Once in the U.S., the stresses continue. Adapting to new environments, languages and cultures can affect mental health as much as the trauma of life in a war-torn nation.
“They probably think they have a really good picture of the life in the U.S., but the situation is probably different than they thought,” Zhang says.
And there are barriers to getting help.
Sometimes it’s a cultural issue. Accessing health care in the U.S. is probably different than in refugees’ home countries. Davey says her clients face several challenges before they even see a mental health professional -- like getting reliable transportation and child care for appointments.
“If I have someone on the south side that needs to see someone in midtown, it’s at least two buses and it’s probably about an hour commute for a one-hour session,” Davey says.
During those sessions, refugees who don’t speak English also need a quality interpreter, which is expensive for health care providers. Interpreters are also needed to explain basic information such as how doctors’ appointments are made, what treatment is covered by insurance and what fees are associated with treatment.
“It can be very difficult for our clients to navigate, and they feel frustrated and just kind of give up and just don’t go back,” Davey says.
Refugees are people who come to another country fleeing persecution, war and violence in their homelands. Research shows the trauma refugees suffer before coming to the U.S., and the difficulties they face starting over in a new country, can cause anxiety, depression and other mental health issues.
Rates of post-traumatic stress disorder in refugees are especially high, says Diane Mitschke, an associate professor in the school of social work at the University of Texas at Arlington.
“Sometimes as much as 10 times the rates we see in a typical American population,” she says. “Across the board we do see very high rates of depression, both major depressive disorder and temporal depression.”
The reason for these increased rates starts with refugees’ experiences in their home countries. For example, about half of the refugees resettled in Indianapolis come from violence-plagued Burma, also called Myanmar.
“There were a lot of issues with the military in Burma targeting and harming the people,” says Chelsea Davey, mental wellness coordinator for Exodus Refugee Immigration Inc., which has settled more than 1,600 refugees in Indianapolis in the past three years.“There was a lot of forced labor, a lot of violence, a lot of loss of land and property and acts against humanity that people fled from that area.”
When people are forced to leave their country, they face period of rapid change. They move to refugee camps, often leaving family behind or splitting up family members. In the camps, there isn’t much to do, like work or school, to keep refugees occupied.
This can lead to substance abuse, says Mengxi Zhang, a Ball State University assistant professor of health science who studies refugee health.
"The drinking is a really big issue among, especially, the male population,” she says.
Kazito Kalima was 14 at the start of the Rwandan genocide. Over just a few months in 1994, hundreds of thousands of Tutsi people in his country were killed, including most of his family.
Kalima was bashed over the head with a machete, beaten up and left in a ditch filled with dead bodies. He escaped into the jungle, where he lived for three months eating grass and drinking swamp water.
“It’s hard to understand,” Kalima says. “It’s hard to understand it if you never lived through it.”
It’s a horrific story. Unimaginable, for most people, including many of the mental health professionals Kalima met with to process his trauma.
“Some of the counselors I’ve met, they would start crying when I talk. I’m like, ‘You’re supposed to help me,’” he says with a laugh.
Kalima is the founder and executive director of the Peace Center for Forgiveness & Reconciliation in Indianapolis. He came to the U.S. on a basketball scholarship after lviing as a refugee in East Africa. Now, the nonprofit he founded raises awareness of genocide and other human rights atrocities. It also connects immigrants and refugees to mental health resources.
“Everybody who has been through any kind of civil war, any conflict, might have some sort of mental health issues,” he says.
Dozens of students spoke with hospitals, child welfare agencies and other employers during the School of Social Work’s Field and Career Day held March 27 at UTA’s University Center.
The event drew social work students who, among other things, were searching for internships, summer jobs, permanent placements and research opportunities at agencies across North Texas.
“I think it went really well” said Elizabeth Anderson, a junior social work major and treasurer of the student-run Social Work Council. “I like how streamlined it was.”
Field and Career Day was held in March to coincide with National Social Work Month.
The day’s activities included field agencies featuring more than 60 North Texas employers and organizations, a Career Panel comprised of professional social workers and alumni, student research displays, a training session that offered continuing education credits and even an opportunity for students to take professional photos for their social media business profile pages.
Field and Career Day is hosted by the School of Social Work to connect area agencies with students who are available for work, field internships and for students interested in research and career development.
Prinston Hill, a BSW student, said he chatted extensively with a representative of Arlington Police Department’s Victim Services Unit, a program that employs social workers to offer crisis counseling to those who have been sexually assaulted.
“I had no idea their victim services unit has MSW positions,” says Hill, a retired Air Force Master Sergeant and acting president of the student Social Work Council. “I have a police background. That would be an awesome job for me.”
For the training event, School of Social Work Assistant Professor in Practice Karla Arenas-Itotia taught professionals how to recognize signs of domestic violence, understand its prevalence and empathize with those impacted during a two-hour presentation.
Across the nation one of five women and one of seven men report severe physical violence during their lifetimes, according to data, Arenas provided during the training.
Globally, 275 million children are impacted physically, mentally or emotionally by domestic violence, according to statistics collected by Childhood Domestic Violence Association and shared by Arenas-Itota, who is a Licensed Master of Social Work who previously oversaw the Relationship Violence and Sexual Assault Prevention (RVSP) department, as well as served on the Behavior Intervention Team (BIT) as a Case Manager here at UTA.
“This is a pretty big deal. That’s a lot,” she said during the training. “We know that it happens nationally and at the global level.”
Domestic violence also affects survivors’ physical, psychological and social health, she said.
In 2004, is began the Fetal Alcohol Spectrum Disorder (FASD) Prevention Project, funded by the Texas Office for Prevention of Developmental Disabilities and has staff currently certified to provide this FASD training. Also in 2004, funding was obtained from the Office of the Governor – Criminal Justice Division to begin the Staying Connected Program, a prevention
program targeting teens.
In 2006, the programs moved from UT Southwestern to UT Arlington’s School of Social Work, which has been committed to the advancement of knowledge and pursuit of excellence to provide leadership and service in promoting social justice, to respect diverse cultures, and to enhance well-being in local, state, national and global arenas.
That same year, the program obtained funding to begin a Youth Prevention Selective Program from the Texas Department of State Health Services. In 2008 additional funding from the Office of the Governor – Criminal Justice Division funds were obtained to expand the youth prevention services along with a contract with Department of Family and Protective Services
to provide parenting instruction for women with substance use disorders
A significant change occurred in 2011 when the program transitioned into a research center, the Center for Addiction and Recovery Studies (CARS). Since then, UTA faculty have conducted research on trauma, smoking and parental knowledge of child development. CARS continues to grow in programs offered to the community as well as research provided to add to the knowledge base of substance abuse – prevention, intervention and recovery support.