Mülteci Ruh Sağılığında Güncel Yaklaşımlar

Year 2022, Volume: 12 Issue: 1, 180 - 187, 14.01.2022

Esra Işık Fatmagül Ertuğrul

https://doi.org/10.33631/sabd.1055671

Abstract

Son yıllarda, dünyada mülteci sayısının artmasıyla birlikte ruh sağlığı sorunları artmakta ve buna bağlı olarak ruh sağlığı ve psikososyal destek hizmetlerine olan ihtiyaçlar da artmaktadır. Kişilerin memleketlerini terk edip göçe zorlanmaları, yeni bir çevreye ve kültüre uyum sağlama süreçleri oldukça streslidir ve beraberinde birçok ruh sağlığı sorununu getirmektedir. Mülteci gruplarda TSSB, duygudurum bozuklukları ve anksiyete bozukluklarının sıklıkla görüldüğü belirtilmiştir. Bunun yanı sıra zorunlu göç ile birlikte sosyal/toplumsal yapının ve aile birliğinin bozulması gibi birçok psikososyal sorun da ortaya çıkmaktadır. Mültecilerin ruh sağlığı sorunlarının tespiti ve ardından çok katmanlı ruh sağlığı ve psikososyal destek hizmetleri içerisinde bu ihtiyaçlara cevap verilebilmesi son derece önemlidir. Öncelikle temel ihtiyaçların karşılanması ve toplum temelli psikososyal müdahalelerin gerçekleştirilmesi ile bireylerin ve toplumun iyilik halinin korunmasına yönelik çalışılmalı ve kendi kendilerine yardım kapasiteleri arttırılmalıdır. Bireysel desteğe ihtiyaç duyan kişiler için ise kısa süreli psikolojik müdahaleler sağlanmalı ve daha ileri düzeyde desteğe ihtiyaç duyan kişilerin klinik hizmetlerden yararlanmaları sağlanmalıdır.

Keywords

Sığınmacılar, göç, ruh sağlığı, psikososyal destek sistemleri

Contemporary Approaches in Refugee Mental Health

Abstract

In recent years, there has been a dramatic rise in number of refugees worldwide. Forced displacement and adapting to a new environment and culture is quite stressful and associated with mental health problems. Refugees frequently suffer from mental health problems and in need of mental health and psychosocial support services. PTSD, mood disorders and anxiety disorders are found to be highly prevalent in refugee groups. In addition, many psychosocial problems such as the disruption of the social/community and family structures occur with the forced migration. It is important to identify the mental health problems of refugees, and respond to these needs within the multi-layered mental health and psychosocial support services. Inıtially, in order to protect the well-being of individuals and society basic needs such as food, shelter and security should be provided. To strengthen self-help capacities, community-based psychosocial interventions should be employed. Along with these services, brief psychological interventions for people who need individual support and clinical services for people who need higher level of clinical care should be provided.

