Overview of the Mental Health Section
The mental health of immigrants has, as in the field of medicine generally, been relegated to secondary status as the acuity of physical and social needs predominates. It is only later, usually in resettlement, that the immigrants’ psychiatric and mental illness needs receive attention. Unfortunately, these needs are often ignored. Partly, this may be due to the chronicity and interrelationship of mental illness and integration or adjustment problems and the concomitant challenges to treatment. It is a testament to the insight of the primary editors of this text that mental health is given considerable priority as a part of immigrant medicine.
After these overview chapters, three chapters discuss populations selected for particular emphasis. Wenzel et al. discuss survivors of torture. This topic is particularly pertinent with recent debate over the definition of torture and whether its use can ever be morally justified, such as to prevent terrorist attacks. Torture victims have many of the same mental illness and social integration problems as refugees who have been traumatized in other ways, but the very personal nature of torture requires especially sensitive approaches to interviewing and treatment. Most of the authors in the mental health section, not only in this chapter, have worked with both traumatized refugees and specifically with torture survivors, illustrating the importance of this subpopulation. Ekblad et al. discuss interpersonal violence towards women, finding that it leads to more health and mental health problems and poorer integration into host societies. Ellis and Betancourt discuss children and adolescents, who have many of the same mental health problems and integration issues as adults, but require special approaches. Treatment ideally occurs in pediatric clinics or in schools. Another population, which is not discussed in a separate chapter, is the elderly. Although elderly immigrants deserve consideration as a special population, very little has been written about them.1 Those older than 60 years comprise up to 30% of the refugees in some United Nations camps. They may be unable to meet their basic needs because of physical disability, mental impairment, loss of social support, or malnutrition.2 Medications for chronic diseases may not be available. Access to health services may be difficult when mobility is limited. Losses after displacement can be more profound, and readjustment challenging, when the elderly have fewer future opportunities for rebuilding their lives. Carlin3 identifies problem areas for the elderly refugee or immigrant, including: (1) separation from or loss of family members, including disapproval by younger family members who are better able to acculturate, have no time to help, and have greater authority; (2) isolation from friends and problems making new friends; (3) compromised independence because of language difficulties and illness; and (4) loss of job status and productivity with few opportunities left. Interventions should take advantage of the respected position that the elderly have in many societies and cultures, such as in conflict resolution and as heads of extended families. Training for new vocations and skills should not be restricted to the younger members of society: the elderly have much to offer.39
