Populations with Trauma Related Mental Health Needs

You will likely have clients who suffer from trauma, depression, or other psychological issues that stem from post traumatic stress (PTSD). Refugees have generally suffered or feared persecution or widespread violence. These experiences often affect one’s psychological well-being, even long after the fact. Rates of depression and PTSD vary widely among different refugee populations. In some populations, the rates of PTSD and depression can be as high as 86% and 31%, respectively.

This section will discuss how to help clients who are suffering from trauma related mental health issues. It will first discuss how these mental health issues may manifest themselves. Then, it will describe how these issues can impact the person’s ability to participate in an asylum interview. Finally, it will discuss different strategies that you can employ in your work to create a supportive environment for these clients and refer them to professional mental health services.

Manifestations of post-traumatic stress and other trauma related mental health issues

Refugees often suffer from mental health issues such as post-traumatic stress, depression, and anxiety as a result of the trauma that they experienced in their home country. This condition may manifest itself in a variety of ways such as depression, panic attacks or disorders, phobias, suspiciousness, distrust, detachment, feeling of isolation or alienation, showing inappropriate emotion, feelings of guilt, shame, or helplessness, anger, or thoughts of suicide.

People may also experience confusion, loss of concentration, loss of memory, and mental dullness. This can make it more difficult for them to articulate their claims.

How survivors of trauma may react to interview questions

The questioning during interviews is usually very emotional for the person and survivors often experience the physical pain, sounds, and smells when they retell their story. Reliving this trauma will likely impact the person’s ability to tell his or her story. For example, the person may avoid discussing what happened so that he or she will not feel the pain associated with those events again. The person may also have trouble remembering what happened. In these instances, the person may display defensive techniques to avoid remembering such as denying that the events occurred, minimizing what happened, blocking their memory of the event, or disassociation. The person may also experience confusion or have distorted memories, which will be manifested as mixing up names or dates or being unable to follow questions.

The person may respond in unpredictable ways to questions. He or she may lose composure because the interview format could remind him or her of being interrogated. The person may exhibit many different emotions throughout the interview such as crying, laughing, or total emotional detachment. A survivor may also not respond to questions even if he or she knows the answers because he or she does not wish to relive the memories.

Finally, the person may distrust the interviewer and therefore avoid revealing certain information. Someone who has survived trauma, and particularly torture, may distrust people in positions of authority. As a result, he or she may be more likely to withhold information if he or she does not see you as an equal.

It is important to be aware of the reactions that your clients may have to questions about their past because you may have to speak with them several times before they feel comfortable telling you their entire story. Moreover, survivors of trauma can be retraumatized through the RSD process and through interviews about their past because it forces them to focus on traumatic experiences.

As a result, your office should take steps to minimize the risk of retraumatization when preparing a client for an interview, appeal, or any other stage of the RSD process. You can minimize this risk through conscientious conduct and supporting refugee clients with professional psychological attention.

Creating a supportive and healthy environment for your clients

There are many techniques that can be used in daily interactions with your clients to promote their mental health and create a supportive environment in which to resolve their legal issues.

Provide space to talk

  • Listen non-judgmentally
  • Do not force people to talk
    • If they want to talk, listen to what they want to share with you
    • If they do not want to talk, empathize
  • Let the person know how well they are coping in such a difficult situation etc.
  • Do not give simple reassurances to people such as “it is God’s will” or “look at how others have suffered”
  • Do not say that you know what they are going through
  • Be sensitive about what you say and what kind of language you use
    • Use words that empower people rather than emphasize helplessness
      • i.e. use survivor rather than victim

Your language and body language

  • Be empathetic
    • Questions that you can ask yourself to think in an empathetic way
      • What would I be feeling if I had undergone the same experiences in the past? How would it impact me?
      • What is the person telling me in their speech and nonverbal behavior about their feelings?
  • Convey compassion and caring
    • Explain that the person’s reactions are normal for what they have experienced
    • Affirm that their responses are the same as other people would have in their situations
  • Do not tell the person to calm down or relax
  • Pay attention to the words that you use
    • Say things like:
      • I would like to help
      • How can I help?
      • I would like to understand.
    • Do not say:
      • Don’t worry, everything will be okay
      • I understand what happened to you
      • Forget about it
      • Don’t think about it
      • It could have been worse
      • You are really lucky
  • Use simple language

Resources and needs

  • Provide accurate information about resources and have this information ready
  • Assess people’s practical needs and link them to local resources that can provide practical help when possible

How to minimize stress and anxiety when conducting an interview

The interview process can be traumatizing for refugees. Here are some steps that you can take to minimize the person’s stress when you interview him or her.

  • Waiting for an appointment may trigger anxiety
    • Tell the person how long he or she will have to wait
    • Make sure that the waiting room is welcoming, comfortable, and child-friendly
  • Most refugees will feel anxious and uncomfortable during the interview
    • Explain who you are, your role, how the interview will work, try to avoid any surprises. This will help give the interviewee a sense of control.
    • Provide a warm and welcoming atmosphere
    • Speak slowly and clearly
    • Speak in a calm and friendly tone of voice
    • Make eye contact and smile, as appropriate
    • Set a gradual pace; start with neutral topics
    • Questions should be asked gently
    • Questions should be tactful, but direct
    • Acknowledge that speaking about some of these issues may be difficult to talk about
    • When appropriate, offer the person a break or a glass of water
    • At the end of the interview, summarize what was said and explain what will happen next
  • Few refugees understand the RSD process and so most find it very stressful.
    • Repeat the information about the process many times
    • Repeat what the next steps are many times
    • Remain calm and patient

Providing professional psychological support

Depending on your office’s resources and caseload, it may make sense to employ a mental health professional in your office to provide support and counseling to your clients who are suffering from trauma. If you are unable to employ mental health professionals, you should build relationships with those professionals who operate locally. They may be willing to offer your clients counseling or referrals on a pro-bono basis. If qualified professionals are unavailable, you could consider approaching final-year clinical psychology students to see if they could help your clients.

When you refer a client to counseling, it is important that you gain permission from him or her first. You are still bound by the duty of confidentiality even when you are seeking to connect the client with mental health services.