As many as six in 10 asylum seekers suffer from mental health issues, but they mostly go undetected or untreated. From self-help groups to dream therapy, Berliners are filling in the gaps…
When your life changes forever, it’s normal to feel sad. But when 24-year-old Ahmed came to Berlin from Syria, he says, “The word depression took on a totally different meaning.”
After arriving in November 2015, he was sent to a refugee shelter on Osloer Straße. “I was alone, with nothing. Knowing my family was still back home in danger of being killed daily only made things worse.” Living in cramped conditions and facing uncertainty about his future, Ahmed became increasingly sad. “The solitude is the worst. In Syria you might get depressed because of the war, but you have family and friends to talk to.”
According to the Federal Chamber of Psychiatry (BptK), as many as 63.9 percent of refugees are suffering from anxiety, depression or, more commonly, post-traumatic stress disorder. Not such a high number, once you consider that up to 30 percent of Germans have been diagnosed with or treated for mental illness. But with only 28,500 licenced psychotherapists available in the whole of Germany, demand is high and resources already limited. As an overwhelmed newcomer with little or no German and no idea how the system works, finding help can seem impossible.
The solitude is the worst. In Syria you might get depressed because of the war, but you have family and friends to talk to.
Ahmed was lucky – within one month of his arrival in the shelter, he was invited to join a weekly Arabic-speaking refugee self-help group by Mariana Karkoutly, a Syrian social worker involved in the state-funded mental health organisation Stadtrand. “At first it was difficult to open up to a group. I didn’t trust them. But as nobody there knew who I was, and I knew no one would pass on my story to others, I slowly relaxed,” Ahmed says.
Opening up is an issue, as BPtK president Dietrich Munz points out. “A lot of refugees, including those from Arab countries, react too late when seeking help. They don’t understand that they have a mental illness, and they don’t even know such treatment is available.” Munz underlines that stigmatisation of mental health is still an issue even in Germany. Karkoutly concurs: “I had an all male-group, and one of the men, a Syrian, started crying. In his culture there is huge shame in crying in front of a woman, which added to his many frustrations.”
Stigma is only one obstacle on the complicated road to treatment. For the first 15 months after a refugee arrives in Germany, they are treated according to the country’s Asylum Seekers Benefits Act, which allows a refugee basic emergency health care, but not psychiatric care. Once asylum has been granted, it can take as long as a year to find a therapist. According to some non-profits, these roadblocks are deliberate, on the premise that refugees with uncertain chances of asylum (such as Afghanis) might fake mental health issues as an excuse to stay in Germany. According to Karkoutly, “If a psychologist states that this person has a mental illness and they can’t receive proper care in their home country, then we have to keep them.”
Once a refugee has been assessed, the wait to gain social insurance to cover treatment and the issue of language barriers (few if any Berlin therapists speak Arabic) can lead to further strain on someone who already has mental health issues. This is where alternative therapies and self-help groups, such as Karkoutly’s, come in.
Karkoutly came to Berlin in July 2015 for a master’s degree in social work and human rights, and ended up being recruited as a social worker at the Osloer Straße refugee shelter last year. She saw that many of the men there had alcohol or drug problems and no drive. “One man there was so extremely depressed that I arranged for a psychologist and a translator to come to the camp and talk to him. Then we noticed that practically all the men wanted to speak with the psychologist! This is where the idea for the refugee self-help groups began.” Stadtrand has run self-help groups all around Berlin since 1990, covering everything from addiction to agoraphobia. It has 12 offices in the city in total, one in each district, with the newest being Karkoutly’s in Moabit. “Ours is slightly different – we go to shelters and promote the groups, and people that feel they need the help can come along.” No paperwork or documentation is needed to join. Karkoutly also co-runs the café Lou-Lou, a five-room space in the Stadtrand office building on Moabit’s Lübecker Straße, where small groups meet in German, Russian and Arabic or English to talk, cook and share over tea and soft drinks.
Another new Berliner active on the refugee mental health front is Stefano Carpani, an Italian researcher with the University of Essex who, following an internship with Charité, decided to expand his dream interpretation workshops to Berlin’s refugee community. Since January, Carpani has been encouraging refugees to share their dreams, daydreams and nightmares during two-hour sessions in groups of 10-12. As most of the workshops are in English, two Arabic-speaking interpreters help with translation.
Sharing and interpreting dreams, Carpani feels, opens up a dialogue within the group, allowing refugees to gain a better understanding of any trauma they may be facing. “I believe all refugees should have psychological screening when entering the country,” he says. “They’ve been through so much, they get here thinking everything will be all right but then they are placed in cramped refugee shelters and their traumas often worsen. People with acute cases can be treated, but what about everyone else – children who have been in wars, for example? How will they be feeling when they grow up?”
So does every refugee need psychological assessment, really? While there is no simple solution, the organisation Mental Health Europe suggests that local authorities should provide more accessible mental health support in refugee shelters, as well as training employees to recognise when someone might need treatment. Meanwhile, groups like Karkoutly’s and Carpani’s fill an important gap for people who may be experiencing a low level of trauma, with many having their feelings of depression and sadness lifted simply by talking to others. “Today I feel less alone,” says Ahmed. “The therapy helped me get to know new people and open up to strangers. I feel much better now.” Receiving his papers and moving out of the shelter into a flat in Charlottenburg might have helped!