Abstract
Refugees and refugee claimants are faced with the task of rebuilding their lives in an unfamiliar environment, while having to deal with past trauma and multiple ongoing stressors. As part of the clinical intervention with this population, it is important to understand and act on the social determinants of health, which may maintain or exacerbate mental health problems and impede integration. In this chapter, we summarize the legal rights of refugees and refugee claimants, with a strong focus on the criteria that a refugee claimant must meet in order to be accepted as a refugee according to international and Canadian law. We then examine some of the main stressors that refugees and refugee claimants may face during the premigratory, transit and postmigration phase, and discuss in greater depth the impact of immigration detention in the host country and of family separation and reunification. This is followed by a discussion of the clinical assessment and treatment of refugees who have experienced trauma and forced migration. Finally, we provide guidance on writing reports assessing refugee claimants’ mental health in the context of refugee status determination proceedings. To conclude, we briefly examine the relevance for clinicians to engage in advocacy on behalf of this population.
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References
Arya, N., McMurray, J., & Rashid, M. (2012). Enter at your own risk: Government changes to comprehensive care for newly arrived Canadian refugees. Canadian Medical Association Journal, 184(17), 1875–1876.
Australian Department of Immigration and Citizenship. (2011). Immigration detention statistics summary, November 2011. Retrieved from www.immi.gov.au/managing-australias-borders/detention/_pdf/immigration-detention-statistics-20111130.pdf
Barudy, J. (1989). A programme of mental health for political refugees: Dealing with the invisible pain of political exile. Social Science & Medicine, 28(7), 715–727.
Beiser, M. (1999). Strangers at the gate: The ‘boat people’s’ first ten years in Canada. Toronto, Ontario, Canada: University of Toronto Press.
Beiser, M. (2009). Resettling refugees and safeguarding their mental health: Lessons learned from the Canadian Refugee Resettlement Project. Transcultural Psychiatry, 46(4), 539–583.
Bolton, P., Bass, J., Betancourt, T. S., Speelman, L., Onyango, G., Clougher, K. F., et al. (2007). Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: A randomized controlled trial. Journal of the American Medical Association, 298(5), 519–527.
Burnett, A., & Peel, M. (2001). Asylum seekers and refugees in Britain: The health of survivors of torture and organised violence. British Medical Journal, 322, 606–609.
Chaudry, A., Capps, R., Pedroza, J. M., Castañeda, R. M., Santos, R., & Scott, M. M. (2010). Facing our future. Children in the aftermath of immigration enforcement. Washington, DC: The Urban Institute.
Cleveland, J. (2008). The guideline on procedures with respect to vulnerable persons appearing before the Immigration and Refugee Board of Canada: A critical overview. Refuge, 25(2), 119–131.
Cleveland, J., Dionne-Boivin, V., & Rousseau, C. (2013). Droit d’asile et incarcération: l’expérience des demandeurs d’asile détenus au Canada. Criminologie.
Cleveland, J., & Rousseau, C. (in press). Psychiatric symptoms associated with brief detention of adult asylum seekers in Canada. Canadian Journal of Psychiatry.
Crépeau, F., Nakache, D., & Atak, I. (2007). International migration: Security concerns and human rights standards. Transcultural Psychiatry, 44(3), 311–337.
Edwards, A. (2011). Back to basics: The right to liberty and security of person and ‘alternatives to detention’ of refugees, asylum-seekers, stateless persons and other migrants. Geneva, Switzerland: Office of the United Nations High Commissioner for Refugees.
Ehntholt, K. A., & Yule, W. (2006). Practitioner review: Assessment and treatment of refugee children and adolescents who have experienced war-related trauma. Journal of Child Psychology and Psychiatry, 47(12), 1197–1210.
Fazel, M., Reed, R. V., Panter-Brick, C., & Stein, A. (2012). Mental health of displaced and refugee children resettled in high-income countries: Risk and protective factors. The Lancet, 379, 266–282.
Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet, 365, 1309–1314.
Fox, P. G., Cowell, J. M., & Johnson, M. M. (1995). Effects of family disruption on Southeast Asian refugee women. International Nursing Review, 42(1), 27–30.
Geltman, P. L., Grant-Knight, W., Mehta, S. D., Lloyd-Travaglini, C., Lustig, S., Landgraf, M. A., et al. (2005). The “lost boys of Sudan”: Functional and behavioral health of unaccompanied refugee minors resettled in the United States. Archives of Pediatrics & Adolescent Medicine, 159(6), 585–591.
Gorst-Unworth, C., & Goldenberg, E. (1998). Psychological sequelae of torture and organised violence suffered by refugees from Iraq: Trauma-related factors compared with social factors in exile. British Medical Journal, 172, 90–94.
Hathaway, J. C. (2005). The rights of refugees under international law. Cambridge, England: Cambridge University Press.
Herlihy, J., Scragg, P., & Turner, S. (2002). Discrepancies in autobiographical memories—Implications for the assessment of asylum seekers: Repeated interviews study. British Medical Journal, 324, 324–327.
Hinton, D. E., Chhean, D., Pich, V., Safren, S. A., Hofmann, S. G., & Pollack, M. H. (2005). A randomized controlled trial of cognitive-behavior therapy for Cambodian refugees with treatment-resistant PTSD and panic attacks: A cross-over design. Journal of Traumatic Stress, 18(6), 617–629.
Hinton, D. E., Hoffmann, S. G., Pollack, M. H., & Otto, M. W. (2009). Mechanisms of efficacy of CBT for Cambodian refugees with PTSD: Improvement in emotion regulation and orthostatic blood pressure response. CNS Neuroscience and Therapeutics, 15(3), 255–263.
Holtan, A., Rønning, J. A., Handegård, B. H., & Sourander, A. (2005). A comparison of mental health problems in kinship and nonkinship foster care. European Child & Adolescent Psychiatry, 14(4), 200–207.
Hyndman, J., & Mountz, A. (2008). Another brick in the wall? Neo-refoulement and the externalization of asylum by Australia and Europe. Government and Opposition, 43, 249–269.
Ichikawa, M., Nakahara, S., & Wakai, S. (2006). Effect of post-migration detention on mental health among Afghan asylum seekers in Japan. The Australian and New Zealand Journal of Psychiatry, 40(4), 341–346.
Immigration and Refugee Protection Act, S.C. 2001, c.27.
Immigration and Refugee Board of Canada. (2006). Guideline 8: Guideline on procedures with respect to vulnerable persons appearing before the Immigration and Refugee Board of Canada. Retrieved from http://www.irb-cisr.gc.ca/Eng/brdcom/references/pol/guidir/Documents/GuideDir8_e.pdf
Keller, A. S., Rosenfeld, B., Trinh-Shevrin, C., Meserve, C., Sachs, E., Leviss, J. A., et al. (2003). Mental health of detained asylum seekers. The Lancet, 362, 1721–1723.
Kidron, C. A. (2012). Alterity and the particular limits of universalism: Comparing Jewish-Israeli and Canadian-Cambodian genocide legacies. Current Anthropology, 53(6), 723–754.
Kinzie, J. D. (2007). PTSD among traumatized refugees. In L. J. Kirmayer, R. Lemelson, & M. Barad (Eds.), Understanding trauma: Biological, psychological and cultural perspectives (pp. 194–206). New York, NY: Cambridge University Press.
Kirmayer, L. J. (2001). Failures of imagination: The refugee’s narrative in psychiatry. Anthropology & Medicine, 10(2), 167–185.
Kirmayer, L. J., Fung, K., Rousseau, C., Lo, H. T., Menzies, P., Guzder, J., et al. (2012). Guidelines for training in cultural psychiatry. Canadian Journal of Psychiatry, 57(3), Insert 1–16.
