Concern about mental health has skyrocketed since the COVID pandemic. In May of this year, Dr. Vivek Murthy, the surgeon general of the USA, issued an advisory about another pandemic, one that preceded COVID-19 but was largely eclipsed by it — the issue of loneliness, affecting over half of Americans and cutting years from their lifespans. He prescribed intentional social connection — committing to friendship — and minimizing distraction, by switching off devices and learning to listen. Addressing loneliness, Dr. Murthy reported, would have a significant impact on physical and mental health.
For refugees who resettle in America, loneliness is typically already a pre-existing condition: having fled their home countries due to war, violence, or the threat of persecution, many refugees move to America without the support of many key relationships with family and friends they once relied upon.
Faresha (not her real name), an Afghan student in our ESOL class, was separated from her husband in the chaos at the Kabul airport during the 2021 U.S. evacuation from Afghanistan. She was ushered onto an American military transport plane and escaped the country; he did not. Her husband is still in Afghanistan, and Faresha is tirelessly working with U.S. immigration officials to bring him to the United States. Tragically, her story is not an unusual one among the refugee community we work with. In our 28 years of walking alongside global refugees who are rebuilding their lives in Atlanta, Georgia, we have seen firsthand that many refugees arrive feeling deeply lonely and having experienced some level of trauma.
Not all refugees can be said to be traumatized in the clinical sense, though some surely are. However, all refugees have experienced grief and loss, putting them at increased risk for adverse mental health outcomes. Our organization’s vision is for refugees to experience abundant life in flourishing communities; we have realized that our work is greatly enhanced when we incorporate holistic, trauma-informed practices that support overall social-emotional health in all our programs. This is even more important as we’ve observed that traditional Western approaches to addressing mental health (talk therapy, psychiatric medications, etc.) are often taboo in many of the cultures of the people we work with. More and more, we are exploring ways we can incorporate practices that are beyond the realm of traditional referrals to counselors, psychiatrists, etc.
Below are three non-clinical approaches we have found most effective to address loneliness and residual grief and trauma. And, while our work is primarily with refugees, we believe that these simple approaches can be adopted by any organization providing direct services to underserved and vulnerable people.
1. Connection is crucial.
More than 50 percent of our staff are New Americans, having come to the U.S. themselves as resettled refugees; their shared culture and common experience means that clients can often find at least one person on our staff with whom they have fewer cultural and language barriers. Though a client may have come to us for a specialized service (childbirth education or English classes), being served by a member of their own culture in a trusted and safe environment opens the door for connection with another person to process grief, loss, and trauma. We also invest in training select staff members in trauma-informed care. Having trauma-aware training empowers our staff to notice clients whose severity of mental health challenges may require a referral to professional mental health providers.
The supportive community, friendships and relationships that are a hallmark of our programs also help preserve cultural connections and identity for refugees. Celebrating a cultural heritage within these communities provides a sense of belonging, continuity, and pride. By maintaining their identity, refugees can draw strength from their roots, find solace in shared customs, and withstand the mental health challenges that arise from post-resettlement stress in the U.S.
2. Well-designed, intentional program spaces are an important tool in fostering connection.
Place matters: the interior design of a space sends a signal about the kinds of relationships and activities we expect to be formed in those places. Sterile, undecorated indoor spaces with an institutional feel reinforce control, formality, and distance between those serving and those being served; refugees are already too familiar with the aesthetics associated with institutions: neglect, mismatched items, broken furniture and the feelings created by lingering in spaces like that. The emerging field of trauma-informed design outlines the architecture and interior design principles with effects that create spaces that speak of safety, comfort, welcome, and belonging.
For my organization, that means creating simple, uncluttered spaces with a warm and welcoming vibe, decorated with culturally diverse decor, and equipped for constant brewing and serving of tea, which is an important cultural rite for many of the refugees coming to America. Our modest extra investment in beauty and hospitality pays off richly in terms of trust creation and relationship-building.
Take as an example our Embrace Refugee Birth Support program, which provides health education, support, and community for refugee women throughout their pregnancy, birth and postpartum experience. A central feature of this program is an eight-week course taught in the mother’s heritage language that prepares her to navigate giving birth in America. This course takes place in a large room that, for a long time, was rather dilapidated: old paint, mismatched furniture, inadequate storage for supplies, uncomfortable seating arrangements, etc. Generous donations from a local women’s leadership group enabled us to recently update this program space with fresh paint, supply cabinets, and multi-functional furniture that can accommodate different cultures’ seating preferences.
It has been remarkable to observe the difference in the Embrace participants’ interactions with our staff and each other in this newly refreshed space: our refugee friends happily lingered longer in the space compared to before, allowing more time to connect with our staff and to form deeper relationships with other refugees.
With this example in mind, we believe funders should value how nonprofit spaces look and feel, because they can reveal a great deal about the quality of services provided and relationships being formed within them.
3. Provide connections to nature to aid mental health.
It has become well-established that time in nature decreases anxiety and depression and facilitates relaxation and a reported sense of well-being. Many refugees who resettle in America are from agrarian cultures and landing in the middle of the city in an apartment complex with little access to green space can exacerbate depression and stress. At Friends of Refugees, we are fortunate to own a piece of property where we have one of Atlanta’s largest community gardens and an open green space. Not only do refugees who live in nearby apartment complexes rent garden plots and grow traditional foods, the open green space on the property is where refugee neighbors gather to talk and sit on benches and youth gather to kick a soccer ball.
In providing access to green space for children to play and community plots for refugees to grow their own food, our staff has observed the positive mental health impact being outdoors has even the most severely traumatized individuals we work with.
In closing, what can funders do to support mental health of those they serve?
- Prioritize organizations that foster human connections in every part of their work, even if that means going slower.
- Recognize the extra costs that accompany culturally informed work, whether that is the cost of creating welcoming spaces that promote recovery, or the cost of training refugee community liaisons as experts and teachers, rather than relying on interpreters for American-born experts and teachers.
- Encourage nonprofits to leverage the healing power of connection to nature on behalf of their community, whether through hiking, gardening, birdwatching, etc.
- Look for organizations that prioritize employing those from the community they are serving in order to build supportive connections with those who share language, culture, background, and experience.
- Challenge organizations to identify measures of outcome and impact that show change in social-emotional health and well-being, in social connectedness, and provide resources to increase their capacity in this area.
In addition to these suggestions, we do our utmost to celebrate the fact that despite often years of experiencing disruption and dislocation, refugees resettled in the United States are amazingly resilient, creative, and resourceful. This is the last piece of advice I will leave you with: a continuous practice of joy and celebration go a long way in creating successful outcomes — I believe that’s worth funding.