San Diego County is home to many refugees and migrants and the current crisis highlights the longstanding crisis of migration that is driven by multiple factors. According to the California Department of Social Services, between the year of 1975 to 2017, 86,598 refugees came to San Diego County. The rate of arrival has increased in recent years. In 2017, 1532 individuals arrived. With the current state of the multiple crises in the world, the rates of migration and the numbers of refugees seeking new homes is expected to continue to increase.
A recent systematic review from a national cohort which included 779 refugee children found that psychiatric illness disproportionately impacts this group. In particular, and not surprisingly, rates of PTSD, depression, and anxiety were higher than expected. Prevalence of PTSD was 22.71%, depression 13.81%, and anxiety disorders 15.77%. Virtually all of these disorders are likely consequences of the dislocation trauma associated with the migration and refugee experience, but it is relevant to note that social isolation, social withdrawal and ongoing trauma from lack of fit with the new cultural expectation and as a consequence of rejection, bullying and the general demands of acculturation are factors that can lead to psychosocial stress and behavioral health difficulties, including higher rates of suicide and psychosis. These difficulties and adaptation issues, of course, are magnified by the impact of detention and family separation that are sadly often an element of the relocation process.
These elevated prevalence rates highlight the importance of multimodal intervention strategies for this vulnerable population to include screening for both general behavioral health problems and for overt psychiatric disorder when refugee families come for care.
As with many at-risk populations, mental health services for migrants and refugee youth and families often encounter challenges in engaging the population. Amidst the multitude of challenges faced by these families, including adjustment to a new culture, language barriers, economic challenges, cultural barriers to family engagement, coupled with the perceived stigma and demands of pursuing treatment for mental health problems put timely intervention for these on the back burner for many. In the face of these multiple issues, even sensitive healthcare providers may not adequately have the time or capacity to prioritize attention for timely and needed behavioral interventions for the youth and for their parents, many of whom have face similar emotional challenges.
Integrating behavioral health care within a nexus of community-based and family-focused services and supports in coordination with other care management activities for basic needs is generally seen as a best practice for refugee families (McNeeley et al, 2019). Actualizing this ideal remains a challenge in most communities.
In San Diego, the following agencies provide services to the refugee communities:
- International Rescue Committee: https://www.rescue.org/united-states/san-diego-ca
- Jewish Family Services: https://jfssd.org/our-services/refugees-immigration/refugee/
- San Ysidro Health Center (Caldean/Iraqi): http://www.syhc.org/cmss-social-services/
- Catholic Charities: https://www.ccdsd.org/refugee-services
- Somali: http://www.somalifamilyservice.org/
- SD County Behavioral Health Services: https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/bhs/TRL/TRL%20Section%203/BHS-CYF%20Outpatient%20Clinics%204-4-19.pdf
Efforts to screen patients and raise awareness about the prevalence of behavioral and psychiatric challenges within primary care settings will increase our community’s opportunities to support refugee families. We know that building a trusting relationship with our patients, increasing access to basic needs and targeting resiliency factors makes a difference. Engagement of pediatric providers in screening, care coordination, treatment and appropriate referral activities can provide an important impetus and an access point to care when behavioral health intervention is indicated.
Blackmore R, Gray KM, Boyle JA, Fazel M, Ranasinha S, Fitzgerald G, Misso M, Gibson-Helm M (2019). Systematic Review and Meta-Analysis: The Prevalence of Mental Illness in Child and Adolescent Refugees and Asylum Seekers. J Am Acad Child Adolesc Psychiatry. 2019 Nov 25. pii: S0890-8567(19)32175-6. doi: 10.1016/j.jaac.2019.11.011.
California Department of Social Services (2017) Refugee Programs Bureau FFY 2017 Refugee Population Data Snapshot By County. https://www.cdss.ca.gov/Portals/9/Refugee/Arrivals/2017_Comprehensive_Chart.pdf?ver=2017-12-27-111308-203
McNeeley, C., Sprecher K., Bates-Fredl, D., Price, O., Allen, C., (2019). Identifying Essential Components of School-Linked Mental Health Services for Refugee and Immigrant Children : A Comparative Case Study. Journal of School Health 2019 1–12. https://doi.org/10.1111/josh.12845