PANEL VII
ANALYSING MIGRANTS’ PUBLIC MENTAL HEALTH: CITIZENSHIP, RESILIENCE,
AND THE ROLE OF RELIGION
Organisers | Önver Cetrez and Valerie Demarinis
This panel focuses on micro, meso, and macro dimensions of citizenship, belonging, resilience and religiosity as they pertain to public mental health for migrants.
The framework of a public mental health perspective incorporates a person-centered approach, which understands that resilience is present and can be nurtured in the face of difficult and persistent traumatic experiences. The perspective is in accord with the Roadmap for Mental Health in Europe (ROAMER) recommendations for public mental health research in Europe (Forsman, A. et al., 2015). This holistic approach includes cultural and existential meaning assessments for identifying potential resources for mental health and well-being as well as providing specific information on beliefs, practices, or values that might be hindering such (Silove, 2013; DeMarinis, 2014).
On the micro level the panel includes papers focusing on refugees’ experiences of citizenship and community belonging and access to regular health care services and informal health services. Some papers look at the role of religion or other meaning-making systems providing resources in daily activities, as well as refugees’ experiences of the role of family and significant others in daily living. On the meso level, papers explore mental health and psychosocial services for refugees, participation of non-state institutions in the implementation of health care, as well as cultural, gender, and contextual approaches to health care by providers. Finally, on the macro level, the panel examines reflections and research on access to citizenship rights, health care provision for refugees and access to mental health and psychosocial services.
Chair: Onver Cetrez - Discussant: Valerie Demarinis and Halina Grzymała-Moszczyńska
abstracts & bios
Migrants’ and refugees’ healthcare access across Europe – citizenship and human rights based claims.
Hannah Bradby, Uppsala University, MigHealthcare Consortium and the UPWEB Project
This paper considers how forced migrants’ healthcare needs are addressed by national health systems in European settings and the factors hindering access at organisational and individual level. The paper draws on two studies: MigHealthcare which involved interviews with service providers, working for NGOs and the public healthcare system and policy makers across ten European countries; UPWEB which interviewed both healthservice providers and healthservice users in highly diverse neighbourhoods in four European countries. The ways that healthcare access is hindered are described from the perspective of professionals and healthcare users.
NGO and healthcare workers in some settings, report that camp facilities for refugee reception have highly negative effects on people’s mental health. In some cases, symptoms of mental distress are evidence, brought on or exacerbated by the conditions in which refugees are received, can allow a refugee to be put forward to be processed by migratory authorities.
Healthcare workers in various countries note migrants’ reluctance to access healthcare for fear that unwelcome attention from migration authorities will ensue. Refugees’ own stories describe the range of strategies adopted as alternatives to accessing medical services, including prayer. Accessing treatment for mental health problems is described as being postponed to a future moment until residency might be resolved.
Forced migrants can rarely claim access to healthcare as a citizens’ right and there is very little means of asserting a human right to healthcare, even when professionals adopt human rights rhetorically. Migrants are caught in what Nash (2009) has termed a new form of inequality, whereby they have neither citizens’ rights nor the ability to pursue a human rights-based claim. As competing priorities the governance of migration tends to over-rule consideration of forced migrants’ public mental health.
Reference | Nash, K. (2009) Between Citizenship and Human Rights, Sociology. 43, 6, 1067–83.
BIO
Hannah Bradby is professor in the Sociology Department, Uppsala University, where she researches how health and healthcare interact with migration. She publishes widely in sociological and public health journals, and books - see http://hannah.bradby.info/ for a listing. Hannah is ethics advisor for RESPONDhttps://www.respondmigration.com/advisory
MigHealthcare consortium includes: Adele Lebano & Sarah Hamed, Uppsala University, Sweden; Ivo Christova, National Center of Infectious and Parasitic Diseases, Bulgaria; Pania Karnaki & Dina Zota, Institute of Preventive Medicine, Environmental and Occupational Health, Greece; Elena Riza, University of Athens, Greece.
Religion and Resilience In the Post-Secular Refugee Settings
Selcan Kaynak, Bogazici University; Cagdas Dedeoglu, Center for Critical Research on Religion; Cansu E. Dedeoglu, University of Toronto
There is a growing literature on resilience and trauma across diverse disciplines. For instance, Forsman et al. (2015) state that resilience factors constitute one of the three purposes of public health research priorities; Silove (2013) offers existential meaning as one of the five pillars of the Adaptation and Development after Persecution and Trauma (ADAPT) model; Çetrez and DeMarinis (2017) discuss the theoretical possibilities as well as the ethical and methodological challenges in regard to the study of refugee health and resilience. These works identify the relationship between religion and resilience as worthy of investigation, and this study aims to contribute to these efforts by a comprehensive understanding of religion supported by empirical evidence. For that reason, it will develop a framework that is grounded on a person-centered, holistic approach (Çetrez & DeMarinis 2017).
