Collaborative mental health care for refugee children

Primary care services, including clinics, schools and community organisations, because of their closeness to the family living environment, are often in a good position to detect problems in traumatised refugee children and to provide help. In a collaborative care model, the child psychiatrist consultant can assist the primary care provider and family in holding the trauma narrative and organising a safe network around the child and family. The consultant can support the establishment of a therapeutic alliance, provide a cultural understanding of presenting problems and negotiate with the provider and the family, a treatment plan. In many settings, trauma focused psychotherapy may not be widely available, but committed community workers and primary care professionals may provide excellent psychosocial support and a forum for empathic listening that may provide relief to the family and the child (Rousseau, Measham & Nadeau, 2012).

Advocates of collaborative primary mental health care for children and adolescents underline its compatibility with systemic approaches which are likely to improve shared decision making and responsibility among providers (Chenven, 2010). Primary care health and social services often express a need for assistance in understanding cultural differences in the mental health consequences of organised violence and in understanding the strategies used by families and communities to cope with trauma. In addition to addressing cultural differences, situations involving children affected by extreme human-perpetrated harm often provoke strong emotional reactions in caregivers. Collaborative mental health care models can help to address these information- and practice-based needs.

This section describes a cultural consultation model in youth mental health collaborative care in Canada including a case scenario of refugee children who have experienced different forms of direct or transgenerational trauma, in order to describe the process of cultural consultation in a primary care setting. The case scenario is used to illustrate the different steps of the process of cultural consultation in a primary care setting in order to highlight three issues that are at the forefront of cultural consultation requests for refugee families: alliance building, assessment and treatment. The challenges of cultural consultation in collaborative care settings addressing refugee children’s mental health are also discussed.

The collaborative care setting

The collaborative mental health care project in Montreal, Canada has been implemented in community-based health and social services clinics servicing multi-ethnic neighbourhoods. Of the children and adolescents living within these clinics’ territories, 80% are first (35%) or second (45%) generation migrants or refugees. Some of these children experience difficulties related to resettlement or to a previous experience of organised violence and few formally seek mental health support. The goal of the project is to provide mental health services to children through community-based clinics. Partners include first line health professionals involved in the psychosocial care of children and adolescents, such as general practitioners, community nurses, social workers and child care workers; as well as schools and community organisations (Rousseau, Measham & Nadeau, 2012).

Each clinic has a Youth Mental Health Team which provides mental health care directly to children and families, and which also supports the work of other teams in the community clinic delivering general health and psychosocial care to the families. Bridges with community organisations and schools contribute to the establishment of support networks for the families. This systemic approach facilitates the appraisal of the child and family’s difficulties within a broader social and cultural perspective and the formulation and implementation of intersectoral (such as school– clinic–community organisation) intervention plans (Rousseau, Measham & Nadeau, 2012).