Afghan refugees struggling with trauma face barriers to mental health care

OASHINGTON — For Salek Haseer, 17, video games are an escape. It’s a way, however fleeting, to end his thoughts – about fleeing Afghanistan last August, about leaving his father behind and about his new home.

“It’s not like I like playing the games,” Haseer said. “I play to remove my feelings.”

Since relocating to Virginia with his three siblings and mother, Haseer has struggled with the overwhelming emotional toll of the past year. Grieving the separation from his father – who was unable to leave with his family – he began to consult a psychologist at his school.

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“I say [the psychologist] I also have depression. I miss my father. I can’t go on with my life, so I try to have better feelings,” said Haseer, who is a high school student. ” It’s difficult for me. Sometimes I say that I am nothing without my father.

Haseer and his family are among a wave of Afghans who have sought refuge in the United States in recent months. While there are mental health resources available to Afghan refugees – who have recently been granted Temporary Protected Status in the United States – there are significant barriers to accessing this care. There is also, for many, an urgent need: families like Haseer’s are struggling with grief, depression and post-traumatic stress disorder after experiencing war and having to leave their homes.

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“The war, the explosion, everything – it affected all Afghans,” said 16-year-old Muzamel Kabuli, who left Afghanistan in August with his mother and four brothers and waited to be relocated to a military base in New Jersey before settling. in Maryland. Muzamel witnessed a suicide bombing outside his school. His brother, Mahdi, has nightmares about Afghanistan like Haseer.

“Sometimes I dream that I’m in [the middle of] airport, working to get in,” said 18-year-old Mahdi. “And sometimes I dreamed that I was with Muzamel, it’s just me and him, and we try to get in, and he gets shot.

Over the course of a month and a half, Haseer and his family stayed at two different military bases in Germany (including Ramstein Air Base, pictured above). They recalled dire conditions, frequently battling cold, unappetizing food. Courtesy of Aryan Fardeen

Their mother, Roya Kabuli, is grappling with loss after leaving her country and many of her loved ones. He misses the brighter taste of fresh fruit, a neighborhood with nearby mosques and the sound of Ahdan, which is broadcast from local mosques to call Muslims to prayer five times a day.

But what it misses the most is sunlight. The large windows in her Kabul apartment let in sunlight all day on the thick, intricate red carpets that adorn the floors, but her family only gets sunlight on the beige walls of their new Maryland apartment. an hour or two before sunset. .

“She says it was so glorious,” Mahdi Kabuli said, translating his mother’s words from the dari. This lack of sunshine makes her sadder, she says. And it makes his physical problems – diabetes, high cholesterol and recovering from surgery – more acute. “She thinks most of her illnesses are due to her nervousness. Sometimes she worries a lot. Sometimes she cries,” said Mahdi Kabuli.

There are no good estimates on the number of Afghan refugees struggling with mental health issues, such as depression, anxiety or post-traumatic stress disorder, and there are no data yet. on their access to mental health care in the United States, although previous reports from the American Psychiatric Association suggest that very few refugees in the United States are referred for mental health care.

While waiting to be relocated to the military base, each member of the Kabuli family was advised to consult a psychologist. But they all refused. They don’t know anyone at the base who has seen a psychologist and never tried to seek mental health care.

“It’s our tradition that if we have a problem, to tell this problem to someone we really know, who we really care about, who really cares about us,” said Mahdi Kabuli. “So we don’t feel very comfortable talking about our problems to strangers.”

Experts say there are many cultural factors that explain why providing mental health services is more difficult for Afghans, including a ‘disconnect’ between Western and Afghan ways of thinking about mental health, according to Anne Saw , a psychology professor who studies mental health equity for immigrants and refugees at DePaul University. “The way in America we typically deal with individual psychotherapy mental health issues…is culturally dissonant with many immigrants and refugees. It might be hard for some people to understand why you would even do that,” Saw said. “Sometimes it’s in direct opposition to what they’ve been taught not to expose your problems to people you don’t know or even people you know.”

Even telling a loved one can feel overwhelming when that same person faces their own challenges. Roya Kabuli worries about her five sons, and she doesn’t want to worry them any more. The Kabuli brothers said that when they feel sad, they support each other. Roya, for her part, tries to rely on her sisters still in Afghanistan, but Wi-Fi connectivity issues make things difficult, and she can only talk to them about once a week.

“She says if ‘I tell you about my problem, it makes you sad, it will affect your study’, so because of that, she doesn’t,” Muzamel Kabuli said.

Salek Haseer’s brother, Baktash, knew he was mourning his father – in the bedroom they shared, he could hear his brother saying his father’s name in his sleep. “Everyday [Salek] comes to me and asks me, what will happen to my father? And every night he wakes up from bed and he screams,” Baktash said. “That’s how I know he thinks of his father.”

But Salek didn’t feel comfortable telling his family that he had been looking for help for over a month – he didn’t want to worry them.

The Kabuli family
Roya Kabuli (right) and her children, (left to right) Mueaser, Muzamel, Mubasher, Mahdi, holding Mohammad, in their new home in Maryland. Courtesy of Jenny Huh

Beyond personal barriers, there are also practical obstacles faced by Afghan refugees seeking help. While large families like Kabulis can provide built-in support systems, it also makes transportation difficult. When Neighborhood Health, which provides medical care to underserved communities in Virginia, spent half a day providing medical services to Afghan refugees, the center’s outreach program coordinator Laura Gonzalez said they needed several cars for one family.

“I once had a family of nine who all need medical services, who all need mental health services,” Gonzalez said. “I wish we could get all nine of them into our office at the same time…but that’s impossible.”

None of the behavioral health providers at Neighborhood Health, which has several clinics in Virginia, speak the two main languages ​​in Afghanistan, Pashto and Dari. A few of the primary care providers do this, and the health center may also use interpreters, but this can often be a challenge.

However, Neighborhood Health said it has successfully introduced mental health as a medical issue by using an integrated form of medical care, in which a primary care provider can check a patient’s mental and physical health, before calling. a behavioral health provider from another chamber if needed.

“We ask about anxiety, we ask about depressive symptoms as part of a doctor’s appointment, which is often less threatening to patients because it’s something that’s familiar to people. culture to culture,” said Courtney Riggle-van Schagen, director of behavioral health at the center.

Often people come for an initial checkup, but lack the ability to return for more comprehensive mental health care, Neighborhood Health experts said. Their patients fear putting food on the table, enrolling their children in school, or trying to help their families still in Afghanistan, and mental health care is pushed to the bottom of the list.

“It’s hard for someone struggling to simply acculturate and relocate their family amid ongoing trauma to think it would be worth spending an hour working and sending money home or work for his family here. to deal with their mental health,” Saw said. “So I think it’s up to the vendors to sell this, to convince customers that this might be useful.”

Haseer has only met with his school psychologist twice so far. He adjusts to his new life as an American high school student, getting up early and going to bed late to finish his homework, and thinks the dates are starting to relieve him during the day, even though he continues to have nightmares.

“I see my dad,” Haseer said. “Only my father.”

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