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The present, fast-moving process of globalisation, culture change, increased mobility and forced migration has led to a global challenge for mental health services, particularly psychotherapy. The significant cultural differences lead to a situation where the training in this specific field of healthcare must be substantially reconsidered. We understand the term “culture” to mean the specific and potentially dynamically changing respective backgrounds of client and psychotherapist, encompassing local culture, social background, religion, ethnicity, political, language, family and transgenerational background. Intercultural aspects of training are particularly relevant in the work with migrants and refugees, but also have relevance to the concepts of psychotherapy in general, and one should pay equal attention to the background of trainers and trainees. Learning psychotherapy in this context is to be seen as a “lifelong learning process” that should extend to post-graduate learning.

Refugees may present with a constellation of mental health and psychosocial problems caused by a combination of exposure to violence and current and ongoing stress. In order to understand the complexity of their experiences, different models and frameworks have been developed. Most converge in attempting to provide an exhaustive and inclusive account of the diversity of mental health and existential impacts incurred as a consequence of exposure to often multiple human rights violations, experiences of forced migration and the stress of relocation. For those refugees in need of assistance for overt mental health problems, psychotherapeutic and psychosocial approaches have been developed, and these will be described together with suggestions and possible directions for future research.

The detention of migrants and asylum seekers has become a common practice in both developing and high-economy regions. The fact of detention but also the conditions of detention are the subject of much criticism. They have been shown to frequently violate international human rights standards and to have an adverse impact on the psychological health and, later, the integration of migrants. In this chapter the authors outline standards and risks, based on research data and a case example, but also alternatives to detention as outlined by UNHCR.

The aim of this chapter is to address impacts of the work with refugees on mental health of helpers, in particular humanitarian aid workers. These assist vulnerable populations on a daily basis and often in challenging environments. Organizations providing assistance to refugees are responsible for mental health and well-being of their staff, since the staff is exposed to situations it would have not been exposed to otherwise. A set of measures and internationally accepted standards for prevention and protection of mental health in humanitarian aid workers and in emergency settings are presented and discussed. Moreover, a Georgian research study of the helpers’ mental health and related issues is illustrating situation in the field in connection with the provided background information.

This chapter aims at presenting a basic introduction to primary health-care needs of refugees during transit and in camps. These include challenges like emergency and first-line treatments, water preparation, hygiene and vaccinations but also recognition of long-term health-care-related needs. The chapter is based on the international standards and on practical (field) experience with the refugees recently arrived in Europe. However, it does not intend to replace handbooks on refugee and migrant medicine.

The quality of services for migrants and refugees depends to a substantial part on the quality of communication. Particularly in refugees, who usually have no realistic opportunity to acquire the language of the host country before their flight and might be distressed or traumatised, experienced interpreters are required. However, these are frequently not available or not integrated so far in healthcare or legal services. Untrained translators or family members are frequently used instead. The chapter explores legal and medical risks attached to different strategies regarding the use of interpreters and the differences between trained and untrained translators. It further gives an overview of standards and alternatives to address this important challenge in refugee care.

OBJECTIVE: To examine sustainability of symptom outcomes of a 1-year phase-based trauma-focused, multimodal, and multicomponent group therapy in a day treatment program for posttraumatic stress disorder (PTSD) over an average period of 7 years. METHOD: Iranian and Afghan patients (N = 69) were assessed with self-rated symptom checklists for PTSD, anxiety, and depression symptoms before (T1), after (T2), and up to 11 years upon completion of the treatment (T3). A series of mixed model regression analyses was applied to determine the course of the measured symptoms over time. RESULTS: At T2, all symptoms were reduced, but PTSD symptoms showed the strongest reduction. The trend of symptom reduction continued up to 5 years posttreatment and was similar for all the examined symptoms. After 5 years, all symptoms started to worsen, but remained under baseline levels at T3. CONCLUSIONS: The applied treatment appears to improve mental health of the studied sample on both the short and longer term. Language: en

