Overcoming Stigma About Mental Health Services: Lessons from Working with Refugee and Immigrant Families

• Background: Stigma about mental illness is often reported as a barrier to providing school mental health services to refugee and immigrant children. • Purpose: Drawing from a five-site comparative case study of school-based mental health programs, presenters will describe three successful cultural adaptations that prevent school mental health services from being stigmatized. • Significance: In the US, 25% of children under 18 have at least one parent who is a refugee or immigrant. • Methodology: 90 in-depth interviews were conducted at five program sites (Chicago, Los Angeles, Boston, Durham, and Fargo) of Caring Across Communities, a national demonstration project of school-based mental health services for refugees and immigrants. Interviews were conducted with mental health professionals; school teachers, administrators, and staff; immigrant and refugee parents; and staff of partner agencies in the community. Analysis was conducted using a modified constant comparison method. • Findings/Results: The sites that integrated mental health services into a comprehensive social service framework without ever labeling mental health services as such successfully increased utilization of mental health services. These successful strategies fully involved parents and staff from community agencies as essential partners. In contrast, when mental health providers attached mental health terminology to children's behavior, due to either habit or necessity (e.g., informed consent), they inadvertently increased and created barriers to help-seeking. • Conclusions/Recommendations: Cultural adaptations that prevent school mental health services from being stigmatized in refugee communities are feasible and increase access to care. These adaptations require increased resources.