Multiculturalism and Compassion: Responding to Mental Health Needs Among Refugees and Asylum Seekers Comment on "A Crisis of Humanitarianism: Refugees at the Gates of Europe"

Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach

Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology.

Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method.

Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person’s country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests.

Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people.

Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach

Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology. Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method. Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person’s country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests. Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people.

Who is Taking Care of Central American Immigrant Youth? Preliminary Data on Caregiving Arrangements and Emotional-Behavioral Symptoms Post-Migration

Migrant youth are at increased risk for mental health problems. Given increases in families migrating to the U.S. and family separations at the U.S.-Mexico border, understanding migrant youth home environments and impacts of family disruption are growing concerns. This study assessed caregiver arrangements and reports of youth emotional and behavioral symptoms from recently immigrated adolescents (N = 111) and respective caregivers (n = 64). 47.7% of youth indicated living with their mother, father, or both; 24.3% another relative, 2.7% a non-relative, and 25.2% reported no caregiver. 25% indicated caretaking responsibilities of their own. Caregiving arrangements were related to emotional and behavioral symptoms. Caregiver documentation status was related to caregiver-reported conduct problems, prosocial behavior, and total symptoms. The migration process is disruptive for youth and home environments. Many youth experience disrupted caregiving post-migration and caregiver features are significant to youth emotional and behavioral symptoms-which were elevated in this sample. The study provides novel insight into effects of family disruption on migrant youth post-migration.