Kirmayer, L., Narasiah, L., Muñoz, M., Rashid, M., Ryder, A., Guzder, J., et al. (2011). Common mental health problems in immigrants and refugees: General approach to the patient in primary care. Canadian Medical Association Journal, 183(12), E959–E967.
Kronick, R., Rousseau, C., & Cleveland, J. (2011). Mandatory detention of refugee children in Canada: A public health issue? Paediatrics & Child Health, 16(8), e65–e67.
Laban, C. J., Gernaat, H. B. P. E., Komproe, I. H., Schreuders, B. A., & De Jong, J. T. V. M. (2004). Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in the Netherlands. The Journal of Nervous and Mental Disease, 192(12), 843–851.
Laban, C. J., Gernaat, H. B. P. E., Komproe, I. H., van der Tweel, I., & De Jong, J. T. V. M. (2005). Postmigration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands. Journal of Nervous and Mental Disorders, 193(12), 825–832.
Lie, B. (2002). A 3-year follow-up study of psychosocial functioning and general symptoms in settled refugees. Acta Psychiatrica Scandinavica, 106, 415–425.
Lorek, A., Ehntholt, K., Nesbitt, A., Wey, E., Githinji, C., Rossor, E., et al. (2009). The mental and physical health difficulties of children held within a British immigration detention center: A pilot study. Child Abuse & Neglect, 33(9), 573–585.
Lustig, S. L., Kia-Keating, M., Knight Grant, W., Geltman, P., Ellis, H., Kinzie, D. J., et al. (2004). Review of child and adolescent refugee mental health. Journal of the American Academy of Child and Adolescent Psychiatry, 43(1), 24–36.
Macklin, A. (1998). Truth and consequences: Credibility determination in the refugee context. In Proceedings of the 1998 annual meeting of the International Association of Refugee Law Judges “Realities of Refugee Determination on the Eve of a New Millennium”. Haarlem, The Netherlands: International Association of Refugee Law Judges.
Mares, S., Newman, L., Dudley, M., & Gale, F. (2002). Seeking refuge, losing hope: Parents and children in immigration detention. Australasian Psychiatry, 10(2), 91–96.
Marshall, G. N., Schell, T. L., Elliott, M. N., Berthold, S. M., & Chun, C. A. (2005). Mental health of Cambodian refugees 2 decades after resettlement in the United States. Journal of the American Medical Association, 294, 571–579.
McKeary, M., & Newbold, B. (2010). Barriers to care: The challenges for Canadian refugees and their health care providers. Journal of Refugee Studies, 23(4), 523–545.
Momartin, S., Steel, Z., Coello, M., Aroche, J., Silove, D. M., & Brooks, R. (2006). A comparison of the mental health of refugees with temporary versus permanent protection visas. Medical Journal of Australia, 185(7), 357–361.
Moreau, S., Rousseau, C., Meikki-Berrada, A., TCMR, & ERASME. (1999). Politiques d’immigration et santé mentale des réfugiés: Profil et impact des separations familiales. Nouvelles Pratiques Sociales, 11(2), 177–196.
Moreno, A., & Grodin, M. A. (2002). Torture and its neurological sequelae. Spinal Cord, 40, 213–223.
Nakache, D. (2011). The human and financial cost of detention of asylum-seekers in Canada. Available from Refworld, United Nations High Commissioner for Refugees Web site, http://www.unhcr.org/refworld/docid/4fafc44c2.html
National Collaborating Centre for Mental Health, & Royal College of Psychiatrists’ Research Unit. (2005). Post-traumatic stress disorder. The management of PTSD in adults and children in primary and secondary care (Vol. National Clinical Practice Guideline Number 26). London, England: Gaskell and the British Psychological Society.
Neuner, F., Onyut, P. L., Ertl, V., Odenwald, M., Schauer, E., & Elbert, T. (2008). Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 76(4), 686–694.
