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5 - Assessing mental health needs

Published online by Cambridge University Press:  26 August 2022

By
Julia Nelki  and
Piyal Sen
Edited by
Chris Maloney ,
Julia Nelki  and
Alison Summers
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Summary

The authors outline areas that need special attention. The purpose of the appointment should be explained, and the practicalities of attendance addressed. The attitude/approach of the clinician is discussed in relation to creating a sense of safety and trust. Individuals may fear authority and may have had experiences they find difficult to disclose.

Confidentiality, safety and anxieties about the assessment are reviewed, as people may have little prior knowledge of the system and have had bad past experiences. Acknowledgement and discussion are crucial. More detailed discussion of working with interpreters follows, as this is an often-neglected area. Pros and cons of ‘remote working’ are reviewed.

Some specific aspects of assessment areconsidered: difficulties in disclosure and how to explore issues such as torture, sexual violence, domestic abuse, moral injury, and rape.

People seeking asylum may be isolated with few resources.Strengths should be emphasised, and sources of support identified, and contact facilitated. Feedback and checking understanding are helpful, and often fosters trust.Scrupulous record keeping is emphasised.

Keywords

trustinterpretersconfidentialitysafetyriskcultural differencesflashbacksdissociationpsychotic symptomstorture
Type
Chapter
Information
Seeking Asylum and Mental Health
A Practical Guide for Professionals
 , pp. 90 - 115
Publisher: Cambridge University Press
Print publication year: 2022

