Mental health care for refugees and the need for cultural competence training in mental health professionals

As a result of war and economic/political instability in different parts of the world, forcibly displaced populations have increased to unprecedented numbers. The most recent update from the United Nations High Commissioner for Refugees estimated that at the end of 2019, 79.5 million people were forced to move from their countries due to persecution, conflict, violence or human rights violations. This is a record-high number, and an increase of 8.5 million from 2018.¹ Although Brazil has not traditionally been a destination for refugees from areas such as Africa and the Middle East, in the last three years it has become more sought-out, particularly by Venezuelans. According to data from the National Committee for Refugees and the Federal Police, there were 206,737 applications for recognition of refugee status in the country between 2011 and 2018, of which 80,057 occurred in 2018 alone.²

Although Brazilian refugee legislation is considered one of the most advanced worldwide, there are several challenges to providing mental health assistance for this population. Local and regional studies have reported adverse mental health outcomes in immigrants.³,⁴ Other studies have described psychiatric treatment experiences with refugees and the development of specialized assistance programs.⁵,⁶ However, there is still a lack of data about mental health issues in this population. Therefore, little is known about cultural implications and other variables for different outcomes. Mental health care interventions for refugees are focused on the following areas: promoting social integration, overcoming access barriers and facilitating engagement with mental health services, and treating refugees with apparent mental disorders. Since post-migration risk factors lead to a higher prevalence of depression and anxiety, social determinants, such as access to housing, work, food, and education, promote mental health.⁷ It is not yet known if such basic conditions can be offered here, since more than 50 million Brazilians (25.3% of the population) live in poverty. Concerning other determinants, such as social integration, the local population’s sensitivity and receptivity are not known.

Cultural competence, defined as “the acquisition of cultural knowledge about population subgroups, the adoption of culturally sensitive attitudes, and the acquisition of cross-cultural skills,”⁸ is essential for providing adequate assistance for migrants and refugees.⁷,⁹ Cultural competence skills are considered a priority area for mental health professionals over the next decade. Knowledge of cultural factors and their variations must be considered in the context and significance of mental disorders in different individuals or groups.⁹ Psychiatry residents in developed countries are required to master a body of knowledge related to cultural competence. However, in Brazilian mental health education, especially psychiatry residency programs, cross-cultural aspects of mental health have not been highlighted. Such an emphasis will be important for developing the cultural competence skills needed to deal with this population.

References

• ¹
  United Nations High Commissioner for Refugees (UNHCR). Global trends: forced displacement in 2019. Geneva: UNHCR; 2020.
• ²
  Brasil, Secretaria Nacional de Justiça. Refúgio em números. 4a ed. Brasília: Ministério da Justiça e Segurança Pública. Brasil; 2019.
• ³
  Bustamante LH, Cerqueira RO, De Marzio F, Leite KP, Cadurin TD, Leclerc E, et al. Barriers to care and psychopathology among Bolivian migrants living in São Paulo, Brazil. Transcult Psychiatry. 2020;57:71-80.
• ⁴
  Brunnet AE, Bolaséll LT, Weber JL, Kristensen CH. Prevalence and factors associated with PTSD, anxiety and depression symptoms in Haitian migrants in southern Brazil. Int J Soc Psychiatry. 2018;64:17-25.
• ⁵
  Medeiros GC, Sampaio D, Sampaio S, Lotufo-Neto F. Mental health of refugees: report of a successful case in Brazil. Braz J Psychiatry. 2014;36:274-5.
• ⁶
  de Santana CL, Lotufo-Neto F. Developing a mental health programme for refugees based on participatory action research: an experience from São Paulo, Brazil. Int J Action Res. 2015;11:265-88.
• ⁷
  Giacco D, Laxhman N, Priebe S. Prevalence of and risk factors for mental disorders in refugees. Semin Cell Dev Biol. 2018;77:144-52.
• ⁸
  Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O 2nd. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2003;118:293-302.
• ⁹
  Bhugra D, Tasman A, Pathare S, Priebe S, Smith S, Torous J, et al. The WPA-Lancet Psychiatry Commission on the future of psychiatry. The Lancet Psychiatry. 2017;4:775-818.

Publication Dates

• Publication in this collection
  19 Oct 2020
• Date of issue
  Mar-Apr 2021

History

• Received
  3 Aug 2020
• Accepted
  26 Aug 2020