Mental Health and Violence

Recently, the mental health of refugees and other migrants affected by conflicts has attracted more attention and become a priority for WHO (Brundtland, 2000). Studies conducted in the field have shown a high prevalence of traumatic events with high levels of mental morbidity (50%) and PTSD symptoms (De Jong et al, 2000; Lopes Cardozo et al., 2000). In refugees and asylum seekers arriving in European countries, similar rates have been observed. Over 60% of asylum seekers arriving in Geneva, Switzerland reported having been exposed to trauma, 18% to torture and 37% reported at least one severe symptom during the previous week, most often of a psychological nature, such as sadness most of the time, insomnia, nightmares and anxiety (Loutan et al., 1999). Exposure to war-related trauma or torture may jeopardise seriously their capability to adjust to a new environment and a new society. Adaptation difficulties can be numerous and the administrative status may or may not facilitate this process. Concern has been expressed about the impact on mental health of restrictive policies: not allowing asylum seekers to work; and maintaining them in a high level of uncertainty about their future, with pending demands for asylum lasting for years (Silove et al., 2000). At present there is much debate on the validity of western classification of mental and psychiatric symptomatology across the cultural diversity of societies from various origins. This has led to much confusion for both researchers and primary care providers on how to identify and characterise mental health problems in different communities and persons, and how to address these problems and provide support to those suffering in an adequate manner. Some authors are looking at the various adaptive systems in response to exposure to human rights violations and trauma to propose new frameworks for adequate care (Silove, 1999).

Primary care physicians should be aware of possible previous exposure to war, torture or other trauma and its impact on health. Recognising physical and psychological symptoms related to rape or to various forms of physical abuse, symptoms of PTSD or depression, and how there are being expressed in a specific society or ethnic group, is of prime importance. Very often, victims of organised violence will not present to doctors as such, but will come with common unspecific symptoms, such as headache, fatigue and general pain. It is only when trust, confidence and empathy are established, when the patient feels that the physician or the nurse is open to listening, that he or she will talk about traumatic experiences and then allow the therapeutic process to start.

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