New Hampshire State. (2005). Guidelines for initial medical screening and care of refugees resettled in New Hampshire. Concord, NH: New Hampshire Department of Health and Human Services Division of Public Health.
Newman, L. K., Dudley, M., & Steel, Z. (2008). Asylum, detention, and mental health in Australia. Refugee Survey Quarterly, 27(3), 110–127.
Nickerson, A., Bryant, R. A., Brooks, R., Steel, Z., Silove, D., & Chen, J. (2011). The familial influence of loss and trauma on refugee mental health: A multilevel path analysis. Journal of Traumatic Stress, 24, 25–33.
Nickerson, A., Bryant, R. A., Silove, D., & Steel, Z. (2011). A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clinical Psychology Review, 31, 399–417.
Nickerson, A., Bryant, R. A., Steel, Z., Brooks, R., & Silove, D. (2010). The impact of fear for family on mental health in a resettled Iraqi refugee community. Journal of Psychiatric Research, 44(4), 229–235.
Nickerson, A., Steel, Z., Bryant, R., Brooks, R., & Silove, D. (2011). Change in visa status amongst Mandaean refugees: Relationship to psychological symptoms and living difficulties. Psychiatry Research, 187(1–2), 267–274.
Paciocco, D., & Stuesser, L. (2008). The law of evidence. Essentials of Canadian law (6th ed.). Toronto, Ontario, Canada: Irwin Law.
Peltzer, K. (1997). Counselling and rehabilitation of victims of human rights violations in Africa. Psychopathologie Africaine, XXVIII(1), 55–87.
Phillips, J. (2011). Asylum seekers and refugees: What are the facts? Available from the Parliamentary Library of the Parliament of Australia Web site, http://www.aph.gov.au/binaries/library/pubs/bn/sp/asylumfacts.pdf
Porter, M., & Haslam, N. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. Journal of the American Medical Association, 294(5), 602–612.
Pottie, K., Ng, E., Spitzer, D., Mohammed, A., & Glazier, R. (2008). Language proficiency, gender and self-reported health: An analysis of the first two waves of the longitudinal survey of immigrants to Canada. Canadian Journal of Public Health, 99(6), 505–510.
Prabhu, M., & Baranoski, M. (2012). Forensic mental health professionals in the immigration process. Psychiatric Clinics of North America, 35, 929–946.
Protecting Canada’s Immigration System Act, S.C. 2012, c.17.
Pynoos, R. S., Steinberg, A. M., Layne, C. M., Briggs, E. C., Ostrowski, S. A., & Fairbank, J. A. (2009). DSM V PTSD diagnostic criteria for children and adolescents: A developmental perspective and recommendations. Journal of Traumatic Stress, 22(5), 391–398.
R. v. Lavallee (1990) 1 S.C.R. 852.
Re X (2007) CanLII 49705 (IRB).
Re X (2008) CanLII 45239 (IRB).
Robjant, K., Hassan, R., & Katona, C. (2009). Mental health implications of detaining asylum seekers: Systematic review. The British Journal of Psychiatry, 94(4), 306–312.
Robjant, K., Robbins, I., & Senior, V. (2009). Psychological distress amongst immigration detainees: A cross-sectional questionnaire study. British Journal of Clinical Psychology, 48(3), 275–286.
Rousseau, C., Crépeau, F., Foxen, P., & Houle, F. (2002). The complexity of determining refugeehood: A multidisciplinary analysis of the decision-making process of the Canadian Immigration and Refugee Board. Journal of Refugee Studies, 15(1), 43–70.
Rousseau, C., de la Aldea, E., Viger Rojas, M., & Foxen, P. (2005). After the NGO’s departure: Changing memory strategies of young Mayan refugees who returned to Guatemala as a community. Anthropology & Medicine, 12(1), 3–21.
Rousseau, C., & Drapeau, A. (2003). Are refugee children an at-risk group?: A longitudinal study of Cambodian adolescents. Journal of Refugee Studies, 16(1), 67–81.
