Question, from an IRMHP Course Participant:
I am learning about the mental health needs of refugee children and wanted to clarify something. How can we best differentiate between normal stress or distress due to resettlement and a mental health disorder like PTSD or depression in newly arrived refugee children? Additionally, what are the most effective ways to provide support during the early post-migration period before referral to specialized services is necessary?
Answer, from Dr. Debra Stein, Child and Adolescent Psychiatrist, Garry Hurvitz Sickkids Centre for Community Mental Health, Assistant Professor of Psychiatry, University of Toronto, and IRMHP’s Subject Matter Expert:
It is not always easy to tease out at what point a child’s reactions to trauma and displacement constitute a mental health disorder. In fact, I sometimes tell clients that their distress and symptoms are a normal, human response to very abnormal situations (e.g. witnessing violence, being physically or sexually assaulted). Even in the absence of trauma, children in particular are very sensitive to changes in their environment and routines and it is expected that we might see more anxiety, changes in sleep or eating patterns, or more acting out in newly arrived families.
Three lines of inquiry can help you decide if a mental disorder like Post-Traumatic Stress Disorder or Major Depressive Disorder is possible, warranting referral to more specialized mental health services:
- Symptom severity: for example, are the symptoms intense, occurring daily or for many hours in the day?
- Impaired function: are the symptoms impeding relationships, school, social functioning, or physical health?
- Threats to safety: do the symptoms include self-harm, harm to others, suicidal thinking or dangerous risk taking?
In terms of what is helpful for distressed children in the early post-migration period:𠊎nsuring the family’s stability (addressing housing, finances, and food insecurity) and safety (advocating for protected status) is first and foremost, as is making sure parents have good social and mental health supports.
Helping parents to re-establish daily routines, including rituals that provide opportunities for comfort and connecting (bedtime stories, family prayers, sharing a favorite meal) is also important.
Enrollment of children in safe, welcoming and supportive schools, and liaising with teachers about the child’s needs can also go a long way in supporting a child’s resilience, as schools provide so much of what children need to thrive: friendships, opportunities for physical activity and, of course, play.
I hope this helps!
Debra