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  1. The Healing Triad: Supporting Effective Interpretation in Refugee Mental Health Dr. Sarah P. Combs Ms. Sajit Greene Baltimore, Maryland October 24-26, 2012 Copyright: Sarah Combs & Sajit Greene

  2. Sponsored by: State of Maryland Department of Health and Mental Hygiene Office of Immigrant Health 500 N. Calvert Street, Fifth Floor Baltimore, Maryland 21202 410-767-6500 Ms. Dipti Shah, Chief, Office of Immigrant Health Ms. Amy Greensfelder, Refugee Mental Health Program Coordinator

  3. Day One Plenary I: Welcome and Pretest

  4. Purpose To enhance the knowledge, skills, and performance of interpreters working in mental health settings. To support effective communication between refugees and mental health providers. To improve mental health outcomes in refugees through improved client and provider communications.

  5. A to Z “I write these words and send them to youTo let you know that we live through language”. Maxamed Xaashi Dhamac, 'Gaarriye’, Somali Poet

  6. Evaluation of Workshop

  7. Who are we? Dr. Sarah P. Combs “Sarah” Public health nurse, educator, global health Ms. Sajit Greene “Sajit” Movement therapist, educator, life coach Worked together for five years at Rocky Mountain Survivors Center (RMSC), ORR-funded treatment center for survivors of torture

  8. Who are the clients? 1. Refugees: Any person who is outside his or her country of nationality who is unable or unwilling to return to that country because of persecution or a well-founded fear of persecution 2. Asylees: A person in the United States or at a port of entry unable or unwilling to return to his or her country of nationality, or to seek the protection of that country because of persecution or a well-founded fear of persecution 3. Other:Victims of sexual trafficking, survivors of torture Who are our clients?

  9. Who are you? Derj भ Oui Moni Odi ziwa Ubu Ego Ngai kitabu درى

  10. Activity: Good Morning Introductions and Warm-up Activity: Day One Good Morning!

  11. Care for Yourself: Preventing Stress and Burnout Interpreters who work with traumatized people may develop symptoms similar to their clients Fear, intrusive imagery, difficulty sleeping They may also experience feelings of “burnout” or “compassion fatigue” Exhaustion, depression, hopelessness

  12. Recognizing Stress Pay Attention to Your Body’s Signals Notice areas of physical tension Tight shoulders or headache Be aware of your breathing: Are you holding your breath?   Is your breathing shallow?   Are you sweating? Do you feel stuck in one sitting position? 

  13. Activity: Good Morning Plenary II: Cultural Concepts of Mental Health

  14. Mental Health and Illness Every culture recognizes when a person is feeling at peace, is able to do his/her work, and is in harmony with family, friends, and community. This is a state of “wellbeing”. Every culture recognizes when a person is experiencing extreme emotional upset, behaving oddly, or is not getting along with others. This person is out of balance. Traditional healers and Western mental health practitioners share common goal of relieving human suffering

  15. Cultural Concepts of Mental Health

  16. “Explanatory Models” of Mental Health Source: Vasilevska, B. & Simich, L. (2008).

  17. Traditional Causes Spiritual dis-ease (spirit possession, curse, problematic relationship with ancestors, punishment, karma, soul-loss) Planetary influences Poor diet

  18. Traditional Treatments Prayer, chanting, mantras Healing rituals or ceremonies Protective charms Ayurvedic medicine, herbs Energy healing, acupuncture Massage, physical exercise

  19. Traditional Healers Shaman Astrologer Traditional healer (Ayurveda) Spiritual leader, Priest Midwife

  20. Stigma of Mental Illness Sense of shame or disgrace Shunned by the community Labeled as “crazy” Seen as dangerous Seen as contagious Bring a bad influence into the family and community

  21. Biomedical Concepts of Mental Health Not just about the mind “Mental Health” is about how a person functions in terms of: Thoughts Emotions Behavior Relationship to others

  22. Mental health versus Mental illness Source: Canadian Mental Health Association, 2012

  23. Concepts of Mental Health Source: Canadian Mental Health Association, 2012

  24. Biomedical Model: Causes Causes of Mental Disorders • Biological • Developmental • Psychosocial Most mental illnesses are caused by a combination of biological, developmental, and psychosocial factors

  25. Causes, continued A person may have a biological (genetic) predisposition for a mental illness, such as schizophrenia or depression, but may not show symptoms of the illness until they experience certain developmental or psychosocial factors that serve as a trigger to those genetics.