Rousseau, C., & Guzder, J. (2008). School-based prevention programs for refugee children. Child and Adolescent Psychiatric Clinics of North America, 17, 533–549.
Rousseau, C., Hassan, G., Moreau, N., & Thombs, B. D. (2011). Perceived discrimination and its association with psychological distress among newly arrived immigrants before and after September 11, 2001. American Journal of Public Health, 101(5), 909–915.
Rousseau, C., & Measham, T. (2007). Posstraumatic suffering as a source of transformation: A clinical perspective. In L. J. Kirmayer, R. Lemelson, & M. Barad (Eds.), Understanding trauma: Integrating biological, clinical and cultural perspectives (pp. 275–293). Boston, MA: Cambridge University Press.
Rousseau, C., Measham, T., & Nadeau, L. (2012). Addressing trauma in collaborative mental health care for refugee children. Clinical Child Psychology and Psychiatry, 18(1), 121–136.
Rousseau, C., Mekki-Berrada, A., & Moreau, S. (2001). Trauma and extended separation from family among Latin American and African refugees in Montreal. Psychiatry: Interpersonal and Biological Processes, 64(1), 40–59.
Rousseau, C., Rufagari, M. C., Bagilishya, D., & Measham, T. (2004). Remaking family life: Strategies for re-establishing continuity among Congolese refugees during the family reunification process. Social Science & Medicine, 59(5), 1095–1108.
Rousseau, C., Said, T. M., Gagne, M. J., & Bibeau, G. (1998). Between myth and madness: The premigration dream of leaving among young Somali refugees. Culture, Medicine and Psychiatry, 22, 385–411.
Ryan, D. A., Benson, C. A., & Dooley, B. A. (2008). Psychological distress and the asylum process: A longitudinal study of forced migrants in Ireland. The Journal of Nervous and Mental Disease, 196(1), 37–45.
Ryan, D. A., Kelly, F. E., & Kelly, B. D. (2009). Mental health among persons awaiting an asylum outcome in western countries. A literature review. International Journal of Mental Health, 38(3), 88–111.
Schweitzer, R., Melville, F., Steel, Z., & Lacharez, P. (2006). Trauma, post-migration living difficulties and social support as predictors of psychosocial adjustment in resettled Sudanese refugees. The Australian and New Zealand Journal of Psychiatry, 40, 170–187.
Semprun, J. (1994). L’écriture ou la vie. Paris, France: Gallimard.
Silove, D. (1999). The psychosocial effects of torture, mass human rights violations, and refugee trauma: Toward an integrated conceptual framework. The Journal of Nervous and Mental Disease, 187(4), 200–207.
Silove, D., Austin, P., & Steel, Z. (2007). No refuge from terror: The impact of detention on the mental health of trauma-affected refugees seeking asylum in Australia. Transcultural Psychiatry, 44(3), 359–393.
Silove, D., Sinnerbrink, I., Field, A., Manicavasagar, V., & Steel, Z. (1997). Anxiety, depression and PTSD in asylum-seekers: Associations with pre-migration trauma and post-migration stressors. The British Journal of Psychiatry, 170(4), 351–357.
Sjölund, B. H. (Ed.). (2007). RCT field manual on rehabilitation. Copenhagen, Denmark: Rehabilitation and Research Centre for Torture Victims.
Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. Journal of the American Medical Association, 302(5), 537–549.
Steel, Z., Frommer, N., & Silove, D. (2004). Part I—The mental health impacts of migration: The law and its effects: Failing to understand: Refugee determination and the traumatized applicant. International Journal of Law and Psychiatry, 27(6), 511–528.
Steel, Z., Momartin, S., Bateman, C., Hafshejani, A., Silove, D., Everson, N., et al. (2004). Psychiatric status of asylum seeker families held for a protracted period in a remote detention centre in Australia. Australian and New Zealand Journal of Public Health, 28(6), 527–536.
