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King County Pioneers New Practice For Refugee Mental Health

KUOW Photo/Liz Jones
Farhiya Mohamed was 19 years old when her family came to the U.S. from Somalia as refugees.

On a recent afternoon, about a dozen Somali women talk in spurts as they weave 4-inch metal needles through a basket.

It doesn't look like therapy, but in a way, it is.

Washington state is one of the top entry points for new refugees coming to the U.S. For many newcomers, the trauma from their home countries follows them here. Many struggle with nightmares, depression or PTSD. And they often suffer alone.

Some service providers in King County have developed new ways to help refugees overcome mental health issues. And the work has gained international attention.

[asset-images[{"caption": "Farhiya Mohamed (in middle) leads a group of Somali women in a weaving circle.", "fid": "11812", "style": "card_280", "uri": "public://201402/P1030801.JPG", "attribution": "Credit Liz Jones / KUOW"}]]

Connecting To A New Community

Farhiya Mohamed leads a weaving group at a nonprofit in SeaTac where women make baskets and other decorations out of palm leaves brought all the way from Somalia. “Very soft ones, we make it into like floor mats,” Mohamed said as she demonstrated the technique.

Mohamed said all the women in this group fled Somalia’s brutal civil war. They’ve seen bombings, shootings and violence against their families. Mohamed saw these things, too. "Yes, I remember because they came to our house,” she said. “They beat my father, my cousin, my sister. I remember they almost shot her.”

Mohamed recounted these events matter-of-factly. Then, without flinching, adds that the good thing is those men did not rape her or her sisters, as was common.

Awo Mohamed has come to this group since it started two years ago. Farhiya Mohamed interpreted for her. “I forgot about weaving stuff," Awo Mohamed said. "I used to do it before, but when I came to the refugee camp, I stopped doing it.” 

Awo Mohamed said the group helps her connect with a new community in America and deal with her memories from Somalia.

"Before, by myself, I was thinking a lot and then my memory is not right," she said. "But now my memory gets back because I come with the women here and then I start talking with them. So, now I’m getting much, much better."

[asset-images[{"caption": "Shamis Farah weaves a traditional Somali basket.", "fid": "11813", "style": "card_280", "uri": "public://201402/P1030795.JPG", "attribution": "Credit Liz Jones / KUOW"}]]Activities For Healing

Beth Farmer is a program director with Lutheran Community Services and has an office just upstairs from the weaving group. “Having an activity that’s meaningful and joyful, that’s an amazing thing to healing people,” Farmer said.

Gatherings like this help people avoid isolation, depression and a possible crisis down the road, she explained.

Until recently, Farmer said it was often only when crisis hit that a refugee’s mental health issues would surface. "They had lost their jobs, they were being evicted, they had attempted suicide," she said.

Local agencies want to get to people sooner.

When new refugees arrive in the U.S. they get a mandatory health exam. It’s supposed to cover mental health, too, but Farmer said that rarely happens. Physicians don’t have time. Or they don’t have a good, cross-cultural way to assess people who have no translation for terms like “mental health” or “depression.”

The federal Office of Refugee Resettlement lays out guidelines to assess mental health. Officials there declined a recorded interview. But in a written statement, they acknowledge there’s no verification that the assessments get done.

‘Too Many Thoughts’

Three years ago, Farmer led efforts to create a tool that more physicians would want to use. Farmer riffles through a drawer stuffed with case files for recently arrived refugees.

"These are all positives of people we’ve reached out to since the beginning of the project," she said. They all were screened for mental health, almost upon arrival. That’s a sea change from a few years ago.

Farmer worked with partner organizations and Public Health - Seattle & King County to develop a new system. They came up with a 15-question survey that was simple, effective and culturally correct, crafting the questions carefully. Farmer read one of them: "Are you having too much thinking or too many thoughts?"

If that phrase sounds familiar it's because that's how Awo Mohamed put it when she was talking during the group. Saying they have too many thoughts is a way many cultures express worry.

King County now uses this tool to screen all new refugees. It's shown that one out of every three people shows signs of significant distress from PTSD, depression or other issues.

[asset-images[{"caption": "Somali women weave various crafts out of soft palm leaves from Somalia.", "fid": "11817", "style": "card_280", "uri": "public://201402/P1030800.JPG", "attribution": "Credit Liz Jones / KUOW"}]]"We just shook our heads the whole first year," Farmer said. "We would just think, 'Oh my god, what would this person have done? If they – what would they have done?'"

Among those referred to mental health treatment, Farmer said up to 70 percent follow through, depending on the language or type of case. To her, that’s a huge success rate since mental health tends to carry a big stigma among refugees. To many, it just means “crazy.”

Plans are underway to roll out the tool statewide. It’s also used in 50 sites across the country, and Farmer has had interest in the tool from all over the world, including Hong Kong, Germany, Canada and Australia.

In King County, the screenings have revealed a growing need to help torture victims. That’s sparked some new services paid for with a federal grant.

But perhaps one of the most meaningful ways Farmer sees success is with the refugees who walk into her office every day. Just like the Somali women weaving baskets, Farmer’s relieved to see more refugees seek out support on their own terms, before a crisis hits.

She described a recent knock on her door. "They came in with one my cards that looked all beaten up and folded like eight times and they just kind of slid it to me and they said, 'I was told to come with you, that I could get some help,'" Farmer said.

[asset-images[{"caption": "Group portrait of the weaving circle.", "fid": "11814", "style": "placed_wide", "uri": "public://201402/P1030803.JPG", "attribution": "Credit Liz Jones / KUOW"}]]

Year started with KUOW: 2006