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References

Baarnhelm, S., Laban, K., Schouler-Ocak, M., et al. (2017). Mental health for refugees, asylum-seekers and displaced persons: A call for a humanitarian agenda. Transcultural Psychiatry, 54(5–6): 565–74.Google Scholar
Bhugra, D., Gupta, S., Bhui, K., et al. (2011). WPA guidance on mental health and mental health care in migrants. World Psychiatry, 10: 2–10.CrossRefGoogle ScholarPubMed
Braakman, M. H., Kortmann, F. A. M., and Van Den Brink, W. (2009). Validity of ‘post-traumatic stress disorder with secondary psychotic features’: A review of the evidence. Acta Psychiatrica Scandinavica, 119(1): 15–24.Google Scholar
Boyles, J., and Talbot, N. (2017). Working with Interpreters in Psychological Therapy: The Right to be Understood. Abingdon-on-Thames: Routledge.Google Scholar
Brewin, C. (2018). Memory and forgetting. Curr Psychiatry Rep. 2018; 20(10): 87. Published online 28 Aug. 2018. https://doi.org/10.1007/s11920-018-0950-7.CrossRefGoogle ScholarPubMed
Chase, E. (2010). Agency and silence: Young people seeking asylum alone in the UK. The British Journal of Social Work, 40 (7): 2050–68.Google Scholar
Cole, E., Espin, O., and Rothblum, E. (1992). Refugee Women and Their Mental Health [PDF]. New York: Taylor & Francis.Google Scholar
Gaudiano, B. A. and Zimmerman, M. (2010). Evaluation of evidence for the psychotic subtyping of post-traumatic stress disorder. British Journal of Psychiatry, 197: 326–7.Google Scholar
Giacco, D., Laxhman, N. and Priebe, S. (2018). Prevalence of and risk factors for mental disorders in refugees. Seminars in Cell and Developmental Biology, 77: 144–152.Google Scholar
Graham, B., Herlihy, J., and Brewin, C. R. (2014). Overgeneral memory in asylum seekers and refugees. Journal of Behavior Therapy and Experimental Psychiatry, 45(3): 375–80.CrossRefGoogle ScholarPubMed
Holtz, T. H. (1998). Refugee trauma versus torture trauma: A retrospective controlled cohort study of Tibetan refugees. Journal of Nervous and Mental Disease, 186: 24–34.CrossRefGoogle ScholarPubMed
Im, H., Ferguson, A., and Hunter, M. (2017). Cultural translation of refugee trauma: Cultural idioms of distress among Somali refugees in displacement. Transcultural Psychiatry, 54(5–6): 626–52.CrossRefGoogle ScholarPubMed
Jenkins, J. H. (1991). A state construction of affect: Political ethos and mental health among Salvadoran refugees. Culture, Medicine and Psychiatry, 15: 139–65.CrossRefGoogle ScholarPubMed
Jurh, W. M., and Kim, K. C. (1990). Correlates of Korean immigrants’ mental health. Journal of Nervous and Mental Disease, 178: 703–11.Google Scholar
Kastrup, M. (2008). Staff competence in dealing with traditional approaches. European Psychiatry, 23(1): 59–68.CrossRefGoogle ScholarPubMed
Keatley, E. (2013). Self-reported head injury among refugee survivors of torture. J Head Trauma Rehabilitation, Nov–Dec; 28(6): E8–E13. https://doi.org/10.1097/HTR.0b013e3182776a7.CrossRefGoogle ScholarPubMed
Kinzie, J. D. (2020). Diagnosis and Treatment. In Kinzie, J. D. and Keepers, G. A. (eds.), The Psychiatric Evaluation and Treatment of Refugees, pp. 21–130. Washington, DC: American Psychiatric Association Publishing.Google Scholar
Kirmayer, L. J. (2012). Rethinking cultural competence. Transcultural Psychiatry, 49: 149–64.CrossRefGoogle ScholarPubMed
Kirmayer, L. J. (2013). Embracing uncertainty as a path to competence: Cultural safety, empathy, and alterity in clinical training. Culture, Medicine and Psychiatry, 37(2): 365–72.Google Scholar
Kohli, R. (2006). The sound of silence: Listening to what unaccompanied asylum seeking children say and do not say. British Journal of Social Work, 36(5): 707–21CrossRefGoogle Scholar
Lehti, V., Antas, B., Karna, T. and Tuisku, K. (2016). The assessment of traumatized refugees: Clinical practices at the Cultural Psychiatry Outpatient Clinic. Psychiatria Fennica, 47: 17–31.Google Scholar
Litz, B. T., Stein, N., Delaney, E. et al. (2009). Moral injury and moral repair in war veterans: a preliminary model and intervention. Clin Psychol Rev., 29(8): 695–706. https://doi.org/10.1016/j.cpr.2009.07.003.CrossRefGoogle ScholarPubMed
Orbach, S. (2010). Bodies. London: Profile Books.Google Scholar
Papadopalous, R. (2002). Refugees, Home and Trauma. In Therapeutic Care for Refugees: No Place Like Home, pp. 31–5. Tavistock Clinic Series.Google Scholar
Priebe, S., Gavrilovic, J. J., Bremner, D., et al. (2012). Psychological symptoms as long-term consequences of war experiences. Psychopathology, 46: 45–54.CrossRefGoogle ScholarPubMed
Rafighi, E., Poduval, S., Legido-Quigley, H., and Howard, N. (2016). National Health Service principles as experienced by vulnerable London migrants in ‘austerity Britain’: A qualitative study of rights, entitlements, and civil-society advocacy. International Journal of Health Policy Management, 5(10): 589–97.Google Scholar
Rohlof, H., Knipscheer, J. W., and Kleber, R. J. (2009). Use of the cultural formulation with refugees. Transcultural Psychiatry, 46(3): 487–505.CrossRefGoogle ScholarPubMed
Schafer, I. and Fisher, H. L. (2011). Childhood trauma and psychosis: What is the evidence? Dialogues in Clinical Neuroscience, 13(3): 360–5.CrossRefGoogle ScholarPubMed
Schönfeld, S. and Ehlers, A. (2017). Posttraumatic stress disorder and autobiographical memories in everyday life. Clinical Psychological Science, 5(2): 325–40.Google Scholar
Schlapobersky, J. (2021). When They Came for Me: The Hidden Diary of an Apartheid Prisoner. Oxford: Berghahn Books.Google Scholar
Schouler-Ocak, M., Graef-Calliess, I. T., Tarricone, I., et al. (2015). EPA Guidance on cultural competence training. European Psychiatry, 30(3): 431–40.CrossRefGoogle ScholarPubMed
Tervalon, M., and Murray-Garcia, J. (1998). Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2): 117–25.CrossRefGoogle ScholarPubMed
Tribe, R. & Raval, H. (eds.) (2003) Working with Interpreters in Mental Health. London: Brunner- Routledge.Google Scholar
Waterman, L., Katona, C., and Katona, C. (2020). Assessing asylum seekers, refugees and undocumented migrants. BJPsych Bulletin, 44(2): 75–80. https://doi.org/10.1192/bjb.2019.67.Google Scholar
Weingarten, K. (2010). Reasonable hope: Construct, clinical applications, and supports. Family Process, 49(1): 5–25.CrossRefGoogle ScholarPubMed

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