McNeely and Morland Respond

We thank Azer for his response to our commentary on how the US public health system can improve the health of Syrian refugees—and all refugees. We agree that the rate of refugees experiencing torture is indeed high among Syrians, although it still remains challenging to estimate numbers. In addition, exposure to extreme traumatic events, including witnessing the death of family members and experiencing repeated, deadly bombing, is heartbreakingly common for Syrian refugees, half of whom are children.¹ We also agree that refugees could benefit greatly from interdisciplinary assessments and coordinated services for medical, psychological, social, and economic needs. As Azer implies, the challenges inherent in coordinating these community services can be daunting. Because of space limitations, we chose to focus on the accomplishments of two communities, although there are many more such successful efforts across the United States. We have described the challenges to service coordination in more depth in another publication.²

We have found at least three major challenges to early psychological assessment and support. First, many mental health assessments rely on Western constructs such as posttraumatic stress disorder and have difficulty capturing refugee cultural idioms of distress and suffering (e.g., feeling broken or destroyed³) as well as identifying individual, family, and community strengths. Understanding culturally salient risks and protections is critical to an effective assessment and coordinated response. Second, a general shortage of professionals and interpreters with needed language skills often results in required mental health assessments not being performed during the initial US medical screening. Third, communities vary in their capacity to provide appropriate services to refugees identified through screening as being in need of care. Our mental health care capacity nationwide is limited for all those in need, but particularly so for the specialized needs of refugee survivors of torture and extreme trauma.

By drawing attention in our editorial to local communities providing culturally responsive, coordinated services to newly arrived Syrian refugees, we hope their efforts will be recognized and even inspire such partnerships in other communities. Given the diversity of funding systems, community capacities, and refugee groups, it is difficult to conceive of a standardized procedure that could be applicable everywhere. However, stronger evaluations of existing programs can help identify principles of practice and policies that could help overcome these myriad challenges.