Mental Health Enables Integration: Re-thinking Treatment Approaches for Refugees
The majority of refugees has been affected by traumatic stressors. The accumulation of these stressors increases the risk for stress- and trauma-related mental health problems, as the risk for trauma-related disorders increases with the number of experienced traumatic event types. This dose-effect relationship partly explains the high and also varying post-traumatic stress disorder (PTSD) prevalence rates in conflict and crisis regions. Yet, the consequences of trauma exposure and high PTSD prevalence in refugees go beyond individual suffering and impact the livelihoods of families and whole communities. Beside trauma-related psychopathology, impaired cognitive functioning may explain the impaired psycho-social functioning in everyday life. The resulting impairments in psychosocial functioning reduce the resources needed for social adjustment and integration. Refugees are expected to meet high functional requirements in terms of social integration into and financial independence from the host society. Yet, mental health problems affect the successful integration and adaptation. In addition, several factors constitute barriers to access to healthcare for refugees. As a consequence, only a small and selected minority of refugees currently seeks and finds treatment options for mental health impairments in Germany. Inspired by evidence-based stepped care approaches that have been implemented in overstrained health systems in (post-) conflict settings, in this chapter we propose a community based stepped care for refugees in Germany. The principle aim of this approach is to overcome barriers for refugees through the involvement of staff with a refugee or migrant background as outreach screeners and counsellors. The outlined community based stepped care approach could turn into a national and possibly even international model for the mental healthcare of refugees.
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