As DeMarinis (2018) puts it, “[m]eaning-making takes place within cultural contexts.” In this regard, the importance of agency (Asad 2003), relationality, and contextuality in understanding religion and resilience guide this research. Consequently, two bodies of literature will be engaged. The first one rests on a bio-psycho-social model of resilience and mental health; the second one rests on a critical reading of religion and nature.
Methodologically, this research relies on semi-structured interviews with refugees from two diverse cultural contexts, Toronto and Istanbul. We expect to see first if there are significant differences among the meaning-making and coping strategies of refugees who are living in two different cultural settings, and second, if the demographic profile has any impact on these strategies. In other words, we expect to map the different refugee ontologies based a post-secular comprehension of religion. In conclusion, we will discuss our findings with the results of similar research (Ahmadi & Ahmadi 2015; Çetrez & DeMarinis 2017; Ahmadi et al. 2019).
BIO
M. Selcan Kaynak is an Assistant Prof. in the Department of Political Science at Bogazici University in Istanbul. Her research and teaching focus on media systems and socio-political change and political psychology. She has published on Turkey's public diplomacy, media and politics in Turkey, and electoral behaviour of Euro-Turks. She has served as the President of the International Communication Section of the International Studies Association and on the Executive Committee of the Information Technology and Politics Section of the American Political Science Association. Her recent research interests address forced migration and trauma. She is interested in investigating massive trauma as a result of displacement and vicarious trauma experienced by therapists and aid workers in contact with traumatised populations. She aims to research the resources available for such populations in Turkey and the immediate regions receiving the influx of refugees. Dr. Kaynak received her PhD in Communications from Temple University and her BA in Political Science at Bogazici University. She has an MA in Clinical Psychology from Bilgi University.
Çağdaş Dedeoğlu is a Research Associate at The Center for Critical Research on Religion. He is a member of Postsecular or Postcritique? New Approaches to Reading Religion Working Group at University of Toronto’s Jackman Humanities Institute. Previously, he worked as an Assistant Professor of Political Science and Public Administration at Istanbul Arel University and as a research scholar at the University of Florida’s Department of Religion. Dedeoğlu’s research interests include political ecology of religion and science, secularism, and critical ontologies. These interests animate his involvement with other research organizations, including the International Society for the Study of Religion, Nature and Culture and the Political Ecology Network. You can learn more about his research and publications on his website www.cagdasdedeoglu.com or follow him on Twitter @CagdasDedeoglu
Cansu E. Dedeoglu is a Ph.D. student at the University of Toronto's Faculty of Information. Her research interests include social and ethical implications of technologies.
Psychosocial health and resiliency among Syrian refugees in secular Sweden: A mixed method approach
Önver Cetrez, Uppsala University
Within the health area, the approach to migration is mainly from a problem-oriented perspective. As a consequence, this narrative frames the problem as an individual, immigrant-related one, placing the responsibility with the newcomers, rather than pointing out and identifying the structural and social problems in society. Instead, we argue that human beings, individually and collectively, have the capacity to be much more proactive in relation to ill-health. Furthermore, despite the many challenges faced by refugees, some still show a good level of resilience, where they use health-promoting resources and coping mechanisms with connection to family, community and culture as meaningful. Therofe, our aim is to understand these protection factors, which reduce ill-health and instead contribute to better mental and also often physical health among Syrian and Afghani migrants living in Sweden, with special attention to gender specific factors.
Design: This mixed method study used instruments (CD-RISC, PC-PTSD, and self rated mental health) for quantitative purposes (n=700), as well as semi-structured interviews (n=60) among refugees fleeing to Sweden during 2011-2017.
Results: Preliminary results show a high experience of trauma and PTSD, more so among women. At the same time the material shows efforts towards recovery and growth among participants, as well as resilience factors such as family, community, and belief systems to be of strong importance.
Keywords: resiliency, belief systems, religion, community, family, gender, refugees, Sweden.
