It’s time to get good at talking about mental health.
Three ways to help refugees – and each other – create a healthy path
This story was produced as a larger project by Tim O'Shei for the 2020 National Fellowship. His project focuses on explaining the myriad mental health challenges refugees face and taking readers up close to those realities through the experience of families.
His other stories include:
Robert Kirkham/News file photo
One set of statistics is blasting upward. Another group of numbers is about to rise. They may seem to have nothing to do with each other – but in truth, they are related as we head into 2021, and they mean this:
The numbers rising fast are those that measure Americans’ chronic stress during the pandemic. Depression and anxiety are rampant: A Census Bureau survey last month revealed nearly one in four New Yorkers reported feeling anxiety for at least half of the previous week, and 13.5% also reported feelings of depression. Those results mirror several other reports, and health experts fear that as vaccines help us transition into a new normal, post-traumatic stress disorder – especially for health care providers who have been fighting Covid-19 since March – may become an acute problem, too.
The numbers that are about to rise are those of refugees resettling in the United States, likely including Buffalo. Resettlement numbers in this area dropped from 1,929 people in 2016 under then-President Barack Obama to just 474 by 2019 under the Trump administration’s tightened immigration policies. But President-elect Joe Biden has signaled that he plans to raise the refugee admissions ceiling to 125,000 nationally. (By contrast, the current number under Trump is 15,000.)
Though the change won’t be immediate, that means Buffalo will likely see an increased number of refugees coming here to build new lives. They fill jobs, boost the population, increase diversity, open businesses – and as they do that, many will need mental health support, even if they don’t call it that, or even recognize it.
“You try to work through their PTSD, and for some, it’s pretty impossible,” said Douglas Klotzbach, executive director of H.E.A.L. International, a Buffalo nonprofit that supports career development for refugees.
Klotzbach has been dealing with trauma in his own family: His brother-in-law died of Covid-19. “So I get it,” he said. “It’s just been a hard year for us.”
But Klotzbach – a white, American-born architect-turned-nonprofit executive who grew up in a rural area, then lived in Clarence before moving to the city – is quick to point out that refugees’ trauma is “10 times worse” than the struggles his family is facing. “They went through war,” he said. “They went through – literally – hell. It’s hard: You come here and not only are you learning a new language and a new culture – a very different culture than what they’re coming from – but you’re then bringing that together with PTSD.”
That can manifest in issues from self-harm to suicide to addiction to abuse. Klotzbach’s point is pandemic-related tragedies aren’t the same as the trauma of war, poverty, famine and rampant death. But it seems clear that 2021 will be a year of healing.
Here are three ways we can do that better as a community, based on interviews with health care executives and practitioners, as well as refugees:
1. Think (and talk) about “mental health” as “health, period.” The implications of the mind-body connection are well-established: Stress that is ongoing or toxic – meaning intense and prolonged – causes inflammation that impacts a person’s organs and immune system. But experts say we need to talk more about mental health as simply “health,” especially for people from cultures that don’t separate the two.
“We have to be careful how we say mental, because mental is taboo in some cultures – it doesn't exist,” said Abdirahman Farah, who is a practice manager at the Community Health Center of Buffalo, which performs health assessments on refugees. Farah, who also works with H.E.A.L. International, moved here from Somalia. “In the Western world, they don’t really view the mental and the mind and the body as one,” he said. “They’re divided. But in other cultures, when somebody has physical pain, mental is included. It’s a whole.”
2. Look for signs that someone needs support — even if they’re not asking. America’s self-help culture – from pop psychology books to social media confessionals to Dr. Phil – has made it easier for many people to openly talk about their mental health. But that doesn’t include everybody, and to the aforementioned point, it excludes anybody from a culture that doesn’t recognize mental health. So whether you’re a health provider, a coworker, a friend or a family member, it helps to look for signs that something unsaid is happening.
When conducting refugee health assessments, Michelle Smith, a nurse practitioner at the Community Health Center of Buffalo, sometimes notices jittery behavior, shaking legs and hair pulling. Her patients may not be reporting any signs of depression or anxiety, but their body language suggests it. “You can view that they’re having trauma,” she said. “They’re not able to express exactly what it is.”
Ting Lee, a licensed mental health counselor in Buffalo, works with a range of clients, including those who are American-born and refugees around the world. “The way that trauma is manifested is extremely different across the cultures,” said Lee, who is from Singapore. Her Asian and Arab clients, she said, tend to externalize their symptoms by noting physical conditions such as, “My back hurts,” or “I can’t get out of bed.” Sometimes, she added, her clients will see doctors who order an MRI, but then find no serious physical ailments, which then leads to a behavioral health referral.
On the opposite, Lee said, “Cultures that identify with Abrahamic religions are very in touch with affect and emotion. They’re able to say, ‘I have no meaning. I'm unable to build a new home in the U.S. I have a lot of survivor’s guilt.’ ”
Gender differences play out here, too. One example: Research by Dr. Isok Kim, an associate professor at the University at Buffalo’s School of Social Work, found a "pronounced" gender disparity in Karen refugees, who are an ethnic minority from Burma. The rate of alcohol use disorder for Karen men was 24%.
For Karen women? Zero.
“Women tend to report more of the symptoms when it comes to depression, or anxiety or some trauma-related symptoms, but they don't drink,” Kim said. “And for men, it’s on the flip side.” Men tend not to verbalize symptoms, Kim said, but instead will “drink – and drink a lot.”
3. Reframe thinking around humanity and individuality. Labels that stick can strip humanity. “Refugees” are people – and just because they all come from faraway places under arduous conditions, they still have individual personalities, preferences, needs and insecurities. “Refugee is not a definition,” said UB’s Kim. “It is an experience.”
And though the comparison isn’t direct, you could say the same for anybody affected by the pandemic: If you’re “jobless” or “infected,” you’re not just a statistic. You’re a person dealing with the difficult reality – and, most likely, so are the people around you.
As 2020 becomes 2021, we’ll be applying the concepts of survival, healing and rebuilding to our own lives. And so, too, will the people who will be joining us in the coming years. Dr. LaVonne Ansari, the CEO of the Community Health Center of Buffalo, hopes that we can broaden our thinking to recognize the worldview of people from other places, rather than expecting them to force-fit themselves into our own.
“We have to begin to incorporate who they are as human beings,” Ansari said. She was talking about refugees, but that advice applies to all people and challenges – silently or aloud.