The refugee crisis is a global phenomenon that continues to affect people regardless of age, race, sex, gender, and economic status. Furthermore, the COVID-19 pan-demic and political unrest have brought to the forefront the ongoing challenges refugees experience on a continuing basis. A refugee is defined by the United Nations High Commission for Refugees (UNHCR) as “someone who is unable or unwilling to return to his or her country of origin because of a well-founded fear of persecution for reasons of race, religion, nationality, membership in a particular social group, or political opinion” (2010, as cited in Gateri, 2018, p. 18). In Canada, there are different categories under which a refugee can be classified upon arrival. For example, a refugee claimant is defined as a temporary resident who requests protection upon or after arrival by making a refugee claim (Canadian Council for Refugees, 2010), whereas a resettled refugee is someone who holds permanent sta-tus and is sponsored either privately or by the government.
Over the past few years, Western countries including the United States, Canada, and those in Europe have experienced an influx in the number of refugees seeking residency. Among those refugees are children and youth. Of the 27.1 million refu-gees worldwide, 41% are counted as persons under the age of 18 (UNHCR, n.d.). Refugee youth make up a large proportion of those arriving in Canada by them-selves or with family members (Marshall et al., 2016).
Upon arrival in their host country, refugee youth need resettlement services, including learning a new language, transitioning into a new culture and educational environment, and (in some instances) mental health support services (Marshall et al., 2016). The loss of loved ones and community due to displacement can have negative impact on the mental health of refugee youth (Marshall et al., 2016). Refugee youth are vulnerable to poor mental health as a result of exposure to trauma and disruptions to their psychological, emotional, and physical development (Beiser
- Hou, 2016; d’Abreu et al., 2019; Im & Swan, 2022; Vasic et al., 2021). A study conducted within the Canadian context reveals that pre- and post-migration trauma among refugee youth in Canada can manifest in the form of aggressive behaviours and emotional problems (Beiser & Hou, 2016). However, within the Canadian con-text, research that focuses on the mental health experiences of refugee youth is sparse, leading scholars to draw from other countries (e.g., France and the United States), where the approach to addressing the needs of these youth is similar in nature to Canada (Marshall et al., 2016).
Public Mental Health Theoretical Framework
This chapter explores the need for early mental health intervention and support for refugee youth during and after resettlement in host communities using the public mental health theoretical framework. Dykxhoorn et al. (2022) assert that public mental health is the science and art of promoting mental health and well-being and preventing mental health problems through organized efforts in society. In practice, this theoretical framework takes a population-level approach to the prevention of mental health problems and the improvement of well-being (Gibbons, 2021). This approach is integrated by acknowledging a wide range of determinants across indi-vidual, family, community, and structural levels that contribute positively or nega-tively to mental health and well-being. These determinants are connected in complex ways and effective in addressing refugee youth mental health simultaneously and across multiple levels. In this chapter, we discuss the mental health challenges refu-gee youth experience during immigration and post migration. We also provide a critical discussion on interventions to address refugee youth mental health at vari-ous levels, including individual, family, school, and community.
Mental Health Challenges of Refugee Youth There is a common consensus in the literature that refugee youth experience several unfavourable conditions before, during, and post migration (Im & Swan, 2022). While this experience is substantiated by many scholars (Beiser & Hou, 2016; d’Abreu et al., 2019; Im & Swan, 2022; Marshall et al., 2016; Vasic et al., 2021), it is significant to acknowledge the unique challenges refugee youth encounter. Understanding the mental health of refugee youth is complex and there are several factors to consider. These factors include the challenges associated with pre- migration, forced migration, post-migration, and the various traumas these youth may experience as they travel to the host country (Im & Swan, 2022; Marshall et al., 2016). For instance, during the pre-migration stages, youth can be separated from their loved ones, which can create safety concerns (Vasic et al., 2021). Furthermore, the migration stage may result in exposure to violence, harsh living conditions, language barriers, and social exclusion (Im & Swan, 2022; Marshall et al., 2016). Following migration into their host country, youth are met with several challenges, including adjustment difficulties following prolonged exposure to the stress of inse-curity, fear, and loss; they also face wait times to receive proper documentation to access medical help and adequate housing (Abou-Saleh & Hughes, 2015). Consequently, the post-migration experience can lead to emotional, physical, spiri-tual, and psychological harms that increase the risk of developing a psychotic disor-der, risks which can increase even more after encountering racism and discrimination in their resettled communities (Kirmayer et al., 2011). Refugee youth may also struggle with feelings of loneliness and the stress of acculturation, which have been shown to have a negative impact on emotional well-being (d’Abreu et al., 2019). A mental health framework that addresses the effects of acculturative stress can help safeguard the psychological well-being of refugee youth.
Vasic et al. (2021) explored mental health problems among refugee youth in the Republic of Serbia; they found that youth who lived in different refugee camps were more likely to experience emotional and behavioural challenges and were also at a higher risk of being physically abused. These authors further postulate that because alcohol and substance use are prevalent among refugee youth, mental health preven-tive services should target these issues (Vasic et al., 2021). In addition to precarious living conditions, Marshall et al. (2016) identified individual, family, community, and societal factors that contribute to mental health outcomes of refugee youth. Individual factors include a person’s exposure to conflict and trauma and their inher-ent ability to cope. Family factors include the breakdown in family relationships when parents are separated from their children, a factor which is reported as making youth more vulnerable to mental health problems such as anxiety. Community fac-tors include experiences of discrimination that erode the self-esteem of refugee youth and affect their ability to form healthy connections in their new environment.
Scholars have identified trauma exposure as a risk factor to mental health in refu-gee youth (Im & Swan, 2022; Vasic et al., 2021). Trauma exposure is linked to substance use, social functioning, aggression, and other mental health symptoms in refugee youth (Im & Swan, 2022; Vasic et al., 2021). Despite the role trauma plays in influencing the mental health outcomes of refugee youth, there is a lack of research exploring this phenomenon (Gadeberg & Norredam, 2016). A deeper understanding of how trauma shapes emotional and psychological outcomes can help foster appropriate approaches to addressing the mental health of refugee youth. Marshall et al. (2016) assert, “Despite difficulties, young refugees demonstrate adaptability, perseverance, and resilience; having mental health professionals acknowledge their strengths and abilities will help them on their healing path and support them to adapt positively to a new home” (p. 308). Therefore, the strengths that refugee youth present should be treated as a protective factor and valued in the delivery of mental health service. Gadeberg et al. (2017) conducted a systemic review to explore the screening and measurement tools use to assess the mental health of refugee youth. The authors concluded that “there is a lack of trauma and mental health screening and measure-ment tools developed directly for refugee youth” (Gadeberg et al., 2017, p. 445). Gadeberg and Norredam (2016) question the validity of screening tools used for assessing trauma in refugee children and youth. These scholars argue that “the use of non-validated screening tools may result in pathologization of healthy individu-als or in overlooking of refugee children and youth with mental health problems and consequently preventing further follow-up and treatment” (Gadeberg & Norredam, 2016, p. 929). There is an urgent need for trauma screening tools that are reliable and valid to assess the mental health needs of refugee youth (Gadeberg & Norredam, 2016). Keeping in line with the public health framework, interventions must be targeted at the individual and family level, as well as within the youth’s school set-ting and community, to address their varied and presenting needs.