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MENTAL HEALTH MENTAL HEALTH

distress, a phenomenon known as somatiza- walking distance of an area where a signifi-
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tion. Furthermore, some refugees may be- cant portion of the city’s refugee community
lieve their symptoms and/or mental health has settled. The SARHC provides free pre-
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concerns have no treatment. Others may ventive and acute medical, psychiatric and
also think that talking about mental health dental care to uninsured and underinsured
problems can worsen their condition, and members of the refugee community. On-site
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thus, it is best not to discuss it. interpreters help facilitate communication
There is still much to do regarding the ap- between providers and patients. In addition
propriate treatment for refugees and asylum to health concerns, patients can consult the
seekers. Providers can open meaningful dis- Center for Refugee Services (CRS). The cen-
cussions and provide education to destigma- ter often has representatives on-site for social
tize symptoms and mental health services, as needs, including employment opportunities,
well as make refugees more comfortable dur- ESL classes and citizenship applications. The
ing visits with the use of direct questions and SARHC has made additional efforts to be
trained interpreters. Another potential so- community- and patient-centered by allow-
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lution is through a holistic approach focusing ing walk-in services and providing prayer
on collaboration with local community part- mats as needed for religious practices.
ners to decrease risk factors for adverse men- In 2018, SARHC began working with UT
tal health outcomes. Health Psychiatry residents and faculty to
An evidence-based intervention to detect provide mental health care in response to
ongoing mental health concerns for the pur- community-expressed need, titled “Wellness
pose of connecting with care is through the Nights.” At weekly SARHC clinics, patients
The San Antonio Refugee Health Clinic: Differences in cultural beliefs surrounding use of culturally competent screenings for can request to be seen or referred by their
medical provider to psychiatry staff, who see
refugee mental health, such as the Refugee
Addressing Barriers to Refugee Mental Health health care is another social barrier that must Health Screener 15-item questionnaire patients monthly. Additionally, medical stu-
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be addressed. Due to previous health care
dent coordinators have implemented screen-
(RHS-15). The RHS-15 is a sensitive, vali-
experiences, refugees often have different ex- dated instrument for screening various ing with the RHS-15. Once someone is
By Emily Liu, Melissa M. Donate, Zeba Bemat, Anuradha S. Helekar, MD and Blake A. Harrell, DO
pectations of health care compared to native refugee populations for emotional distress identified as potentially benefitting from re-
U.S. citizens. For instance, some refugees are and mental health considerations. The ferral to wellness resources, medical student
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T have had an arduous path, including forced care. Common structural barriers include not accustomed to preventative care or hav- RHS-15 has been translated and validated coordinators are the first point of engage-
he United Nations Refugee Agency de-
ing providers who are a different gender from
for use in several languages. The translated
ment, normalizing the need to request help
fines a refugee as someone who has been
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barriers (transportation, child care needs, ac-
forced to flee their country because of perse- displacement, a difficult journey away from lack of access to health insurance, logistical themselves. This can contribute to negative screeners have language-specific semantics to for their mood and/or physical symptoms,
their home country and the struggles associ-
perceptions of medical care. Finally, stigma
ensure the meanings are accurate in their own
while also providing context around psychi-
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cution, war or violence. In 2020 alone, 82.4 ated with resettling in a new, unfamiliar cess to care, etc.) and language or other com- around mental health disorders may deter language. The screener is only recommended atric services. Patients who consent to being
million people were forcibly displaced. This country. Thus, an important consideration to munication barriers. 10,11 Of note, refugees seeking care due to fears of hospitalization, for use if there are adequate resources avail- seen will then be scheduled for a future Well-
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is an increase from past years, even with the make when characterizing the health needs admitted to the United States are provided alienation from their community, being seen able for the conducting and scoring of screen- ness Night appointment by a psychiatrist.
COVID-19 pandemic slowing the rate of of refugees is to examine the trauma they ex- short-term health insurance called Refugee as “crazy” or loss of confidentiality. ings, as well as the method of referral for Since April 2019, 35 patients have received
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new displacement. Furthermore, the U.S. has perience preflight, during flight and in reset- Medical Assistance for eight months. 12,13 Finally, the detection of mental health further evaluation and treatment. 18 both acute and long-term, follow-up care
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historically resettled more refugees than any tlement. These stressors put refugees at an However, after that expires, up to 50% of problems in refugees can be challenging due through Wellness Night. Common diagnoses
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other country, with Texas often resettling the increased risk for mental health disorders. refugees may be uninsured, even with policies to differences in mental health conceptual- Program Overview: seen include depression (57%), PTSD (34%)
highest number of refugees compared to On average, one in every three refugees ex- which allow for immediate access to Medi- ization. 10,15 For example, mental health pre- The San Antonio Refugee Health Clinic and anxiety (26%), with many patients having
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other states. Since 2010, more than 10,000 perience depression, anxiety or PTSD, with caid, CHIP and the health care marketplace. sentations in refugees may not adhere to the (SARHC) is a collaborative effort of stu- comorbid disorders. Medications are pro-
refugees have resettled in San Antonio as per- prevalence rates ranging between 20-80%, Language and communication barriers com- norms of what is considered a “symptom” of dents and faculty from medical, nursing and vided on-site via a pharmacy stocked through
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manent residents. depending on the population. Despite the plicate all stages of health care, through filling a mental health disorder. For example, previ- dental schools at the University of Texas the Center for Medical Humanities and
Though the specifics of refugee experi- high prevalence of mental health concerns, out health insurance forms, scheduling ap- ous trauma experienced by refugees can pres- Health Science Center San Antonio. The Ethics at UTHSCSA. Labs can also be per-
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ences vary widely, many of these individuals many refugees do not seek out mental health pointments and filling prescriptions. ent through somatic symptoms which cause clinic is held weekly at a local church, within formed through University Health.
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28 SAN ANTONIO MEDICINE • October 2021 Visit us at www.bcms.org 29