Trauma mental health and the support of vulnerable refugees in Denmark -Mads Ted Drud-Jensen

Trauma, mental health and the support of vulnerable refugees in DenmarkMads Ted Drud-Jensen Knowledge Center for Vulnerable Refugees, Danish Refugee CouncilPALOMA, Helsinki – 7 February 2017

SP1

18 2015

01-05-23

Danish Refugee Council Integration Department

01-05-23Mads Ted Drud-Jensen, Knowledge Center for Vulnerable Refugees

Todays presentation All refugees are shocked by the turn their life has taken Conditions in the country of exile are crucial to the

possibilities of healing and integration for refugees with trauma

Some refugees are affected by what they have been through in a way that affects their mental health and life in exile

Education, work and daily structured activities help create normality and meaning in the life of vulnerable refugees

All refugees are shocked by the turn their life has taken

The global challenge60 mio flygtninge og fordrevene

Den globale udfordring60 mio flygtninge og fordrevene

Hospital in Aleppo – before and after

Homs(The guardian 2014)

Courses/education - IT

Shop in the refugee camp

Conditions in the country of exile are crucial to the possibilities of healing and integration for refugees with trauma

Danish numbersNumber of asylum applicants and residence permits in Denmark

Biggest nationalities 2015 …and 20161 Syria 8,608 1,251

2 Iran 2,787 299

3 Afghanistan 2,331 1,122

4 Eritrea 1,740 267

5 Stateless 1,734 488

6 Iraq 1,537 449

  2011 2012 2013 2014 2015 2016

Asylum applicants

3,806 6,148 7,557 14,792 21,316UAM: 2,144

6,235UAM: 1,219

Residence permits

2,249 2,583 3,889 6,104 10,849 7,494

Side 17Conditions in exile impacting on

mental health and quality of lifthee

> Ongoing existential uncertainty

> Poor socio-economic conditions

> Lack of social relations

> Lack of connection to the established healthcare system

> Lack of treatment for PTSD

> ‘Common’ stressfactors e.g. divorce, illness…

The different categories of residence permits indicate the conditions of security (DK example)

• Convention status (§7.1) – persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion (Residence permit for 2 years + 2 years)

• Protected status (§7.2) (Residence permit for 1 year + 2 years)

• Temporary protected status (§ 7.3) (Residence permit for 1 year+1 year+1 year without acces to family reunification)

Family reunified children and spouses of refugees can no longer have their journey to Denmark paid for by the danish state

Permanent residence is far away

Temporary residence permit – everyone!

Permanent residence permit can be applied forafter 6 years

CitizenshipCan be applied forafter 8 years

Refugees are not free to choose in which municipality they want to live

Quota system with dispersal to (almost) all municipalities

Refugees are expected to live five years in the municipality they are referred to (the duration of the integration period)

Muncipalities receiving most refugees 2016: Aalborg (423)Århus (277)

Municipal integration> Housing from day one and assignment of permanent housing when

possible

> Integration contract, payment of integration benefit until employment

> No coordinated health screening

> Everyone is entitled to Danish education for 5 years. But the danish classes should not stand in the way of employment.

> Help to find employment – an intervention targeting private companies (internship) within 14 days of arrival

The integration program runs for 1 year with the possibility of extending up to 5 years.

Distribution on the Danish education program

Job market participation for refugees and their reunified spouses

With significant differences between men and women (1) Rambøll for UIMB jan 2016 - (2) Danmarks Statistik via Carsten Kock

Danish education

Level 1 Level 2 Level 3

Refugee students 39% 52% 9%

Some refugees are affected by what they have been through in a way that affects their mental health and life in exile

Fleeing implies many losses> Country> Culture and familiarity> Language> Climate> Traditions> Family and friends> Status and identity> Life plans and future

Symptoms of trauma and PTSDConstant state of allert- Increased arousal - Violent reactions to small changes- Difficulty finding peace and concentrating

Invasive thoughts, feelings and images- Flashbacks- Inner images- Nightmares

Avoidance behaviour- Overly focus on job/studies- Isolation- Avoiding intimacy and social contact- Avoiding situations similar to the traumatic one

Traumatized refugees in Denmark• Right to specialized treatment via public health care system. Rehabilitation centres

in all regions – referred to by general practitioner

• Traumatized refugees still a challenge for municipalities – 2013 study:• 74%: unsatisfactory screening• 72%: disagree that local government measures was comprehensive and

coordinated(Traumeundersøgelsen af LG-Insight 2013)

• No longer a right for all to be offered a health screening

• The Danish Agency for International Recruitment and Integration is developing tools for tracing and identifying trauma:• Tracing tool for teachers, pedagogues etc. meeting refugees – municipal

contact point• Identification tool for social workers referring to screening/treatment – inspired

by Protect Questionnaire (PQ)

Refugees with trauma need a meaningful everyday life

The significance of having a job for traumatized refugees:1.There is a positive correlation between having a job and mental health2.The work has to be meaningful3.Conditions in the country of exile are often more important than the trauma itself4.There is a correlation between psychological well-being and the scope of network and social support

Kindergarten, school, employment etc. can help create normality and meaning in the life for vulnerable refugees

Various levels of supportive interventions

3. Specialized therapy/treatment

2. Restore protection and resilience

1. Support factors of protection and resilience

Trauma as a part of the picture

How to treat vulnerable refugees?> Language education, going to school, to work – if possible – is

important and beneficial to vulnerable and traumatized refugees > Daily activities, social community and inclusion

> Meet refugees as individuals, not as diagnoses> Avoid stigmatization, reactions to trauma vary significantly, refugees with

trauma have ressources too, accomodate to individual needs

How to treat vulnerable refugees?> Traumas implies internal chaos – daily education contributes to

external structure> Sense of security, structure, routines, personal boundaries, communication

> Be aware of yourself as a professional> Keep focus on your job/function> Avoid counter-transference:

> Watch out for overidentification (being overprotective, low expectations) or distancing (emotional absence or trivialization)

> Find a good empathetic standpoint

Refugees with trauma are normal people who have experienced something very abnormal

Thank [email protected]

01-05-23