New paradigms for refugee health problems Marjorie A Muecke Social Science and Medicine 354 1992 What traumas and stressors do asylum seekers and refugees experience ID: 565332
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Slide1
“Refugees present perhaps the maximum example of the human capacity to survive despite the greatest of losses and assaults on human dignity
.”
‘
New paradigms for refugee health problems’
Marjorie
A
Muecke
, Social
Science and Medicine,
35:4
,
1992Slide2Slide3Slide4
What traumas
and stressors do asylum
seekers and
refugees experience?
Group 1:
Experience
of
torture/violence/persecution
Group 2: Escape; The Journey; Losses
Group 3: Arrival in UK; Asylum Process in
UK; daily stressors and adaptation process
Group FeedbackSlide5
What impact can these experiences have on a persons’ mental health? What might people tell us or we notice?Slide6Slide7
Cultural bereavement‘Clinical work with refugees poses a special challenge because the usual difficulties in making a diagnosis with any people of a different cultural background are compounded when they have suffered massive trauma in the wake of
war’
‘Symptoms’ reflect communal suffering, the
e
xperience, meaning and expression of which are culturally determined.’
Eisenbruch
(1991)Slide8
The core experiences of psychological trauma are disempowerment and disconnection from others.
Recovery therefore is based upon the empowerment of the survivor and the creation of new connections.
Judith HermanSlide9
What helps?Slide10
Judith Herman’s Stages of Trauma Recovery1. Re-establish a sense of safety2. Support environment for remembrance & Mourning
3. Reconnection with communitySlide11
What is person centred practice?Therapeutic relationshipActive listeningAcceptanceEmpathyQuality of presenceBeing genuine and real ourselvesNon-judgingSlide12
‘Successful
participation in everyday occupations and life roles and the fabric of the community enables people to move beyond displacement and strengthens inclusion and peace in a community.’
World
Federation Occupational TherapistsSlide13
Between power and powerlessness: a meta-ethnography of sources of resilience in young refugees. Sleijpen, M., Boeije, H. R., Kleber, R. J., & Mooren, T. (2015). Ethnicity & health, 1-23.
Six sources of resilience emerged:
(1) social support
(2) acculturation strategies
(3) education
(4) religion
(5) avoidance
(6) hope
S
ources indicated social as well as personal factors that confer resilience in young refugees, but most of them also had counterproductive aspects.
Highlighted interplay between protective and risk processes in the mental health of young refugees who have resettled in Western countries
Further research is needed to explore the cultural shape of resilience and the long-term consequences of war and migration on young refugees.Slide14
Recent Lancet correspondence on planning mental health work with Syrian refugeesResiliency factors and functional capacity. Establish what people need in
community-oriented and collaborative ways.
S
upport
individuals to
restore relationships
, build new,
healthy patterns
of
interaction
and
develop coping
strategies.
Creativity-based group
programmes using the
arts, such
as theatre, singing,
drawing, or
writing
poetry and
centres designed to
attract people
with social events,
workshops, groups might
play a part
. Slide15Slide16
What does this work do to us? (and reception, interpreters….)Apathy, feelings of hopelessness, rapid fatigue, disillusionment, melancholy, forgetfulness, experiencing work as heavy burden….Anxiety, nightmares, feeling of isolation, powerlessnessAvoiding obvious questions, not noticing certain statements or emotions, unconsciously changing subject when unnerved, temptation to step back from work too far, lowering professional norms.
Too distanced or too strongly identifying?Slide17
How do we take care of our strong emotions and feelings?SupportSupervisionSelf careSlide18
“Refugees present perhaps the maximum example of the human capacity to survive despite the greatest of losses and assaults on human dignity
.”
‘
New paradigms for refugee health problems’
Marjorie
A
Muecke
, Social
Science and Medicine,
35:4
,
1992Slide19