BIO
A. Önver Cetrez is Associate Professor in psychology of religion, at Uppsala University. He is currently the coordinator for the Horizon2020 project RESPOND – Multilevel Governance of Mass Migration in Europe and Beyond (www.respondmigration.com). During 2014-2016 he held the position as deputy director at the Swedish Research Institute in Istanbul. Cetrez’ peer reviewed articles, chapters, and scientific evaluation reports link to topics of migration, refugees, psychosocial health, meaning-making/religiosity, resilience, coping, acculturation, and youth, both qualitatively and quantitatively. He has edited three books, in the topics of identity, knowledge and borders, and the psychology of religion. He is a member of the Ethics Board in Sweden. See more: http://katalog.uu.se/profile/?id=N96-5719
Experiences of Polish economic migrants with the Norwegian healthcare system: Exploring dimensions of cultural competence and complexity at individual, group and system levels
Valerie DeMarinis, Uppsala University
Research area: European migrant ethnic minorities and their experiences with a given healthcare system in another European country, an area for public mental health promotion within a public health framework.
Aim: This research project explored Poles, being from a nation of high mobility within the EU and other European countries, living in Norway, where they are currently the largest group of immigrants.
Design: A qualitative, semi-structured interview design was used with 20 Polish migrants who resided in Norway, in the Østlandet region. The Cultural Formulation Interview, (CFI), adopted from the DSM-5 (American Psychiatric Association, 2013) was used as a base-tool for constructing the interview areas. Mental health and well-being instrument were also used. A thematic analysis approach was used for interview data analysis.
Results: Respondents reported both positive and negative experiences in interactions with the Norwegian healthcare system. Cultural differences, including religion, were identified as factors influencing respondents’ attitudes. Negative experiences were associated with cited cultural differences, language problems, and continued medical help-seeking in Poland. The results are discussed in relation to implications for how areas of cultural competence on the part of migrants as well as healthcare professionals in the host country are necessary for: person-centered care, increased resilience for patient and healthcare professional, and an improved therapeutic alliance influencing the processes of diagnosis, treatment and compliance.
Keywords: economic migration, cultural differences, secular majority culture, religious minority culture, person-centered care.
BIO
Valerie DeMarinis is Professor in Public Mental Health Promotion at Innlandet Hospital Trust in Norway and The Department of Public Health and Clinical Medicine at Umeå University (Medical Faculty) in Sweden. She is also Professor in Psychology of Religion at Uppsala University in Sweden. She is the chief psychologist for the RESPOND project. DeMarinis publishes widely in mental- and somatic healthcare areas, as well as on specific topics of healthcare related to migration, radicalization and cultural aspects of mental health and wellbeing.
Co-author affiliations:
Adam Anczyk, Institute of Psychology, Jesuit University Ignatianum, Kraków, Poland, anczyk.adam@ignatianum.edu.pl
Halina Grzymała-Moszczyńska Institute of Psychology, Jesuit University Ignatianum, Kraków, Poland, halina.grzymala-moszczynska@ignatianum.edu.pl
Agnieszka Krzysztof-Świderska, Institute of Psychology, Jesuit University Ignatianum, Kraków, Poland, agnieszka.krzysztof-swiderska@ignatianum.edu.pl
The role of religion and culture in the coping process of Syrian refugee women in Turkey
Marysia Kanal, University in Kraków
Background and aim: Numerous studies describe the trauma and suffering experienced by the refugees followed by negative mental health outcomes such as PTSD and depression. With refugee women being often presented as victims and depicted as vulnerable ‘womanandchild’ (Enloe 1990, 1991) or suffering in silence “madonna like” figures (Malkki 1996, Fiddian-Qasmiyeh 2016) the refugee women resilience and coping abilities are often overlooked. The aim of this study is to highlight the importance of emic cultural and religious strategies in the process of coping with forced migration-related stressors among the Syrian women in Turkey.
Both sociocultural model of coping (Aldwin, 2007) and the cultural transactional theory of stress and coping (Chun, Moos, & Cronkite, 2006) describe the culture’s influence on the entire coping process (from defining stressors to the degree of perceived stressfulness and the choice of coping strategies). The main objective of this study is to identify how the intersection of religion, culture and gender contributes to the wellbeing of Syrian women in Turkey. Keeping in mind that coping is both gender- and culture-specific process the presented study is attempting to answer the question – how is the Islamic faith and culture affecting the coping process of the refugee women?
Design: 15 qualitative, in-depth interviews were conducted with Syrian refugee women living in the Hatay region of Turkey. Grounded theory was used as a methodological framework for this study.
Results: The preliminary data analysis was made and some emerging categories of coping strategies were identified such as patience (sabr), thankfulness (tahmid), surrender to God/believing in God’s plan (acceptance coping) and hospitality.