Steel, Z., Momartin, S., Silove, D., Coello, M., Aroche, J., & Tay, K. W. (2011). Two year psychosocial and mental health outcomes for refugees subjected to restrictive or supportive immigration policies. Social Science & Medicine, 72(7), 1149–1156.
Steel, Z., Silove, D., Bird, K., McGorry, P., & Mohan, P. (1999). Pathways from war trauma to posttraumatic stress symptoms among Tamil asylum seekers, refugees, and immigrants. Journal of Traumatic Stress, 12(3), 421–435.
Steel, Z., Silove, D., Brooks, R., Momartin, S., Alzuhairi, B., & Susljik, I. (2006). Impact of immigration detention and temporary protection on the mental health of refugees. The British Journal of Psychiatry, 188(1), 58–64.
Steel, Z., Silove, D., Phan, T., & Bauman, A. (2002). Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: A population-based study. The Lancet, 360, 1056–1062.
Suarez-Orozco, C., Bang, H. J., & Kim, H. Y. (2011). I felt like my heart was staying behind: Psychological implications of family separations and reunifications for immigrant youth. Journal of Adolescent Research, 26(2), 222–257.
Suicide Prevention Australia. (2011). Submission to the joint select committee on Australia’s immigration detention network. Retrieved from http://www.aph.gov.au/Senate/committee/immigration_detention_ctte/immigration_detention/submissions.htm
Taylor, K. (2009). Asylum seekers, refugees, and the politics of access to health care: A UK perspective. British Journal of General Practice, 59, 765–772.
Taylor, D., & Hattenstone, S. (2012, January 6). Child asylum seekers win compensation for 13-month detention. The guardian. Retrieved from http://www.guardian.co.uk/uk/2012/jan/06/child-asylum-seekers-win-compensation
The Refugee Forum. (2012). By the numbers: Refugee statistics 1989–2011. Available from Human Rights Research and Education Centre of the University of Ottawa Web site, http://www.cdp-hrc.uottawa.ca/projects/refugee-forum/projects/documents/REFUGEESTATSCOMPREHENSIVE1999-2011.pdf
Tseng, W.-S., Cheng, T.-A., Chen, Y.-S., Hwang, P.-L., & Hsu, J. (1993). Psychiatric complications of family reunion after four decades of separation. The American Journal of Psychiatry, 150, 614–619.
Turner, S. W., Bowie, C., Dunn, G., Shapo, L., & Yule, W. (2003). Mental health of Kosovan Albanian refugees in the UK. The British Journal of Psychiatry, 182, 444–448.
United Nations High Commissioner for Refugees. (2010). Convention and protocol relating to the status of refugees. Retrieved from http://www.unhcr.org/protect/PROTECTION/3b66c2aa10.pdf
United Nations High Commissioner for Refugees. (2013). UNHCR global appeal 2013 update—Populations of concern to UNHCR . Retrieved from http://www.unhcr.org/50a9f81b27.html
Vaage, A. B., Thomsen, P. H., Silove, D., Wentzel-Larsen, T., Van Ta, T., & Hauff, E. (2010). Long-term mental health of Vietnamese refugees in the aftermath of trauma. The British Journal of Psychiatry, 196, 122–125.
Van Ommeren, M., de Jong, J. J. T., Sarma, B., Komproe, I., Thapa, S. B., & Cardena, E. (2001). Psychiatric disorders among tortured Bhutanese refugees in Nepal. Archives of General Psychiatry, 58(5), 475–482.
Weinstein, H., Dansky, L., & Iacopino, V. (1996). Torture and war trauma survivors in primary care practice. The Western Journal of Medicine, 165(3), 112–118.
Williams, A. (1990). Families in refugee camps. Human Organization, 42(2), 100–109.
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Cleveland, J., Rousseau, C., Guzder, J. (2014). Cultural Consultation for Refugees. In: Kirmayer, L., Guzder, J., Rousseau, C. (eds) Cultural Consultation. International and Cultural Psychology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7615-3_12
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