International Day Against Violence &...
By: Rosalind Ghafar Rogers, PhD, LMHC, Clinical Behavioral Health Subject Matter Expert with USCRI’s Refugee Health Services in Arlington, VA...
READ FULL STORYby: Rosalind Ghafar Rogers, PhD, LMHC, Clinical Behavioral Health Subject Matter Expert
with USCRI’s Refugee Health Services in Arlington, VA
October 10 is World Mental Health Day and this year’s theme is It is Time to Prioritize Mental Health in the Workplace. In recognition of this important day, USCRI would like to emphasize how integrally connected mental health and work are, particularly for refugees and other forcibly displaced populations.
Mental health is more than the absence of mental health conditions. Rather, mental health is an essential component of health and well-being that enables us to cope with the stresses of life, to realize our abilities, to contribute to our communities, and to learn well and work well. Under positive and safe conditions, work can provide connection, purpose, and stability, playing a vital role in protecting our mental health. Mental health and employment have a reciprocal relationship – not only does employment affect mental health, but also mental health affects employability and employment.
Refugees and other forcibly displaced populations face numerous challenges as they flee persecution, war, and violence. As a result of these traumatic experiences and stressors, refugees are at a high risk of experiencing mental health challenges, such as posttraumatic stress disorder (PTSD), depression, and anxiety (Kirmayer et al., 2011; Li et al., 2016). The traumatic events experienced in their home countries, compounded by the difficulties of the migration journey, and the stressors of adapting to a new environment, can exacerbate these mental health issues. Moreover, refugees often experience social isolation, language barriers, discrimination, and the loss of social status, all of which contribute to increased psychological distress (Silove, 2013).
Research specific to refugee populations has found that their health and well-being is promoted when they engage in meaningful roles and activities (Hess et al., 2019). Among the key factors mitigating these stressors and improving mental health outcomes for refugees and other forcibly displaced populations is employment. While gaining employment can bring some financial stability, employment has been shown to play a crucial role in promoting psychological well-being among refugees. Employment plays a pivotal role in the social integration of refugees, aiding them in the process of adjustment, providing sufficient income to support their families, and providing them with opportunities to build social networks and regain a sense of productivity, purpose, and control over their lives (Beiser & Hou, 2017; Teodorescu et al., 2012). Furthermore, economic opportunity (defined as the right to work, access employment, and maintenance of socioeconomic status) is also associated with higher life satisfaction and better physical, as well as mental health among refugee populations (Lai et al., 2022).
Numerous post-migration factors and resettlement stressors have been linked to poor mental health in refugees, however, no other resettlement stressor has more effects on refugee families than unemployment (Disney & McPherson, 2020). Unemployment has the potential to negatively impact refugee families in multiple areas, including income, housing, social status, social support, and mental health. Unemployment among refugees has been found to worsen existing mental health symptoms and can predict psychological distress. Prior research has demonstrated that a prior diagnosis of depression can predict difficulty maintaining stable employment and refugees with higher levels of both pre- and post-migration traumas have a much higher likelihood of being unemployed (91%) than refugees with low levels of trauma (20%; Disney & McPherson, 2020; Wright et al., 2016). There is consistent evidence across resettlement countries and cultural groups linking unemployment and challenges securing employment with mental illness, including depression, anxiety, and PTSD (Ziersch et al., 2023).
Despite the well-documented benefits of employment, many refugees and other forcibly displaced populations face significant disadvantages and barriers entering the workforce. These barriers include poor host country language proficiency, discrimination, lack of social support networks, visa restrictions, economic and educational barriers, unfamiliarity with local job markets, and lack of qualifications or recognition of overseas qualifications, also known as underemployment. Among refugees, underemployment has been associated with downward social mobility, a sense of dissatisfaction and disempowerment, increased poverty, and poorer physical and mental health (Disney & McPherson, 2020; Hynie, 2018; Lai et al., 2022; Li et al., 2016). Experiences of discrimination among refugees have been linked with lower life satisfaction and higher levels of depression (Lai et al., 2022). Visa insecurity, particularly for asylum-seekers who may not have the right to work, has been associated with the inability to afford basic living necessities, depression, anxiety, PTSD, one or more psychiatric disorders, a lack of autonomy, and a sense of shame (Hynie, 2018; Lai et al., 2022). Furthermore, for those refugees able to secure work, they are more likely to hold low-skilled and low-paying jobs characterized by shift and informal work, high stress and demands, and extreme or hazardous working conditions, all of which are associated with poorer mental health outcomes, lower life satisfaction, and a greater likelihood of being a victim of exploitation and abuse (Herold et al., 2023).
To mitigate the mental health challenges associated with unemployment and underemployment, support services aimed at helping refugees access the job market are critical. These services may include tailored language support and training, vocational skills development, career counseling, recertification programs, and mentorship programs designed to assist refugees in navigating the job market and understanding workplace rights. In addition, providing mental health support during the employment search can help refugees manage the stress associated with finding employment, minimize psychosocial risk factors, and prevent the onset of mental health issues. Empirical studies consistently conclude that mental health professionals should understand that assisting refugees towards full and meaningful employment is a mental health intervention (Disney & McPherson, 2020). Employers should be provided with regular training to improve and build capacity to understand the specific challenges faced by refugee populations, to address workplace exploitation and discrimination, and to provide reasonable accommodations to support workers with mental health conditions in the workplace.
