Research Paper Sample: Immigrant and Refugee Mental Health

Mental health illness is on the rise, but are some groups at higher risk than others? 

Immigrants/Refugees face many unknowns and have many obstacles to overcome when entering the U.S. Some obstacles include academic, legal, political, housing, transportation and healthcare resources (book quote). With many new changes and cultural shifts, these populations are at higher risk of developing mental health disorders. Many refugees felt oppression in their previous homeland and survival pressured their desire to leave their homeland. Many refuges faced trauma, physical and sexual violence in their previous country (quote). Despite needing mental health services, very few seek them (4.9% of Asian-Americans, 7.3% for Hispanic-Americans, 8.6% for African-Americans (Utilization Quote)

Nurses that work in primary care or emergency departments would be the first encounter for these patients. Most patients will not go beyond primary facilities (book quote), so it is vital for nurses to understand mental health issues and recognize when proper treatment is advocated. If the provider and patient build positive rapport in this setting, consent with treatment will increase. Some of the leading factors of mental illness for refugees/immigrants are accessibility, culture adaptation, and social environment.

Accessibility and language barriers are some problems refugees face when looking for mental health services. Refugees don’t know what services are accessible in their host country (mental health and refuges). Each country’s healthcare system is set up differently and patients might be slow to search for treatment based on communication difficulties. Patients might feel uncomfortable providing mental health issues to interpreters, especially if the mental health disease is shamed in their country. The cost of interpreters makes it limited to communication over the phone which further complicates the relationship(mental health quote). Some success with older immigrants was when they sought mental health professionals who had similar cultural traditions and were able to communicate in the same language. (Utilization). Nurses can provide treatment if they know who the providers are in their neighborhood. Communication and culture barriers can cause misdiagnosis which can lead to failed treatments (mental health and refuges). If treatment fails, patients will be reluctant to trust psychiatric medicine. Besides communication barriers, refugees that are undocumented might have no access to medical insurance (utilization quote). This narrows their available resources for treatments and medication, and they only seek treatment in emergency cases.

Nurses need to consider that mental health issues for refugees/immigrants might present differently than what they’re known to. Physical manifestations, consisting of pain and fatigue, might raise in these patients (mental health and refuges). This is especially true with cultures that don’t acknowledge mental issues. Nurses need to be up to date on their cultural knowledge. Some cultures present depression in this manner, while other cultures might present it differently. Mental illness is recognized differently in diverse cultures. The more encounters a nurse has, the better educated she will be. 

Another factor for refugees/immigrants is disruptions in social networks (mental health an quote). Although when immigrants enter the US, they are happier than when they were in their home country, but over time some may develop psychiatric illness (mental vs pop). Accumulating stressors such as unemployment or housing issues can place refugees in uneasy situations. These patients may have limited family. The isolation and loneliness can expose them to alcohol and drugs. Nurses need to be conscious of patients that are self medicating. Referral to social workers will provide for services such as housing and help with nutrition. Refugees of a certain age have harder times of adjustment, this includes adolescent and older populations. (mental health and refuges).

Nurses in primary care will need to understand their population. While working with certain groups, nurses need to be aware of their own cultural views and separate those from treatment. Certain cultures are more open to mental health treatment, while other cultures might consider mental illness as a weakness. Nurses can develop cultural knowledge by attending events and programs (book quote). Communicating with someone from that culture who’s already established in the US can help you understand them. Certain patients prefer to get information from their friends and family vs providers. (Utilization). Building trust with these patients is a priority. Understanding that you are not working with one patient but a culture can help these patients accept advice from providers. One study that had surprising results was that “Chinese immigrants with a high school education or more were 70.8% less likely to receive mental health services” (utlization). This is surprising, as with some education, they refused to receive treatment. Educating patients regarding the normal response to trauma can get compliance with treatment. Patients need to understand that reactions to PTSD are normal. This normalization of mental illness will help refugees accept treatment. Many Chinese immigrants did not know how mental health issues present themselves (utlization) Nurses can also provide educational services for patients regarding mental illness and what the symptoms look like.

Not all immigrants reject treatment, when a study was done with Chinese immigrants in New York City the reasons some used mental health services were if “they were female, lived over 10 years in the community, perceived a need for help and perceived higher depressive symptoms” (Utlization). Building bridges with community will create healthier outcomes.