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Stages of Forced Migration and Adaptation to a new culture

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Stages of Flight:1. Pre-flight

2. Flight

3. Post-flight

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ForcedForced Migration Migration

The sense of choice, agency, and potential for psychological preparation during the preflight phase differ along a continuum of relative degrees of voluntariness.

The role of violence in forced/ involuntary flight situations can also result in increased psychosocial difficulties.

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Risk and Protective FactorsRisk and Protective Factors

Risk factors for determinants of poor mental health = minority status, socioeconomic disadvantage, poor health/ starvation and malnutrition, head trauma & other injuries, collapse of social supports, mental trauma, adaptation stress in new cultural environment.

Protective factors = family, employment, group belonging including religion and ethnic identity, cultural history can ensure the ability to provide meaning to events.

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“Migration alone does not lead to poor mental health…a number of forces, from employment status to housing conditions to traumatic events before, during, or after dislocation, can lead to psychological distress.

The key factors that determine a migrant’s well-being include: if one adapts to the changes, if one is living in a safe and healthy environment, & a meaningful and culturally integrated life.”

-Dejarlais, Dislocation

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Fritz/Dejar., see MODELFritz/Dejar., see MODEL: : Health Dimensions of DislocationHealth Dimensions of Dislocation

1. Phases of Dislocation (post-flight generic term instead of “asylum and resettlement”);

2. Precipitors of Distress (ie-RISK FACTORS);

3. Health Consequences (Mental and Physical: Anxiety/PTSD, Depression/suicide, Family Violence, malnutrition, etc.);

4. Policy Recommendations (ie-Interventions).

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Stages of Flight: 1. Pre-flightStages of Flight: 1. Pre-flight

1. Violence: sexual assault, torture, detention, family loss, systematic persecution, etc. are common.

2. Famine/ Drought/ Food Shortages/ poor economic prospects are often present with or without violence.

Very seldom do either of the above allow for extensive preplanning. Flight can be sudden with limited information on likely conditions in arrival destination.

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“If your house is burning, any means of escape is welcome, even if you land in the mud and break your leg after jumping from the

roof…”

-refugee in Cairo when asked if he would still advise asylum seekers to come to Cairo despite all of the problems…

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Stages of Flight: Stages of Flight: 2. Flight and Separation2. Flight and Separation

SEE MODELSEE MODEL1. LOSS: of family, culture, home, income earning /self-

reliance opportunities, social role and status, collapse of social supports…a sense of “unfinished business”…

2. Often dangerous conditions during flight: trafficking/ human smugglers taking advantage of limited info re arrival destination;

3. Limited resources, financial and otherwise;

4. Lack of familiarity with new systems along the way and at arrival destination.

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Flight: crossings along the way….

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Stages of Flight: 3. Post-flightStages of Flight: 3. Post-flight

Asylum may be followed by one of the 3 “durable solutions”:

1. Going home: Repatriation2. Staying: Settlement & Local Integration3. 3rd country relocation: Resettlement

Or persons may remain in “limbo” indefinitely for a decade or longer, for generations…waiting for one of the above.

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Stage 3: Post-flightStage 3: Post-flight

Unemployment compounded by limited resources Food shortages Inadequate health services Social isolation Cultural differences/ acculturation problems Language barriers Pre-flight experiences begin to set in, dashed

hopes and expectations raised during flight re arrival destination expectations…

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Post-flight: Life in Refugee Camps

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Post-flight: Repatriating from Camps in Tanzania home to Burundi

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Post-flight: Arrival in Burundi after transiting home from TZA camps

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Post-flight: Reconstruction and uncertainty

Rebuilding ones life and home

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Acculturative Stress and Acculturative Stress and AdaptationAdaptation

In the post-flight stage, forced migrants face the challenge of adapting to a new culture.

This includes adaptation to life in the initial country of asylum - camps, rural settings, or in urban settings (such as Cairo) - as well as potential challenges to adaptation in third country/ resettlement environments.

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BerryBerry: Acculturation: AcculturationSEE MODELSEE MODEL

Acculturation: “culture change that is initiated by the conjunction of two or more autonomous cultures…selective adaptation of value systems, the process of integration and differentiation.”

Assimilation: relinquishing cultural identity and moving into the larger (dominant) society is not the only option…

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BerryBerry:: Acculturation Acculturation Acculturative stress will be highest when the gap between

cultures is wide, and when the new society insists that the person or group assimilate completely in order to be able to function within that society.

In multicultural societies groups can maintain some tradition (results in better mental health) while in uni-cultural societies the dominate culture forces one to adjust or oppose the society (may lead to greater risk of psychological breakdown).

Do you think that Cairo is a multicultural or uni-cultural society? (consider dominant language, behavioral norms, etc.)

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Berry:Berry: Acculturation Process ModelAcculturation Process Model

Areas of Psychological Functioning

Pre-contact (conflict then…)

Type of Adaptation1. Attitudes Traditional Assimilate, integrate or

reject

2. Identity Traditional Dominant culture ID, ethnic ID, or traditional

3. Personality Traditional Dominant, synthesis, quasi-traditional

4. Cognitive Style Traditional Dominant, bicultural, traditional

5. Language Traditional New, bilingual, traditional

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Case example: Somali WomanCase example: Somali Woman

Review this case in small groups and determine the following for presentation in larger group:

1. What types of loss might this woman have experienced according to Fritz/ Dejarlais model?

2. Which of Fritz/Dejar. flight stages is she likely in now?3. What type of acculturative adaptation does she appear to

be embracing according to Berry’s model (across language, identity or other areas of psychological functioning)?

4. Does she appear to be experiencing any subjective distress?

5. Does she appear to be experiencing any functional impairment?

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DVD: Surviving War, Surviving DVD: Surviving War, Surviving Peace (30 minutes)Peace (30 minutes)

A training video for service providers working with refugee youth in resettlement context.

This film highlights the struggles of refugee youth in Australia including the challenges of acculturation (learning a new language, racism, and the search for belonging). The youth featured in the film were co-producers, and they provide advice on how they would like others to treat refugee youth.

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Wrap upWrap upDistinctions in terminology: refugee vs forced migrant, mental

health/psychological vs psychosocial.

Stages of forced migration – related dangers, forms of loss and acculturative stress.

Ecological Framework – guidelines for psychosocial interventions.

Understanding basic terms: risk and protective factors, coping mechanisms, resilience.

Types of interventions and broad goals of all interventions.

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Readings for tomorrowReadings for tomorrow

Mollica RF, Son L (1989). Cultural Dimensions in the Evaluation and Treatment of Sexual Trauma. Psychiatric Clinics of North America, 12(2), 363-379.

Simalchik, J. (2002). The politics of torture: dispelling the myths and understanding the survivors.

Gorman, W. (2001). Refugee survivors of torture: Trauma and treatment. Professional Psychology: Research and Practice, 32, 443‑451.

de Jong JP, Scholte WF, Koeter MWJ, Hart AAM (2000). The Prevalence of Mental Health Problems in Rwandan and Burundese Refugee Camps. Acta Psychiatrica Scandinavica, 102 (3), 171-177

Bolton P (2001). Local Perceptions of the Mental Health Effects of the Rwandan Genocide. The Journal of Nervous and Mental Disease, 189(4), 243-248.