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 As the United States prepares to take in 10,000 or more Syrian
refugees in the coming year, social service groups are urging more
funding for mental health counseling for cases like Alghazally's,
saying it makes resettlement easier.
The 48-year-old finally began undergoing psychotherapy last year in
Dearborn, a southeastern Michigan city that is home to many
Arab-Americans - but not before becoming addicted to anti-anxiety
pills and leaving his job as a limousine driver.
"The best time to get treatment is once it's fresh and it's new,"
said Sharehan Ayesh, Alghazally's counselor at the Arab Community
Center for Economic and Social Services in Dearborn, which calls
itself the nation's largest social service agency for
Arab-Americans.
"We're having to do 20 years' worth of repair that should have been
done" earlier, Ayesh said recently.
President Barack Obama has pledged to take in thousands more
refugees from Syria's civil war.
 Many of those fleeing the violence - which has included barrel
bombs, chemical weapons, gunfire and summary executions - will need
mental health counseling.
But if history is any guide, few will get it.
Because it competes with basic needs such as housing, schooling and
job placement, counseling for refugees often is neglected.
BACK TO NORMAL
This is the case even though refugees who learn to cope early on
with PTSD tend to settle more easily into the United States and
benefit more from other services, said officials from groups that
will soon be assisting Syrian new arrivals.
"Folks really need to be able to get back to their lives: school,
work, things that they were doing in their own countries," said
Alison Beckman, clinical supervisor at the St. Paul, Minnesota-based
Center for Victims of Torture, one of the largest treatment centers
of its kind in the United States.
But refugees with PTSD or depression often cannot resume those
aspects of their lives because their symptoms are so severe, she
said.
Fear, uncertainty and trauma can combine in PTSD - an illness that
can affect veterans and other survivors of wars or other major
traumas - to cause violent flashbacks, an inability to trust others
and other symptoms.
Between 15 percent and 20 percent of all refugees globally have
mental health problems, but fewer than 1 percent of the total will
get care for them, Mark van Ommeren, a public mental health adviser
for WHO, said in an email.
In general, mental health care in the United States has long been
criticized as inadequate. More than 43 million American adults
experience mental illness annually, but nearly 60 percent of them
did not receive care for it in the past year, according to the
National Alliance on Mental Illness, an advocacy group based in
Arlington, Virginia.
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MONEY TIGHT
A lack of funding is part of the problem. WHO estimated that for
every $1,000 spent globally on humanitarian aid, only $1 goes toward
mental health care, according to a 2011 study, the most recent year
for which numbers were available.
"That is way too little," van Ommeren said. He said care is
essential so that refugees can perform day-to-day activities, engage
with their communities and hold down a job.
The U.S. Office of Refugee Resettlement added four more funded
programs to its Survivors of Torture initiative this fiscal year,
bringing the total nationwide to 34, spokesman Kenneth Wolfe said.
But, despite calls from physicians and lawmakers to increase the
agency's $11 million annual budget, it remains the same.
To treat traumatized refugees, programs typically offer talk
therapy, group counseling and physical rehabilitation. Another key
aspect is psycho-education - teaching refugees about mental health -
to help combat cultural stigmas that often prevent them from asking
for help.
Officials said many Syrians are expected to resettle in areas where
their community is already being established: largely in Michigan,
Texas and California, according to U.S. State Department data
mapping the distribution of Syrian refugees so far this year. (For a
graphic on Syrian and other refugees admitted to the United States
in fiscal year 2015, click on http://reut.rs/208UR7W)
The Detroit area, a common destination for the past 15 years for
Iraqi refugees, is ready for a Syrian influx, said Hassan Jaber,
executive director of the Arab Community Center for Economic and
Social Services in Dearborn.
At resettlement agencies, officials rush to meet basic needs while
urging refugees to become self-sufficient as soon as possible,
before government aid runs out.
"The clock starts ticking really right when they arrive," said Aaron
Rippenkroeger, chief executive of Refugee Services of Texas, which
has centers in five major cities in the state. He called the time
pressures a shortfall of the U.S. resettlement model.
"There's not a lot of time for them to engage with the facts of what
they've been through," he said.
(Editing by Kevin Drawbaugh, Stuart Grudgings and Jonathan Oatis)
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