Academic journal article International Journal of Action Research

Developing a Mental Health Programme for Refugees Based on Participatory Action Research: An Experience from São Paulo, Brazil

Academic journal article International Journal of Action Research

Developing a Mental Health Programme for Refugees Based on Participatory Action Research: An Experience from São Paulo, Brazil

Article excerpt

1. Introduction

Immigrants are faced with a series of problems after their arrival in a new country, including language difficulties, cultural differences, ethnic, economic and religious discrimination, loss of social relations, broken families and the loss of valuable social roles, identities and occupational positions (Ryan, Leaveyg, Golden, Blizard, & King, 2006).

In addition to the common problems of immigrants, refugees are often faced with additional burdens related to the circumstances that forced their relocation. This situation requires preventive approaches and specific therapies in all areas of health, especially mental health.

This study is a participatory action research aimed at developing a mental health programme with/for refugees living in Sào Paulo based on an understanding of the refugees' experiences and psychodynamic aspects.

Background

Studied context description

Brazil is home to the largest refugee population in South America, comprising approximately 5208 people (based on statistics of 2013) from 79 different countries. Women constitute 34% of the refugee population. The majority of the refugees in Brazil are concentrated in large urban centres. Most of them come from Colombia (1,154), Angola (1,062), Democratic Republic of the Congo (617) Syrian Arab Republic (333), Liberia (258) and Iraq (203) (UNHCR, 2014). In Brazil, the civil society is responsible for the reception of refugees. Caritas (an institution linked to the Catholic Church) is the reception centre for refugees, and this organisation assists with the documentation of refugees after they arrive in the country. The Caritas offices are located in the two largest Brazilian capitals, Säo Paulo and Rio de Janeiro.

Brazil is internationally recognised as a safe country for refugees. However, refugees still face difficulties as they integrate into society. The first obstacles are the language and culture. The main problems affect refugees and Brazilians alike, including difficulties in achieving employment, access to higher education and access to public health services and housing (UNHCR, 2011).

Problem statement and research question

In response to the request of the State Department of Health, a service to provide clinical psychiatric care and psychotherapy to the refugee population in Säo Paulo was set up. Three months after this service was offered, it had not yet received any patients. On the other hand, according to observations of the staff who oversee the reception of refugees, almost all refugee applicants were in need of psychological and psychiatric support. Based on this initial experience, we sought to improve our knowledge of the characteristics of this population and their needs.

First, we designed a study to address the following research questions: What is the prevalence of mental disorders in this population? What is the most common type of psychopathology? How can we help the Caritas team provide better screening of cases? To answer these questions, we designed an epidemiological study that aimed at investigating the prevalence of mental disorders among refugees in Sào Paulo. We began by administering the Self Reporting Questionnaire-20 (SRQ-20) to refugees who receive financial support from the United Nations.

The SRQ (Self Reporting Questionnaire) consists of twenty-four short questions that are often used in psychiatric practice. This questionnaire was developed by the World Health Organisation (WHO) as a screening instrument for the detection of psychiatric disorders in primary care. This is a tool that was designed to "describe the presence or absence of symptoms clearly defined", and its format enables the questions be answered objectively by members of different cultures (Harding, De Arango, & Baltazar, 1980). Of the applied 44 questionnaires, we had 14 positive responses (indicating the possibility of a mental disorder due to the presence of symptoms) and 1 refusal to respond. …

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