Keywords

Refugees, migration, mental health, psychosocial support systems

References

• UNHCR [Internet]. Figures at glance. Switzerland; 2021[Updated: 2021 June 18; Cited: 2021 Oct 12]. Available from: https://www.unhcr.org/figures-at-a-glance.html
• UNHCR [Internet]. Turkey general Fact Sheet. Turkey; 2020 [Updated: 2020 Sept; Cited: 2021 Oct 12]. Available from: https://www.unhcr.org/tr/wp-content/uploads/sites/14/2020/10/UNHCR-Turkey-General-Fact-Sheet-September-2020-FINAL330.pdf
• Silove D, Ventevogel P, Rees S. The contemporary refugee crisis: an overview of mental health challenges. World Psychiatry. 2017; 16(2): 130-9.
• Kirmayer LJ, Narasiah L, Munoz M, Rashid M, Ryder AG, Guzder J, et al. Common mental health problems in immigrants and refugees: general approach in primary care. Canadian Medical Association Journal. 2011; 183(12): E959-E967.
• Steel Z, Chey T, Silove D, Marnane C, Bryant RA, Van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. The Journal of the American Medical Association. 2009; 302(5): 537-49.
• Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. The Journal of the American Medical Association. 2005; 294(5): 602-12.
• Lindert J, von Ehrenstein OS, Priebe S, Mielck A, Brahler E. Depression and anxiety in labor migrants and refugees–a systematic review and meta-analysis. Social science & medicine. 2009; 69(2): 246-57.
• Hijazi Z, Weissbecker I [Internet]. Syria Crisis: Addressing Regional Mental Health Needs and Gaps in the Context of the Syria Crisis. United States of America; 2015 [Updated: 2015 March 16; Cited: 2021 Sept 12]. Available from: http://internationalmedicalcorps.org/document.doc?id=526
• McColl H, Johnson S. Characteristics and needs of asylum seekers and refugees in contact with London community mental health teams: a descriptive investigation. Social Psychiatry Psychiatric Epidemiology 2006; 41: 789-95.
• Dapunt J, Kluge U, & Heinz A. Risk of psychosis in refugees: a literature review. Translational psychiatry. 2017; 7(6): e1149.
• Staehr MA, Munk-Andersen E. Suicide and suicidal behavior among asylum seekers in Denmark during the period 2001-2003. A retrospective study. Ugeskrift for laeger, 2006; 168(17): 1650-3.
• Slodnjak V, Kos A, Yule W. Depression and parasuicide in refugee and Slovenian adolescents. Crisis: The Journal of Crisis Intervention and Suicide Prevention. 2002; 23(3): 127-32.
• Al-Ibraheem B, Kira IA, Aljakoub J, Al-Ibraheem A. The health effect of the Syrian conflict on IDPs and refugees. Peace and Conflict: Journal of Peace Psychology. 2017; (23)2: 140.
• Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC International Health and Human Rights. 2015; 15(1): 29.
• Bogic M, Ajdukovic D, Bremner S, Franciskovic T, Galeazzi GM, Kucukalic A, ve ark. Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK. The British Journal of Psychiatry. 2012; 200(3): 216-23.
• de Jong JT, Komproe IH, Van Ommeren M, El Masri M, Khaled N,van De Put W ve ark. Lifetime events and posttraumatic stress disorder in 4 postconflict settings. JAMA. 2001; 286(5): 555-62.
• Bhugra D. Migration and Mental Health, Review Article, Acta Psyhiatrica Scandinavica. 2004; 109: 243-58.
• Steel Z, Silove D, Brooks R, Nomartin S, Alzuhairi B, Susljik I. Impact of immigration detention and temporary protection on the mental health of refugees. British Journal of Psychiatry. 2006; 188: 58-64.
• Miller KE, Weine S, Ramic A, Brkic N, Bjedic ZD, Amer Smajkic A, ve ark. The relative contribution of war experiences and exile-related stressors to levels of psychological distress among Bosnian refugees. Journal of Traumatic Stress. 2002; 15(5): 377-87.
• Miller KE, Omidian P, Rasmussen A, Yaqubi A, Daudzai H. Daily stressors, war experiences, and mental health in Afghanistan. Transcultural Psychiatry. 2008; 45(4): 611-38.
• Siriwardhana C, Ali SS, Roberts B, Stewart R. A systematic review of resilience and mental health outcomes of conflict-drive adult forced migrants. Conflict and Health. 2014; 8: 1-14.
• Beiser M, Hou F. Language acquisition, unemployment and depressive disorder among Southeast Asian refugees: a 10-year study. Social Science and Medicine. 2001; 53: 1321-34.
• Miller KE, Rasmussen A. War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Social Science and Medicine. 2010; 70(1): 7-16.
• Nickerson A, Bryant RA, Steel Z, Silove D, Brooks R. The impact of fear for family on mental health in a resettled Iraqi refugee community. Journal of Psychiatric Research. 2010; 44, 229-35.
• Oras R, de Ezpeleta SC, Ahmad A. Treatment of traumatized refugee children with eye movement desensitization and reprocessing in a psychodynamic context. Nordic Journal of Psychiatry. 2004; 58: 199-203.
• Robjant K, Fazel M. The emerging evidence for narrative exposure therapy: A review. Clinical Psychology Review. 2010; 30: 1030-9.
• Meffert SM, Abdo AO, Alla OAA, Elmakki YOM, Omer AA., Yousif S, et al. A pilot randomized controlled trial of interpersonal psychotherapy for Sudanese refugees in Cairo, Egypt. Psychological Trauma: Theory, Research, Practice, and Policy. 2014: 6(3): 240.
• Summerfield D. A critique of seven assumptions behind psychological trauma programmes in war-affected areas. Social Science and Medicine. 1999; 48(10): 1449-62.
• Miller KE, Kulkarni M, Kushner H. Beyond trauma‐focused psychiatric epidemiology: Bridging research and practice with war‐affected populations. American Journal of Orthopsychiatry. 2006; 76(4): 409-22.
• Scholte WF, Verduin F, Kamperman AM, Rutayisire T, Zwinderman AH, Stronks K. The effect on mental health of a large scale psychosocial intervention for survivors of mass violence: a quasi-experimental study in Rwanda. PLoS One. 2011; 6(8): e21819.
• Weinstein N, Khabbaz F, Legate N. Enhancing need satisfaction to reduce psychological distress in Syrian refugees. Journal of consulting and clinical psychology. 2016; 84(7): 645-50.
• Hermosilla S, Metzler J, Savage K, Musa M, Ager A. Child friendly spaces impact across five humanitarian settings: a meta-analysis. BMC Public Health. 2019; 19(1): 1-11.
• Budosan B, Benner MT, Abras B, Sabah A. Evaluation of one mental health/psychosocial intervention for Syrian refugees in Turkey. International NGO Journal. 2016: 11(2): 12-9.
• Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, et al. No health without mental health. The Lancet. 2007; 370(9590): 859-77.
• WHO [Internet]. mhGAP Humanitarian Intervention Guide (mhGAPHIG). Switzerland; 2015 [Updated: 2015 Feb 28; Cited: 2021 Oct 28]. Available from: http://www.who.int/mental_health/publications/ mhgap_hig/en
• Kahiloğulları AK, Alataş E, Ertuğrul F, Malaj A. Responding to mental health needs of Syrian refugees in Turkey: mhGAP training impact assessment. International Journal of Mental Health Systems. 2020; 14(1): 1-9.
• IASC [Internet]. Inter-Agency Standing Committee IASC guidelines on mental health and psychosocial support in emergency settings. Switzerland; 2007 [Updated: 2007 June 01; Cited 2021 Oct 20]. Available from: https://interagencystandingcommittee.org/system/files/2020-11/IASC%20Guidelines%20on%20Mental%20Health%20and%20Psychosocial%20Support%20in%20Emergency%20Settings%20%28English%29.pdf
• Hobfoll S, Watson P, Bell C, Bryant R, Brymer M, Friedman M, et al. Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Focus. 2009; 7(2): 221-42.
• Dawson KS, Bryant RA, Harper M, Kuowei TA, Rahman, Schafe A, et al. Problem Management Plus (PM+): a WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry. 2015; 14(3): 354-7.
• Sijbrandij M, de Graaff A, Cuijpers P, Kieft B. Problem management plus (PM+) for Syrian refugees in the Netherlands. European Journal of Public Health. 202; 30 (5): ckaa165.628.