MENTAL HEALTH
The San Antonio Refugee Health Clinic: Addressing Barriers to Refugee Mental Health By Emily Liu, Melissa M. Donate, Zeba Bemat, Anuradha S. Helekar, MD and Blake A. Harrell, DO
T
he United Nations Refugee Agency defines a refugee as someone who has been forced to flee their country because of persecution, war or violence.1 In 2020 alone, 82.4 million people were forcibly displaced.2 This is an increase from past years, even with the COVID-19 pandemic slowing the rate of new displacement. Furthermore, the U.S. has historically resettled more refugees than any other country, with Texas often resettling the highest number of refugees compared to other states.3,4 Since 2010, more than 10,000 refugees have resettled in San Antonio as permanent residents.5 Though the specifics of refugee experiences vary widely, many of these individuals 28
SAN ANTONIO MEDICINE • October 2021
have had an arduous path, including forced displacement, a difficult journey away from their home country and the struggles associated with resettling in a new, unfamiliar country. Thus, an important consideration to make when characterizing the health needs of refugees is to examine the trauma they experience preflight, during flight and in resettlement.6 These stressors put refugees at an increased risk for mental health disorders.7,8 On average, one in every three refugees experience depression, anxiety or PTSD, with prevalence rates ranging between 20-80%, depending on the population.9 Despite the high prevalence of mental health concerns, many refugees do not seek out mental health
care. Common structural barriers include lack of access to health insurance, logistical barriers (transportation, child care needs, access to care, etc.) and language or other communication barriers.10,11 Of note, refugees admitted to the United States are provided short-term health insurance called Refugee Medical Assistance for eight months.12,13 However, after that expires, up to 50% of refugees may be uninsured, even with policies which allow for immediate access to Medicaid, CHIP and the health care marketplace. Language and communication barriers complicate all stages of health care, through filling out health insurance forms, scheduling appointments and filling prescriptions.11
