Refugees are people who flee their native countries to seek sanctuary in another country as a means of escaping persecution or oppression. Typically, refugee populations are especially active in times of war, though many also leave their countries of origin to escape an oppressive government. The traditional countries that accept refugees are Australia, Canada, Denmark, Finland, the Netherlands, New Zealand, Norway, Sweden, and the United States. In certain political eras in history, the criteria for receiving refugee status and the countries that the United States aided by accepting refugees fluctuated. During World War II, when thousands of people were fleeing violence and persecution, the United States and many other countries turned away refugees because their numbers were much higher than the immigration quotas instituted at the time. The U.S. Department of State refused to increase the quotas and to relax the limits on immigration. In response to the overall failure of countries to respond to the needs of World War II refugees, the United Nations High Commissioner for Refugees (UNHCR) was created, and the 1951 Convention Relating to the Status of Refugees delineated the international obligation, which the United States accepted, to shelter people who faced death and persecution in their own countries.

In contrast to the response to refugees during World War II, during the cold war, people from Southeast Asia, the Soviet Union, and Cuba were accepted into the United States as refugees although they did not meet the criteria for being a refugee. This illustrates how the political atmosphere—in this case, the need to “liberate” people from communism—influences which nationality groups of refugees are allowed into the country. More recently, the United States has focused on smaller refugee groups, such as Sudanese refugees, who have been victims of repression in Egypt, Ethiopia, and Kenya, and refugees from Bosnia and Kosovo who were fleeing religious persecution.

The United States traditionally has accepted more refugees than the other countries of resettlement combined. However, after the terrorist attacks on September 11, the number of refugees admitted has declined. For persons to be declared refugees in the United States, they are generally interviewed by an officer from the UNHCR and an officer of the U.S. Citizenship and Immigration Services to assess if the person is considered a refugee under U.S. law. Despite these procedures, there are still ways to allow refugees into the country who do not fit the profile of a refugee. For example, under the Widows and Orphans Act, (a) women who fear they will be harmed because of their sex and (b) children under 18 whose parents cannot provide adequate care can be admitted into the United States as refugees. Although the United States does not admit as many refugees as in the past, there is still a significant refugee population in the United States that continues to grow.

Refugees are known to suffer extensive psychological distress as a result of war experiences, flight from their native country, residence or incarceration in foreign refugee camps, and their involuntary immigration to a host country. At present, posttraumatic stress disorder (PTSD) and major affective disorders are known to be common symptom patterns within refugee populations, and there has recently been a rise in the prevalence of PTSD. However, despite the known association between refugee status and the likelihood of mental illness, diagnoses may go undetected due, in part, to culture-related presentations (e.g., somatization) and assessment biases of mental health practitioners. Thus, the combination of cultural factors in mental health presentations and new refugee groups in the United States demonstrates a need for research to better understand the problems of refugee populations and to propose effective treatment that is culturally sensitive.

Mental Health Interventions

The task of mental health providers has been to develop programs that refugees can access and utilize, as well as receive in their own language. Kenneth E. Miller discussed an intervention approach with an ecological perspective. He suggested identifying and training community members, who are obviously familiar with local beliefs and practices, to assist as mental health paraprofessionals and with prevention services. It is important that mental health practitioners expand the range of settings in which mental health is practiced from traditional clinic-based approaches to community-based approaches, including psychoeducation, that allow for an expansion of consumers and a network of interdisciplinary collaboration among psychiatrists, psychologists, social workers, translators, teachers, medical doctors, and stakeholders from within the community. In political persecution, perpetrators aim to destroy people’s sense of belonging and their community ties. Thus, interventions for refugees should be embedded in communities. Community outreach projects serve to bring communities and families together in some collaborative effort.

Gargi Roysircar reported on specific guidelines for working with refugee populations. First, counselors should attend to refugees’ immediate and concrete needs; this provides the opportunity to build rapport with refugees. Some guidelines to increase effectiveness in developing a working relationship with refugees include (a) treating them with respect and dignity, (b) determining beforehand the appropriate means of greeting in the refugee’s culture, (c) finding out where the refugee can obtain food appropriate for his or her culture, (d) arranging for an interpreter, (e) locating a religious community appropriate for the refugee’s faith, and (f) connecting new arrivals with other members of their ethnic community. Finally, counselors’ ability to listen to the refugees will be key in the facilitation of a trusting relationship.

Roysircar also suggested several community outreach services appropriate for refugee populations. First, she advocates for the establishment of a life skills group. This educational group should be structured to teach refugees about American society. Topics of a life skills group could include using public transportation, writing a resume, applying for benefits, understanding the school system, and learning how to enroll in English as a Second Language (ESL) classes. Another community outreach program could focus on nutrition classes. The idea behind this service is that it will teach refugees how to prepare nutritious and inexpensive meals. Another possible outreach service could be to offer a stress management class. An example of this type of class might include Tai Chi, deep breathing, and relaxation exercises. In such a class, refugees can begin to understand trauma and its deleterious effects rather than remaining confused about PTSD or stigmatizing it. In addition, an acculturation class can relate life problems of employment difficulties, legal issues, absence of primary support group, lack of American education, housing issues, economic issues, access to health care, and social functioning problems in the challenging process of acquiring a second culture. Other types of groups include men’s and women’s support groups, ESL classes, and community outreach projects (e.g., a gardening project, organizing a cultural festival). Community outreach projects also can serve to bring communities and families together in some collaborative effort.


  1. Barnett, D. (2006, December). A new era of refugee resettlement. Center for Immigration Studies. Retrieved from
  2. Huynh, U., & Roysircar, G. (2006). Community health promotion curriculum: A case study of Southeast Asian refugees. In R. L. Toporek, L. H. Gerstein, N. A. Fouad, G. Roysircar, & T. Israel (Eds.), Handbook for social justice in counseling psychology (pp. 338-357). Thousand Oaks, CA: Sage.
  3. Miller, K. E. (1999). Rethinking a familiar model: Psychotherapy and the mental health of refugees. Journal of Contemporary Psychotherapy, 29, 283-306.
  4. Refugees. In Holocaust encyclopedia. U.S. Holocaust Memorial Museum. Retrieved from
  5. Roysircar, G. (2007). Disaster recovery: Counseling interventions. Alexandria, VA: American Counseling Association.

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