Refugee Mental Health: A Primary Care Approach.

The term refugee is an internationally recognized legal classification for persons fleeing their home country based on a well-founded fear of persecution for reasons of race, religion, nationality, or membership of a particular social group or political opinion.1 These persons have been forced to flee their homes and sometimes their families, often because of violence. The number of displaced persons reached an all-time high in 2015: more than 65 million worldwide.2 Although the ultimate goal is repatriation to their country of origin, ongoing conflicts often prevent this. Thus, the work of resettlement begins. With our focused training on care for the whole patient, and on our patients’ relationships with their families, social environment, and mental health, family physicians are well equipped to serve refugees. In this issue of American Family Physician, Mishori and colleagues review the refugee resettlement process and the clinical aspects of caring for patients who have experienced war, conflict, violence, and threats.3 Because of their history, refugees are at higher risk of mental health disorders than other immigrant groups.4 Attempting to address such needs can be daunting for primary care physicians, especially if their clinics lack integration with behavioral health consultants. The Centers for Disease Control and Prevention addresses these concerns with three recommended action plans based on refugees’ mental health needs (Table 1).5 First— as with all patients—refugees with acute or life-threatening mental health disorders should be referred for immediate psychiatric evaluation and treatment. The second group of patients, those with less serious mental health conditions, can be followed by family physicians and referred for subspecialty evaluation as needed. Finally, most refugees require no clinical mental health services; despite suffering varying degrees of loss, refugees and other immigrant groups can exhibit considerable emotional resilience.6,7 The stigma surrounding mental health in refugees’ countries of origin may dissuade them from discussing certain mental health concerns during their initial visits.