When my brothers call me from behind bars, they sound almost unrecognizable. You can hear the fatigue and uncertainty in their voices. Once proud shoulders slump with exhaustion. The detention experience only enhances what we know to be the root cause of a violent outburst: triggered trauma responses, fear of the unknown, and loss of a sense of control.
As the migration crisis in the Mediterranean region continues to grow in the wake of the COVID-19 pandemic, much of the world has become numb to the “refugee crisis”. Funds start to dry up. Programs are abandoned. Health systems around the globe are being stretched beyond their capacity to cope, and the first people to face the consequences of this are migrants, whose ambiguity allows for governing bodies and organizations to defer responsibility and people are lost through the cracks. Out on the margins, people are forced to turn to alternative ways to meet their basic needs such as “poverty crime”, and the sense of despair can push people to a tipping point. For men, this can mean outward expressions of trauma, frustration, and distress in the form of angry outbursts, drug and alcohol use, self-harm, or even physical violence against those around them.
Forcibly displaced men are neglected from mainstream narratives surrounding migrants and refugees while simultaneously being pulled into the limelight as the victims of stigmatization and stereotypes at a social and systemic level. The Western archetype of a terrorist, criminal, or general threat to society is often synonymous with refugee men predominantly from the Middle East or Central Asia. The knee-jerk reaction of authorities when these outward expressions of deeper psychological problems bubble to the surface is imprisonment; which in some cases is appropriate. But when are we enforcing justice versus perpetuating trauma and failing to recognize signs and symptoms of deep psychological distress?
There are a few key elements that must be taken into consideration when examining the complexity of mental health in forced displacement contexts.
Culture - culture influences many aspects of mental health, both the causative and restorative factors, and the way that people perceive and manage mental health issues when they arise. As a whole, there is a gender role that males are typically expected to fill, and while the specifics of gender roles vary from culture to culture, the pressure to fill these social roles and expectations are a common thread in the human condition.
Many migrants and refugees experience a unique type of mental health crisis when they are forced from their homes and their cultural identity is challenged in a new setting, meaning cultura is not only an influencing factor in mental health, but it can even be a causative one.
The power of one’s cultural ties can also have restorative factors, especially for those in a diaspora. Stronger cultural ties build stronger communities, which can help people not only cope with traumatic events, but actually experience a growth process following them.
Context - the contexts that people come from and the contexts they find themselves in greatly influence their state of mental health. Those who come from traumatic backgrounds and find themselves in contexts where they may continue to experience trauma or a sense of psychological distress will require different interventions than those in more stable situations. The context people find themselves in will also influence their access to services, regardless of whether or not they choose to seek them.
Quality of Care - even in the best environments, mental health care is a constantly developing specialty. Recent papers have pointed to the lack of research, particularly qualitative, on the mental health of refugee men, which could be correlated with their poor access to culturally-appropriate and gender-appropriate services. Poorly informed practices lead to poor quality of care, which often discourages people from seeking care not only immediately, but also moving forward.
Additionally, outside of the scope of forced displacement, the general population as well as the medical community have failed to recognize the differences in response to mental health issues between men and women. “When it comes to mental health maybe the female experience is taken as the default to a certain extent. I think it's a lot easier to diagnose mental health difficulties in a woman than a man simply because a lot of the symptoms that we look out for tend to be more those that manifest in women.” Said In-Sight Collaborative’s Daniel Eichner in a recent webinar. Indeed, while women tend to internalize and withdraw, demonstrating classic symptoms of post-traumatic stress disorder, anxiety, or depression, men tend to express their psychological distress outwardly through substance abuse, self-harm, or even physical violence. Our failure to recognize this not only leads to insufficient care for men, but it can even lead to them being punished for their cries for help.
These factors all increase the risk of developing complex mental health disorders such as PTSD, anxiety, or depression, and not just while migrants are on the move. “This population showed a correlation of depression and anxiety disorders within post-resettlement hardships in regards to finding employment and adapting to a new environment culturally and linguistically.”
The Lost Boys
So what does this mean for men? In 2013, as the Syrian conflict caused an influx in refugees to surrounding countries that pushed regional NGOs and refugee responses to their limits, vulnerability framework or criteria became widely popular and is now a normalized element of the humanitarian response. The concept is simple: design a framework or criteria that help you identify and support those most vulnerable in a context or crisis zone. The problem with this is that the primary indicators of vulnerability were almost universally agreed upon, therefore all organizations adopted nearly identical criteria and the resources have been funneled to the same populations ever since. Because of chronic resource shortages in the sector, it is difficult to notice the unintended consequences of this framework since the “most vulnerable” are rarely adequately supported. It is blatantly obvious, however, when you look at the people who have fallen through the gaps. Who must turn to poverty crime? Who has the higher rate of rejections of their asylum cases? Who are the ones in migrant detention? Who are the ones excluded from safe housing and working black market jobs? Overwhelmingly men.
Those deemed the least vulnerable by the framework receive the least support and services. When it comes to mental health services for men, the odds are stacked against them. This has to change.
It is the responsibility of humanitarian actors to recognize the role that we must play in properly identifying psychological distress and mental health needs in our community members.
We must advocate for brothers in migrant detention whose trauma is only being compounded by injustice. We must adapt our resources to accommodate the rehabilitative needs of those who faced prison sentences for their violent outbursts or substance use.
But most importantly, we must help shift the narrative so that preventative measures can be taken to support our brothers before they reach critical breaking points. Men experiencing displacement need safe spaces, appropriate outlets, and culturally-competent care just as much as women. We also have a responsibility to raise awareness about the stigmas surrounding displaced men and help cultivate more tolerant and welcoming environments for people fleeing conflict, violence, and colonialism.
As Men’s Mental Health Awareness month comes to a close, we hope that you join us in continuing to support efforts to promote a healthier world for our men and boys.
To learn more, you can watch In-Sight Collaborative's webinar about Cultural Considerations with Mental Health Care for Refugee Men and be sure to follow The Brothers Campaign!