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Are Refugees More Prone To Mental Disorders?

by drbyos

The fatal knife attack on June 25th in Würzburg by a Somali asylum seeker and his multiple treatment in psychiatric clinics raised the question: Are refugees particularly psychologically vulnerable or ailing? And how is it to be dealt with? José-Marie Koussemou (49), who comes from Benin in West Africa and has been the chief physician of psychiatry at the Heidenheim Clinic since August, is doing research on this as part of his doctorate. He has been dealing with questions of migration psychiatry for years. Koussemou studied medicine in Würzburg from 1997 to 2003 and was deputy chairman of the city council for foreigners during this time.

Question: Do you recognize certain patterns among refugees undergoing psychiatric treatment?

José-Marie Koussemou: No, except for language problems. Those who give us difficulties are patients with psychosis and drug addiction. And this clinical picture also applies to young German sufferers without a migration background.

Against this background, how typical is the Würzburg case?

Koussemou: I think one shouldn’t fix it too much on the issue of migration. As far as I have seen, someone here was psychotic and drug intoxicated at the same time. Patients with this double diagnosis are a challenge for psychiatry when it comes to aggressive behavior, regardless of their origin. What the population often does not understand: If a patient is sober in the clinic and he wants to go, do you have to let him go? unless there is an acute danger to oneself or others. The sheer fear of it is not enough for compulsory treatment. That is the currently valid legal situation.

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This is what happened in Würzburg. Should something be changed here in the law? Do clinics need more access?

Koussemou: Even if you treat the patient in the clinic for a while? at some point you have to fire him. In the case of patients with drug addiction, the long-term success of withdrawal treatment depends largely on the motivation of the person concerned. We ourselves try from the clinic to visit people in their environment, to accompany and motivate them to go to treatment or to stay. We call this home treatment.

Often these patients do not only have health problems?

Koussemou: That is why we organize regular meetings with the public order office, the police, the health department and the care authority. We then discuss how we can deal with difficulties that arise in caring for people with behaviors that are harmful to themselves and others. There are also psychiatric networks in Baden-Württemberg to specifically seek out such people.

If you look at refugees in psychiatry: Do these people primarily burden experiences from their home country and from the flight or their living conditions in Germany?

Koussemou: I can’t think of a study on it spontaneously. To do this, one would have to know the psychological situation of people before they left their home. The route of migration certainly plays a role – especially when you think of traumatic experiences. We also know today that these traumatic experiences can lead not only to classic post-traumatic stress disorders, but also to psychoses. In addition, people are more likely to resort to drugs if they have no work, are poorly housed or if they form peer groups of people in a similar situation.

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What do you deduce from this?

Koussemou: These people absolutely need a job opportunity from the start, that has to be allowed? like in other countries, for example in Denmark. When you work, you get recognition. But to have a chance on the job market, you have to speak the language. Therefore, language courses should be promoted.

Can the living situation in the communal accommodation be psychologically stressful?

Koussemou: When you are forced to live in a confined space with people you don’t know and who have different customs and religions? this can of course be difficult. If someone is already mentally ill, it should be considered whether placement in shared accommodation will not worsen the mental illness. My experience is that the treating psychiatrist can usually find a solution with the competent authority.

And a possible trauma from civil war or refugee experiences is of secondary importance?

Koussemou: No, of course there are too. You just can’t apply that to all refugees, nor can you generalize it for individual countries of origin. Anyone who comes to Europe through the Sahara and the Mediterranean can experience terrible and traumatic experiences. However, according to my observation, this does not affect the majority of asylum seekers. Also, not everyone who has experienced civil war is traumatized ?? other factors also play a role. You have to look at the individual case and shouldn’t overinterpret the cultural influences.

The perpetrator from Würzburg is said to have had better care since his arrival.

Koussemou: This better care has been required for years. To do this, however, you need interpreters and psychologists who want to work with asylum seekers, who specialize in trauma therapy and have knowledge of transcultural psychiatry. There is a lack of money, technical resources and the corresponding networking.

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