This paper examines the mental health crisis among child refugees globally, drawing on a literature review that spans studies from Cambodia, Bosnia, New Zealand, and beyond. It documents the high prevalence of post-traumatic stress disorder, depression, and other psychosocial disorders among displaced children, while noting that not all children exposed to adversity develop mental illness. The paper reviews intervention models — including New Zealand's ON TRACC transcultural service — and highlights schools as a particularly promising channel for identifying children in need and reaching their caregivers. It concludes by proposing a comparative study to measure the effectiveness of schools versus other communication vehicles in connecting refugee children and their families to mental health support services.
The paper demonstrates effective use of a literature review to build a research rationale. By aggregating findings across multiple studies and populations, it identifies a gap — the lack of tested outreach strategies for refugee children — and uses that gap to justify a specific, feasible comparative study design with defined dependent and independent variables.
The paper opens with global statistics to establish urgency, then moves through a multi-source literature review organized around prevalence data, resilience findings, and intervention models. A focused section on ON TRACC in New Zealand provides a concrete program example. The paper closes with a brief but precise proposed study design, including a three-month communication trial comparing schools against other outreach vehicles. This progression from problem to evidence to proposal is characteristic of an undergraduate research proposal format.
It is estimated that over one billion people of all ages worldwide are affected by mass violence. They suffer from the experience of war, ethnic conflict, torture, and terrorism, and in a large number of cases are separated from their families. About 50 million individuals are displaced, with one out of every 200 homeless (UN Chronicle). The World Health Organization (WHO) reports that 450 million persons suffer from some form of mental or brain disorder, including alcohol and substance abuse, meaning that one in four families has at least one member affected. Approximately 121 million people additionally suffer from depression.
The future does not appear any brighter. The Global Burden of Disease Study (Murray et al., 2002) expects mental illness to rise by 15 percent between 1990 and 2020. That study did not include many post-conflict nations; it has been estimated that their inclusion would result in statistical findings two to four times greater.
Children are among the most vulnerable of all refugees; the percentage of individuals under 21 with mental illness is significant. Not only do they suffer from war or other forms of persecution in their countries of origin, but many continue to endure human rights abuses in countries of asylum. More than half of the world's refugee population consists of children, yet their needs and special protection requirements are frequently neglected.
A literature review indicates that little has been done to address the mental health issues of refugee children. Social workers and other professionals equipped to handle the myriad problems associated with refugee life need to conduct research to determine which intervention approaches are most effective and why. The literature suggests that one of the best ways to identify children most in need of mental health services — and to reach their caregivers — is through the schools. Teachers and administrators maintain ongoing contact with children and can more readily reach caregivers when needed. This paper reviews the relevant literature and proposes a study comparing the effectiveness of schools against other communication vehicles for reaching refugee children and their caregivers.
Child refugees across the world are enduring severe pain and suffering. In addition to homelessness, children in Sri Lanka were being forced to join the LTTE (Liberation Tigers of Tamil Eelam), and some were at risk of being taken for child slavery. Hundreds of thousands of children were affected by the 2004 Indian Ocean disaster. They remain among the most vulnerable survivors, at risk of disease, dehydration, and separation from their families. In areas such as Sri Lanka, children accounted for nearly half of the disaster's victims (Wiseman). The long-term psychological impact on these children will persist for years.
Child refugees elsewhere in the world suffer no less, with mental illness a major concern. According to a study by Lustig et al. (2004), "The impact of war among young refugees manifests empirically as psychopathology defined by Western models of illness." The researchers reviewed stressful experiences and stress reactions among child and adolescent refugees, as well as interventions and ethical considerations in research and clinical work, within the framework of the chronological experiences of child refugees — namely, the phases of preflight, flight, and resettlement. From a mental health perspective, cultural bereavement connotes refugees' responses to losing touch with attributes of their homelands. Elements of cultural bereavement include survivor guilt, anger, and ambivalence.
Similarly, Mollica et al. (2004) note that "Scientists have recently focused on elaborating the mental health problems of children exposed to extreme violence." Their data document the prevalence of mental health disorders — particularly post-traumatic stress disorder (PTSD) — across several refugee populations:
Among a six-year follow-up cohort of 30 young Khmer refugees, PTSD prevalence stood at 50% in 1984 and 38% in 1990. A study of 170 Cambodian adolescent refugees found rates of 26.5% and 12.9%. Among 59 young Cambodian-Americans, the point prevalence was 24% and lifetime prevalence 59%. A sample of 209 Khmer adolescents showed rates ranging from 12.9% to 41.2%. Among 99 Cambodian refugees, the point prevalence was 31.3% and lifetime prevalence 37.3%. Twelve Bosnian adolescents in the United States showed a rate of 25%, while Cambodian refugees in the United States showed a point prevalence of 28.6% and a lifetime prevalence of 37.1%.
A comparative study by Fazel (2003) of children seeking asylum in England examined rates of psychological disturbance in a sample of UK refugee children and compared them with children from an ethnic minority background who were not refugees, as well as with indigenous white children. More than a quarter of refugee children had significant psychological disturbance — greater than in both control groups and three times the national average. Refugee children showed particular difficulties in emotional symptoms.
According to a study by Manchester (2004), around 40,000 people of refugee backgrounds live in New Zealand. Since the early 1980s, the country has settled an annual quota of 750 refugees, one-third of them under the age of 18. Children can suffer from a combination of behavioral problems and mental health concerns such as anxiety, depression, and post-traumatic stress disorder symptoms, as well as care and protection issues. Most refugees, including children, arrive in New Zealand having been deeply traumatized by experiences in their home countries or in refugee camps. Suddenly placed in a new environment where they do not understand the culture or language, they have been uprooted from their homes and, in many cases, from their families.
Approaching the issue from a different angle, Mikus Kos (1999) notes that "It took a long time for the profession — mental health — to recognize that all children exposed to negative life experiences and adversities will not be psychologically damaged." In the past, professionals focused on the environmental causes of psychosocial disorders and consistently found relationships between past traumatic events and clients' current psychological difficulties. The question of why a particular child had developed psychosocial, emotional, or behavioral disorders could always be convincingly answered.
However, professionals did not pay sufficient attention to the large number of children who experienced chronic adversities or traumatic events yet whose development remained healthy. The question of why not — why so many young people exposed to similar or even identical adversities and risk factors were not psychologically disturbed — only emerged as a frequent topic in the professional literature during the last decade before Mikus Kos's writing.
Because of the large and growing numbers of refugee children, more social workers and mental health professionals are seeking additional ways to identify the best approaches for reducing the incidence of mental health issues in this population. They are studying different types of intervention to find the most effective approaches. Mikus Kos (1999) found, for example, that the percentage of refugee families who independently seek mental health care for their children is small; it is usually teachers who recommend treatment. This finding underscores the conclusion that "if the mental health profession wants to reach an important number of children, it has to develop outreaching and population-oriented models. The most important among them is the implementation of mental health activities in primary schools, which are the institutions gathering all children of school age."
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