  26. Biological Factors Genetics (inherited in families): Bipolar Disorder, Schizophrenia Physical injuries: Traumatic Brain Injury Aging: Dementia

  27. Biological Factorsthat affect the functioning of the brain and nervoussystem: Moods can be affected by chemicals in the brain called neurotransmitters Depression may be related to a neurotransmitter called serotonin & dopamine

  28. Developmental Factors Influence how a person grows from childhood into adulthood Examples: Depression Anxiety

  29. Psychosocial Factors Family support Socioeconomic status Interpersonal relationships Traumatic experiences, such as war and torture. Examples: Post Traumatic Stress Disorder (PTSD) Personality Disorders Addictions

  30. Mental Health Treatment Treatment Modalities Providers Group therapy Talk therapy/Counseling Medications Hospitalization Counselor Social Worker Psychotherapist Psychiatrist Nurse

  31. “Integrative”, “Alternative”, “Holistic” “Cultural Syncretism” Combine the best of both systems Example: Acupuncture Blending Traditional & Biomedical Approaches

  32. Activity: Good Morning Activity:Small Group Discussion Concepts of mental health in your culture

  33. 1. Concepts of mental health in your culture What word do you use in your language for what “Western” medicine calls “mental illness”? (Explain the word to your group) What do people in your culture think are the causes of mental health symptoms? (Hearing or seeing things that aren’t there, depression, anxiety, nightmares)

  34. 2. Concepts of mental health in your culture • What kinds of treatment are offered for mental health symptoms in your culture: Traditional treatments and/or Western medical treatments ? • Who is the person providing treatment: Traditional healers or Western-style professionals?

  35. 3. Concepts of mental health in your culture • What is the attitude toward people with mental health symptoms? • How are they treated by their family and the community?

  36. 4. Concepts of mental health in your culture • How does your culture view “sensitive issues”: Alcoholism, domestic violence, rape, physical discipline of children, suicide? • Do psychiatric hospitals exist in your country? If so, what is the attitude towards them?

  37. LUNCH! 12:30 pm to 1:30 pm

  38. Breathing/Stretching

  39. Mental Health Diagnosis Day Two, Plenary III:

  40. Diagnosis Made by a mental health professional Using the Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition, Text Revised Referred to as “DSM-IV” Diagnosis considers 5 dimensions (axes) Source: American Psychiatric Association. (2000a, 2012a).

  41. The DSM-IV -TR Axis I: Clinical Syndromes (depression, anxiety, PTSD, somatization, schizophrenia) Axis II: Developmental Disorders and Personality Disorders (Mental retardation, Borderline Personality) Axis III: Physical Conditions (Brain injury, HIV/AIDS) Axis IV: Psychosocial Stressors (Death of a loved one, starting a new job, fleeing from war) Axis V: Highest Level of Functioning (At the present time and the highest level within the previous year)

  42. Axis I: Diagnoses Common in Refugees Post-Traumatic Stress Disorder (PTSD) Generalized Anxiety Panic Disorder Major Depression Adjustment Disorder Somatization (Will be discussed in depth on Day Two)

  43. Diagnoses Not Specific to Refugees Axis I Axis II Bipolar Disorder Schizophrenia Substance Related Disorders (alcoholism and other addictions) Developmental Disorders Dementia

  44. Axis I: Mood Disorders A mood, such as extreme sadness or extreme happiness, is experienced over a long period of time, or swings rapidly from one mood to another. The disturbance in mood affects many aspects of the person’s life, such as sleeping, eating, relationships, and general functioning

  45. Axis I: Mood Disorders Bipolar Disorder Previously called Manic Depression Symptoms: Periods of depression that alternate with periods of mania.  Mania is an extremely happy mood accompanied by highly energized, sometimes bizarre, thoughts and behaviors.   Cause: Biological basis, often runs in families Treatment: Often requires long-term use of a mood-stabilizing medication.

  46. Axis I: Anxiety Disorders Symptoms of worry, tension, uneasiness, and avoidance Post-traumatic Stress Disorder (PTSD) Generalized Anxiety Disorder Panic Disorder

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