The special psychiatric problems of refugees

Richard F. Mollica


Cpnceptual..mpdel .pftraumaticoutcpmes Traumatic. .outcomes Health ..status.. .and ..medical.illness

Psychiatric symptoms. and ..diagnoses

Functionalstatus. and. .disability



Personality. .characteristics Environmentalcharacteristics Psychiatric .assessment

Primary..carei;M .the.. proper. .,s,,r., a.. refugee.. .clinic Undierstanding.nsoimaticn complaints Psychiatric diagnosis Psychiatric .screening

Psychiatric .treatment Cujturalsensitivity

Caring...fpr., theseriiously ..mentally ..ill

Family/child... ,o.rien.tatip.n Mledic.a!.i.nte.rys.ntipn

The trauma story

Red.u.cing..risk.. and. maximizing. resiliency

Special. .treatment ..needs.. oLseXua!..ViO,le,nce

Speclal.psy.c.hiatric., issues, .oLre.fugee..,C.hli! Trauma

Culturalexpressipnsof .emotionaidistress

Risk ..factprs Chapter., References

While the forced displacement of people from their homes has been described since ancient times, the past half-century has witnessed an expansion in the size of refugee populations of extraordinary numbers. (1..,2) In 1970, for example, there were only 2.5 million refugees receiving international protection, primarily through the United Nations High Commission for Refugees (UNHCR). By 1999, UNHCR was legally responsible for 23 million refugees. In addition, it is conservatively estimated that an additional 30 million people are displaced within the borders of their own countries. Although similar in characteristics to refugees who have crossed international borders, internally displaced persons do not receive the same protection of international law. Adding all refugee-type persons together, the world is forced to acknowledge the reality that over the past decade more than 10 000 people per day became refugees or internally displaced persons. Furthermore, the World Bank in its 1996 annual report estimated that 60 of its client nation states have been devastated socio-economically by mass violence.

The sheer magnitude of the global refugee crisis, the resettlement of large numbers of refugees in modern industrial nations such as Canada, the United States, Europe, and Australia, and the increased media attention to civil and ethnic conflict throughout the world has contributed to the medical and mental health issues of refugees becoming an issue of global concern. This chapter will focus on a comprehensive overview of the psychiatric evaluation and treatment of refugees and refugee communities. Although this mental health specialty is in its infancy, many scientific advances have been made that can facilitate the successful psychiatric care of refugee patients.

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