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Each year, thousands of refugees arrive in the USA for resettlement. Many have experienced traumatizing events in their country of origin or during migration; these events have a long-term impacts on their physical and mental health and social functioning and may be exacerbated by ongoing stressors during resettlement (Fazel et al., 2005; Hollifield et al., 2009; Silove, 1999; Steel et al., 2002). Within the current medical system, service providers who work with refugees struggle to deliver a model of health care that addresses these needs while still serving as many refugees as possible. We explored how integrated behavioral health care (IBHC) can address the medical, mental health and social needs of refugees. Based on findings from in-depth interviews with Karen refugees who have received a year of integrated services in a primary care setting, we report three specific advantages of IBHC in addressing the complex needs of resettled refugees.
This paper studies a sample of Karen refugees from Burma. Previous research indicates that approximately 27.4 percent of Karen refugees report experiencing torture, 51.4 percent report the torture of family members and 85 percent report experiencing war trauma (Cook et al., 2015). These numbers may be even higher, as many survivors may not endorse torture when initially asked (Bögner et al., 2010). Many refugees who have had traumatic experiences will encounter serious mental health conditions. For instance, depression and anxiety are more prevalent among refugee populations than in the larger population (Lindert et al., 2009). Longitudinal studies have found that refugees may struggle with mental health problems even decades after their arrival to the USA. (Carlsson et al., 2006; Marshall et al., 2005). War trauma and torture result in lasting physical and mental health conditions that compromise adaptive functioning. Refugees represent a population disproportionately living with the burden of such experiences. Refugees also have an increased likelihood of diabetes, hypertension, head injury and chronic body pain (Willard et al., 2014; Keatley et al., 2015; Olsen et al., 2007; Dahl et al., 2006).
Access to appropriate mental health services is challenging in the general population and poses an even more serious challenge for refugees (Gong-Guy et al., 1991; Asgary and Segar 2011; Shannon et...