Moreover, policies that recognize and value the skills and qualifications that refugees and other forcibly displaced populations bring to host countries can help alleviate some of the barriers to employment (Liebig & Huddleston, 2014). By facilitating access to education and training programs, governments, organizations, service providers, and employers can play a critical role in improving both employment prospects and mental health outcomes for refugees and other forcibly displaced populations.
If you or someone you know is thinking about suicide or would like emotional support, call or text 988, the Suicide and Crisis Lifeline that is available 24/7. If you or someone you know is having a life-threatening emergency, please call 911 or go to your nearest hospital emergency room.
For resources or more information about USCRI’s Refugee Health Services program for resettled Afghans, please visit: https://refugees.org/the-behavioral-health-support-program-for-afghans/
References
Herold, R., Lieb, M., Borho, A., Voss, A., Unverzagt, S., Morawa, E., & Erim, Y. (2023). Relationship between working conditions and mental health of migrants and refugees/asylum seekers vs. natives in Europe: a systematic review. International Archives of Occupational and Environmental Health, 96(7), 931–963. https://doi.org/10.1007/s00420-023-01981-w
Hess, J. M., Isakson, B. L., Amer, S., Ndaheba, E., Baca, B., & Goodkind, J. R. (2019). Refugee mental health and healing: Understanding the impact of policies of rapid economic self-sufficiency and the importance of meaningful work. Journal of International Migration and Integration, 20(3), 769–786. https://doi.org/10.1007/s12134-018-0628-3
Hynie M. (2018). The social determinants of refugee mental health in the post-migration context: a critical review. The Canadian Journal of Psychiatry, 63(5):297-303. https://doi.org/10.1177/0706743717746666
Kirmayer, L. J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A. G., Guzder, J., Hassan, G., Rousseau, C., Pottie, K., & Canadian Collaboration for Immigrant and Refugee Health (CCIRH). (2011). Common mental health problems in immigrants and refugees: General approach in primary care. CMAJ, 183(12), E959-E967. https://doi.org/10.1503/cmaj.090292
Lai, H., Due, C., & Ziersch, A. (2022). The relationship between employment and health for people from refugee and asylum-seeking backgrounds: A systematic review of quantitative studies. SSM – Population Health, 18, 101075. https://doi.org/10.1016/j.ssmph.2022.101075
Li, S. S., Liddell, B. J., & Nickerson, A. (2016). The relationship between post-migration stress and psychological disorders in refugees and asylum seekers. Current Psychiatry Reports, 18, 1-9. https://doi.org/10.1007/s11920-016-0723-0
Liebig, T., & Huddleston, T. (2014). Labour market integration of refugees: Strategies and good practices. OECD Working Papers, 1-42. https://doi.org/10.1787/5jxxh5hhbx43-en
Silove, D. (2013). The ADAPT model: A conceptual framework for mental health and psychosocial programming in post conflict settings. Intervention, 11(3), 237-248. https://doi.org/10.1097/WTF.0000000000000018
Teodorescu, D. S., Heir, T., Hauff, E., Wentzel-Larsen, T., & Lien, L. (2012). Mental health problems and post-migration stress among multi-traumatized refugees attending outpatient clinics upon resettlement to Norway. Scandinavian Journal of Psychology, 53(4), 316-332. https://doi.org/10.1111/j.1467-9450.2012.00954.x
Wright, A. M., Dhalimi, A., Lumley, M. A., Jamil, H., Pole, N., Arnetz, J. E., & Arnetz, B. B. (2016). Unemployment in Iraqi refugees: the interaction of pre- and post-displacement trauma. Scandinavian Journal of Psychology, 57(6), 564–570. https://doi.org/10.1111/sjop.12320
Ziersch, A., Miller, E., Walsh, M., Due, C., Callaghan, P., Howe, J., & Green, E. (2023). ‘I really want to work for me to feel good myself ‘: Health impacts of employment experiences for women from refugee backgrounds in Australia. SSM-Qualitative Research in Health, 3, 100209. https://doi.org/10.1016/j.ssmqr.2022.100209
By: Rosalind Ghafar Rogers, PhD, LMHC, Clinical Behavioral Health Subject Matter Expert with USCRI’s Refugee Health Services in Arlington, VA...
READ FULL STORYBy: Rosalind Ghafar Rogers, PhD, LMHC, Clinical Behavioral Health Subject Matter Expert with USCRI’s Refugee Health Services in Arlington, VA...
READ FULL STORYWritten by: Rosalind Ghafar Rogers, PhD, LMHC, Clinical Behavioral Health Subject Matter Expert with USCRI’s Refugee Health Services in...
READ FULL STORY