Promoting Mental Health in a Refugee Community Using the RHS-15 and Pathways to Wellness

Saturday, 29 July 2017

Rebekah J. Salt, PhD, MN
School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Margaret E. Costantino, MA
Center for Refugee Services, San Antonio, TX, USA
Emma L. Dotson, BSN
Houston Methodist Hospital, Houston, TX, USA

Purpose: The purpose of this study was to pilot the Refugee Health Screener (RHS-15) and the Pathways to Wellness (PW) intervention program with refugees at the Center for Refugee Services (CRS) in San Antonio, Texas. The specific aims were: 1) To compare the pre and post RHS-15 survey and PW intervention scores, and 2) To identify internal and structural barriers affecting resettlement with a refugee woman’s sewing group at the CRS.

Background: Refugees often suffer life-threatening circumstances prior to flight from their countries. During the resettlement process, they face internal and structural barriers that can affect transition to life in the United States. Studies have reported a higher prevalence of depression and post-traumatic stress disorder (PTSD) in this population. The CRS is as an independent 501(c)3 nonprofit agency whose mission is to promote self-sufficiency and successful resettlement for refugees. The organization hosts a sewing group every week for women to create and sell their wares at an on-site market. These income-generating activities (IGA) are often referred to as cottage industries.

Methods: The RHS-15 consists of 15 questions, screens for common mental conditions in refugees, takes about 4 to 12 minutes to complete, and has been translated into eleven languages. Pathways to Wellness is an intervention that incorporates a support group model and consists of eight 90-minute sessions. The program is designed to help refugees recognize symptoms and understand stigma associated with mental health conditions in the United States. All participants were recruited in person from the woman’s sewing group at the CRS. The purpose of the study was framed around greater good as it was important for the women to know that their input could help other refugees.

Results: Twelve women from six different countries regularly attended the PW sessions. Several of the women were proficient in English. Over seventy percent of the participants who took the surveys scored above threshold on the RHS-15 and required referrals. There were no significant differences in pre-post surveys results; however, the stories that emerged during the PW sessions were powerful. The women discussed the challenges of resettlement related to safe housing, cultural and social norms, stigma, and isolation. Finally, the social cohesion observed in the sessions suggests that participation in a cottage industry could be a protective factor against social isolation and depression.

Conclusion: The resettlement process can be difficult for refugees. Good mental health is important for their successful transition into life in the United States. Using culturally sensitive screening tools and interventions may decrease some of the stigma associated with mental health conditions and lead to improved health outcomes for refugees. Community organizations that provide resources such as income-generating opportunities, has the potential to decrease the multiple internal and structural barriers that refugees experience during the resettlement process.