health tools and resources for children’s mental health, adult mental health, those coping with disasters or traumatic events, people seeking treatment, and public health professionals.

Additional Resources

Behavioral Health Workforce – SAMHSA’s National Hispanic and Latino Mental Health Technology Transfer Center aims to improve the capacity of the behavioral health workforce that serves Hispanic and Latino communities

Resources to Assist Asylum Seekers

Stress Effects on the Body

The Biological Effects of Childhood Trauma

Reactive Attachment Disorder

Psychologists Respond to a Mental Health Crisis at the Border

The Teen Brain: 7 Things To Know

In order to highlight pockets of excellence across the country, the NNED selects a partner organization to highlight once a month. Rocky Mountain Tribal Leaders Council, has been selected as the Partner of the Month for January.

The Rocky Mountain Tribal Leaders Council mission is to preserve the homelands, defend rights of the Indian Treaties with the United States, speak in a unified voice, offer support to the Indian people, offer a forum in which to consult each other and enlighten each other about peoples, and to otherwise promote the common welfare of all of the Tribal people of Montana, Wyoming and Idaho.

The programs and services that are currently offered:

• Tribal Epidemiology Centers (RMTEC) – Tribal Epidemiology Centers provide various types of support and services due to the variation of the TECs organization structure, divisions, Tribal populations, and their mission and goals. There are currently 12 Tribal Epidemiology Centers in the United States.
• Good Health & Wellness in Indian Country (GHWIC) – GHWIC’s goal is to support a coordinated, holistic approach to healthy living and chronic disease prevention, reinforce the work already underway in Indian Country to make healthy choices and lifeways easier for American Indians and Alaska Natives.
• Public Health Workforce Expansion in Indian Country (PHWEIC) – The purpose of the Public Health Workforce Expansion in Indian Country program to help Tribal Public Health workers play a critical role in closing the gap among the Indian population and move toward health equality.
• Tribal Opioid Response (TOR) – The goal is to increase access to culturally appropriate and evidence-based treatment services to reduce the unmet treatment need and opioid overdose-related deaths through prevention, treatment, and recovery support services.
• All Nation Youth Partner for Success (ANYPS) – ANYPS’s primary goal is to reduce underage drinking and marijuana use among Native American youth (ages 9 – 20) by increasing access to cultural activities and ceremonies.

Learn more about the Rocky Mountain Tribal Leaders Council, and their vision to build healthy, prosperous and strong Tribal communities for the Tribal people living in Montana, Wyoming and Idaho; and their goal to create an environment conducive to change within the communities by cultivating positive collaborative efforts with a sense of purpose by building strong, healthy societies where respect and honor is a way of life.

View a list of previous NNED Partners of the Month.

A new ambulance is now driving around the Denver metro area, but it has no intention of picking up emergency patients. Instead, this repurposed, retired ambulance will be taking care of people in a different way.

The ambulance has been transformed into a mobile mental health clinic run by Joy as Resistance, a nonprofit organization that focuses on LGBTQ+ youth through mental health and wellness services. Those services include partnering with schools and other nonprofits, a mentorship program and individual and group mental health sessions. This old ambulance will now host some of those sessions.

Through a grant from The Colorado Trust, a health equity foundation, Donnelly’s organization was able to buy the retired ambulance and transform it into a mobile mental health clinic.

The future isn’t set in stone for this mobile clinic. For now, Donnelly and the other clinician will use it with their current clients to meet them where they are. Most importantly, Donnelly wants young people to know there is someone here to listen to them.

Read more at ColoradoSun.com.

In a culture where machismo dominates, my existence as both a woman and the eldest daughter has been clouded by the notion that I should prepare for a future in which my sole purpose is to cater to anyone and everyone. This mindset coupled with being the only daughter in the family has led to what feels like the weight of the world on my shoulders. Eldest daughters and daughters, in general, have shown to be fundamental to the way Latino families run. We can think of the role of eldest daughters within Latino households as pillars holding up the structure of the family unit.

More and more recently, I’ve come across TikToks, posts, and other forms of media that have made me feel seen in my role as the eldest daughter. Often, being the oldest and first-generation coincides with being the first in everything. The first to navigate higher education, the first to obtain a degree, and the first to address taboo subjects like mental health.

My own experience and that of others who relate begs the question: How do these pressures affect existing mental health issues within the Latinx community? For the community, there are plenty of mental health stigmas that exacerbate the pressures. This can ostracize folks and prevent them from discussing their struggles with their family as well as keep them from seeking help. At the same time, the perception of mental health issues being associated with being “loca/o” — a highly problematic depiction of people facing mental health issues — heightens the fear and shame that prevents people from speaking out. Because often, personal mental health issues are pushed aside so as not to embarrass the rest of the family, not taking into account what that does to the person. These existing stigmas are further impacted by gender and being the oldest.

Read more at HipLatina.com.