Unique challenges and experiences of immigrant and refugee communities inform mental health care services
By Carli Million
Hayfa Dawood arrived in the United States as an immigrant from Ethiopia over 10 years ago. She quickly found that navigating a new nation while raising her children was going to be a very difficult process.
She was also grappling with her own mental health challenges, but she was reluctant to seek services because mental illness is highly stigmatized in Ethiopian culture. That all changed when she found the African Communities Public Health Coalition, where she says she can openly be herself because they understand her unique situation and needs.
Services oriented toward immigrant and refugee mental health can offer guidance for many who find themselves in situations like Hayfa’s. The Mental Health Services Oversight and Accountability Commission (MHSOAC) recently awarded five new stakeholder grants to organizations that are paving the way for the mental health of immigrant and refugee populations in California.
MHSOAC published a Request for Proposals for immigrant and refugee mental health services in February and received 24 proposals. The Commission accepted the top five proposals, one from each of the California regions.
“During the selection process, we prioritized grassroots organizations that are doing the work on the ground at the local level,” said Tom Orrock, MHSOAC Chief of Commission Operations and Grants. “We heard from our stakeholders that small organizations are often passed up for funding opportunities. In response to that feedback, we set out to fund organizations whose employees are immigrants and refugees themselves and who provide care in the languages of the communities they serve.”
The grant recipients include The African Communities Public Health Coalition (The African Coalition) (Los Angeles Region), Boat People SOS (Southern Region), the Hmong Cultural Center of Butte County (Superior Region), Visión y Compromiso (Bay Area Region), and Healthy House Merced within a MATCH Coalition (Central Region).
The organizations will provide local level advocacy, training, and outreach on behalf of the populations they serve.
Properly identifying the mental health needs of individual immigrant and refugee communities may be difficult, as most require care that is culturally specific and highly contextual. Organizations that utilize local outreach services may be best equipped to provide such care, as they are connected directly with the clients they serve.
Senait Admassu, the Founder and Executive Director of the African Coalition, says “we need to understand how each community is unique so we can identify what the underlying issue really is” for each client. At the African Coalition, for example, they serve individuals of any African descent, with the needs of an Ethiopian immigrant being different than those of a Jamaican immigrant.
While each community is unique in its barriers to utilizing mental health services, there are challenges commonly found across most immigrant and refugee communities. This includes the lack of culturally competent and contextually specific services, language barriers, stigma, and a fear or distrust of Western medicine practices.
Culturally competent services are fundamental in providing care to immigrant and refugee populations. Consideration of the culture and language services not only make it easier to deliver care to these populations, but they increase the likelihood that immigrants and refugees will seek services in the first place.
Executive Director of Healthy House Merced, Candice Adam-Medefind, emphasizes the importance of these services for immigrants and refugees as they attempt to navigate an already confusing health system. Healthy House Merced, for instance, has a language bank of interpreters in more than 18 languages.
The organization also implements training to equip interpreters for the unique challenges of mental health services. “Breaking the Silence: Trauma Informed Interpreting” is an example of one such program. The program trains interpreters to provide language services for sensitive topics such as mental health with cultural consideration.
However, even if culturally competent services are available, there are often barriers within immigrant and refugee communities themselves that prevent people from utilizing mental health resources when they need them.
Representatives from the African Coalition, Healthy House Merced, and the Hmong Cultural Center agree that mental health is highly stigmatized and taboo for most immigrant and refugee families. Stigma within the family can highly dissuade an immigrant or refugee from seeking mental health help at all.
Education and outreach programs about mental health can assist in reducing stigma as the discourse surrounding mental health is normalized.
The African Coalition, for instance, provides leadership training for immigrant and refugee community members. During their 40-hour Community Leadership Development training program, participants learn about mental health and methods to engage the community through public speaking, storytelling, and art to increase overall discussion and to reduce stigma. Public engagement in culturally informed practices enables leaders to dispel hesitations about using mental health services with consideration of the nuances of their own community.
Finally, stigma may be exacerbated by a general fear or distrust of Western medicine practices.
Yia Xiong, the Assistant Director of the Hmong Cultural Center of Butte County, says the Center has a program focused on elderly immigrants and refugees, as the distrust of Western practices is especially high among this age group. The program collects data on how culturally competent programs can bridge traditional practices with Western medicine to effectively deliver care.
Despite the challenges in addressing the mental health needs of immigrant and refugee populations, the organizations chosen for stakeholder grants with MHSOAC are actively working with county leaders toward solutions.
In this partnership, MHSOAC will be able to link the work that is being done on the local level to the state level and “connect actual people and their experiences with decision makers,” Admassu said.
MHSOAC is meeting with each individual grant recipient group in the following weeks, and all will be invited to attend the Commission’s Stakeholder Collaboration Meeting on August 15th.