A multitier model of refugee mental health and psychosocial support in resettlement: Toward trauma-informed and culture-informed systems of care

Refugees endure tremendous trauma during migration and resettlement. Despite the wide range of needs and challenges refugees have, previous research on refugee mental health has concentrated on the clinical treatment of certain common mental disorders related to premigration trauma. This narrow attention creates an environment in which positive mental health and social functioning are seen merely as a lack of mental illness among refugee populations. The consequences of such a focus are increased stigma of mental health issues and a negligence of other psychosocial needs critical to the community integration of refugee newcomers. There are few models and studies that focus on service delivery and systematic approaches to guide coordination of mental health services and psychosocial supports for refugee newcomers. To fill such gaps, this paper provides a framework to align stratified interventions and addresses the multilayered mental health needs in refugee communities. We have adopted and applied a multitier mental health and psychosocial support (MHPSS) model developed by the Inter-Agency Standing Committee to provide a holistic framework for a system of care. We have also proposed a two-pillar approach, trauma-informed and culture-informed care, which is embedded into each tier of the MHPSS program. This approach is designed to fill the gaps between mainstream mental health services and refugee resettlement programs, both of which tend to work in silos. Using the case of a statewide refugee mental health initiative in Virginia, we discuss the challenges and opportunities of programs to build capacity and partnerships for coordinated care.