It is estimated that at least 33 million people around the world
have been displaced from their homes by war or persecution.
Numerous studies have documented high rates of psychological
distress among these survivors of extreme violence and forced
migration, yet very few have access to clinic-based mental health
care. In any case, clinic-based services cannot adequately address
the constellation of displacement-related stressors that affect
refugees daily, whether in a new region of their homeland or a new
country--stressors such as social isolation, the loss of previously
valued social roles, poverty and a lack of employment
opportunities, and difficulties obtaining education and medical
care. Additionally, many refugees from non-western societies find
western methods of psychiatric and psychological healing culturally
alien or stigmatizing, and therefore underutilize such services.
This book brings together an international group of experts on the
mental health of refugees who have pioneered a new approach to
healing the psychological wounds of war and forced migration. Their
work is guided by an ecological model, which, in contrast to the
prevailing medical model of psychiatry and clinical psychology,
emphasizes the development of culturally grounded mental health
interventions in non-stigmatized community settings. The ecological
model also prioritizes synergy with natural community resources to
promote adaptation, prevention over treatment, the active
involvement of community members in all phases of the intervention
process, and the empowerment of marginalized communities to address
their own mental health needs. Drawing on their expertise in
community psychology, prevention science, anthropology, social
psychology, social psychiatry, public health and child development,
the authors present a variety of highly innovative, culturally
grounded interventions designed to improve the mental health and
psychosocial well-being of communities that have survived the
nightmares of political repression, civil war, and genocide. They
discuss the various conceptions of well-being and distress that
have informed their projects, their own integrations of western and
indigenous approaches to understanding and relieving psychological
distress, and in several instances their creative use of
well-trained paraprofessionals. They examine with remarkable candor
the challenges they have faced in carrying out their work in
extraordinarily demanding conditions. An extended introductory
chapter reviews and analyzes what we know about the impact of
political violence and exile on mental health, and lays out the
ecological model in rich theoretical and empirical context. The
first of two concluding chapters addresses the critical and
often-neglected issue of the evaluation of community-based
interventions in conflict and post-conflict settings; the second
sums up the implications of the achievements and limitations of the
programs described, poses questions that must be answered, such as
"How adequate is the PTSD construct in capturing the nature of
refugee trauma?", and suggests numerous directions for future
research and practice. The Mental Health of Refugees: Ecological
Approaches to Healing and Adaptation is an essential reference for
all professionals who seek to serve members of this vulnerable
population, for those who train and supervise them, and for program
administrators and policymakers concerned with refugee well-being.
It is also an excellent resource for graduate courses in public
mental health, community psychology and psychiatry, refugee and
immigrant studies, psychological trauma, medical anthropology, and
ethnopolitical violence.
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