Studies on group treatment of posttraumatic stress disorder (PTSD) in asylum seekers and refugees are scarce. The aim of this study was to evaluate the effectiveness of three different trauma-focused day-treatment group programs for treatment of PTSD in male asylum seekers and refugees. Three treatment groups (n = 56) and a waitlisted control group (n = 16) of help-seeking Iranian and Afghani patients were assessed with a set of self-rated symptom checklists for PTSD, anxiety, depression, and psychoticism 1 week before and 2 weeks after treatment. There are no indications that the 2 days' group program with three nonverbal and two group psychotherapy sessions per week is less effective in reducing symptoms than the program with the same amount of sessions spread over 3 days per week. The trauma-focused day-treatment group seems a promising approach for treatment of PTSD among asylum seekers and refugees in industrialized settings. Language: en

This article presents a model for large-scale public mental health interventions appropriate in the context of the Georgian culture and society. Peculiarities of traumatized communities in the country and their link to sociohistorical events and overall cultural identity are explored; Post-Soviet identity—in particular—as an important factor influencing traumatic impact is discussed. It is suggested that an appropriate large-scale public mental health intervention can not be properly designed without considering the sociopolitical and cultural context of a recipient community. The article also analyses the importance of combining complementary approaches—individually focused trauma treatment and community-based psychosocial assistance. Together, they form a bridge that integrates the individual and the extended Self/village experiences, and facilitates individual and communal coping. Finally, some basic ingredients of culturally-sensitive interventions are presented.

The aim of this study was to examine the influence of psychosocial stressors and demographic factors on psychopathology in asylum seekers and refugees with posttraumatic stress disorder (PTSD) prio...

In this study, treatment results of three different trauma-focus group day-treatment programs for asylum seekers and refugees with post-traumatic stress disorder (PTSD), were compared with a suppor...

This article reviews the strategies that have been applied across cultures in order to heal a wounded collective identity of societies upon large-scale conflicts and wars. The issues of truth, memory, and different models of justice executed within this process are discussed. Also, differences and similarities between individual and collective “healing” are explored and commented on. A general cross-cultural normative framework for conflict solving, collective “healing” and justice is neither possible, nor desirable. Models of restorative, retributive and reparative justice should be combined with reconciliation efforts. Societal problems should not be medicalized and individualized. Cultural sensitivity is crucial in designing proper strategies. The contextual model is the one that should be applied while making plans for rebuilding health and dignity after trauma on a collective level. “Healing” must be the outcome of structural and political changes and not their substitute.

To examine sustainability of symptom outcomes of a 1-year phase-based trauma-focused, multimodal, and multicomponent group therapy in a day treatment program for posttraumatic stress disorder (PTSD) over an average period of 7 years.Iranian and Afghan patients (N = 69) were assessed with self-rated symptom checklists for PTSD, anxiety, and depression symptoms before (T1), after (T2), and up to 11 years upon completion of the treatment (T3). A series of mixed model regression analyses was applied to determine the course of the measured symptoms over time.At T2, all symptoms were reduced, but PTSD symptoms showed the strongest reduction. The trend of symptom reduction continued up to 5 years posttreatment and was similar for all the examined symptoms. After 5 years, all symptoms started to worsen, but remained under baseline levels at T3.The applied treatment appears to improve mental health of the studied sample on both the short and longer term.

Background Legal status and other resettlement stressors are known to impact mental health of asylum seekers and refugees. However, the ways in which they interact with treatment of posttraumatic stress disorder (PTSD) with these populations is still poorly understood. The aim of this study was to examine whether legal status and other resettlement stressors influence outcomes of a trauma-focused group PTSD treatment within a day-treatment setting with asylum seekers and refugees. Methods Sixty six male Iranian and Afghan patients with PTSD residing in the Netherlands were assessed with self-rated symptom checklists for PTSD, anxiety and depression, and a demographic questionnaire one week before and two weeks after the treatment. Multivariate linear regression analysis was used to examine the impact of legal status and living arrangements on the treatment outcomes per symptom domain. Results The results suggest that both asylum seekers and refugees can be helped with their mental health complaints with a trauma-focused group therapy for PTSD regardless of their legal status. Obtaining a refugee status in a course of the treatment appears to improve the treatment outcomes. Conclusions Legal status is impacting outcomes of group therapy for PTSD with male asylum seekers and refugees. Asylum seekers may benefit from group treatment regardless of unstable living conditions.