BIO
Maria Kanal is a Ph.D. candidate in psychology of religion from Jagiellonian University in Kraków, Poland.
The Best Interest of the Syrian Migrant Child in Sweden: examining acculturation and public mental health through interaction between religious and secular family systems
Mudar Shakra, Uppsala University
This research project brings together the field of psychology of religion focused on the area of acculturation as a part of public mental health and the field of law focused on international family law. The research is part of a general theme related to the acculturation process of Syrian migrants in Sweden, framed under the umbrella area of public mental health promotion.
Often religion, culture, ethnicity and language are the most studied variables when it comes to the analysis of identity, acculturation and integration. However, the application, implementation of certain laws and policies as well as the perception of them by the subjects (citizens) are some of the most significant elements in this regard, which require further investigation, particularly in the migration context in Sweden. One of the research aims is to present the differences and nuances between the legal, judicial and cultural familial systems in Syria and Sweden. These differences have supposedly put the newly arrival Syrians under complicated if not vulnerable position, as well as the receiving society in a confusing state too. The Islamic-inspired family system such as the Syrian one has a double-gendered nature, meaning that it is not only the parent’s sex that counts for his/her respective parental rights and child’s best interest assessment, but also the child’s sex – different rules apply to girls and boys. These characteristics are completely absent in the European/Swedish secular legal familial system.
This paper focuses on an initial analysis of the semi-structured interviews with Syrian migrants (n=20). Syrian parents’ attitudes, motivations and acculturation/accommodations in Sweden are explored through examination of the parents’ perceptions of their child’s best interest regarding two topics: guardianship and custody after divorce or death of the father, and the child’s religious education.
BIO
Mudar Shakra worked as a lawyer in Syria, and as a Refugee Status Determination Senior Officer at UNHCR Office in Damascus. In Sweden he has worked as an Integration Program Officer for FOCUS Humanitarian Assistance and as a Research Assistant at Uppsala University in the Faculty of Theology in two research projects. He is currently a PhD-Candidate in Psychology of Religion at Uppsala University.
Resilience in Context: A Brief and Culturally Grounded Measure For Syrian Refugee Adolescents in Greek - Host Community
Mary Stylidi, UNHCR Regional Commissioner & Institute of International Relations in Athens
With over 67 million refugees, asylum seekers, or internally displaced people throughout the world, urgent calls have been made to implement reliable and valid measures of resilience in late childhood and adolescence, a crucial time in the transition to adulthood for social, biological, and cognitive development. In cross-cultural work, resilience is often cast as the polar opposite of vulnerability, and culture is conflated with society, religion, or ethnicity—this can lead to reductionist analytical frameworks rather than understanding what really matters in terms of wellness, relationships, and shared understandings about the world.
The Child and Youth Resilience Measure (CYRM) is specifically developed in cross-cultural samples of adolescents facing adversity. This study aimed to develop and validate a brief measure of resilience for inclusion in a longitudinal survey of mental health and psychosocial wellbeing of refugee groups in the island of Lesbos, Greece. After qualitative work to develop culturally grounded understandings of resilience, an Arabic-language version of the CYRM was validated for use with Arabic-speaking adolescent populations. Informed consent was obtained in Arabic from children 11- to 18- year-old and their parents. Confirmatory factor analyses tested three-factor structures for 28- and 12-item CYRMs and measurement equivalence across groups. CYRM-12 showed measurement reliability and face, content, construct (comparative fit index = .92–.98), and convergent validity. Gender-differentiated item loadings reflected resource access and social responsibilities. Resilience scores were inversely associated with mental health symptoms, and for Syrian refugees were unrelated to lifetime trauma exposure. In assessing individual, family, and community-level dimensions of resilience, the CYRM is a useful measure for research and practice with refugee and host-community youth. Resilience scores were inversely associated with mental health symptoms, and for Syrian refugees were unrelated to lifetime trauma exposure. In assessing individual, family, and community-level dimensions of resilience, the CYRM is a useful measure for research and practice with refugee and host-community youth.
BIO
Mary Stylidi is a UNHCR Regional Commissioner for the Unaccompanied Refugee Children in Greece and Syria. Currently, she is deployed in Aleppo, Syria, as well as in the Greek Ministry of Education, Research and Religion Affairs. Also, she is a Delegate in the International Committee of Red Cross in Geneva. Finally, she is the Director of the Department of Military Psychology in the Institute of International Relations in Athens.