Urban Matters: Dr. Brown, the Trauma and Global Mental Health Lab you head at The New School for Social Research works through the New York City Mayor’s Office of Community Mental Health with many of the asylum seekers who’ve arrived here in recent months. What’s been your approach?

Adam Brown: My lab and I have been working with the Mayor’s Office in a number of ways to address potential mental health concerns among recently arriving individuals. First, we have been leading Psychological First Aid (PFA) trainings for staff who are working in hotels (including the Roosevelt Hotel in Manhattan, pictured above) and shelters where migrants are now staying throughout the city. PFA is an evidence-informed strategy used in many contexts globally when there may be many people at risk for mental health concerns given high levels of stress and uncertainty. We are also building partnerships throughout the city with community-based organizations, in which we train staff to deliver mental health support to the communities they serve. 

UM:  In the past, you’ve also worked with migrants to Europe from conflict zones in the Middle East and Africa. Are there mental health concerns specifically related to the often very difficult journeys that migrants have made, or to their situations arriving in a new land, that are frequently evident? If so, how do they manifest themselves?

Brown: Every person’s experience is unique, but there is considerable evidence that the kind of high levels of exposure to adversity and trauma often faced by refugees throughout their journeys is a risk factor for mental health concerns. Although the events leading up to a person’s decision to leave their home country often contribute to mental health issues, such as depression, PTSD, and anxiety, the challenges a person faces as they try to adapt to a new country and culture are often even more predictive of post-migration living difficulties. 

UM: What sorts of things can people working with migrants who’ve recently arrived in New York do to address such concerns? What can the migrants do for themselves?

Brown: I think there is good evidence indicating that many of our most powerful mental health interventions are actually not what most people think of as mental health interventions. 

For example, policies, community groups, schools, and faith-based organizations that can provide a sense of hope, make someone feel safe, provide connections to other people who they trust, will have an important impact in reducing stress. Additionally, educating oneself about a person’s journey is critical; so is listening to the perspectives of the community. People who recently arrived will hopefully get clear information on what services are available and about practicing self-care strategies that promote wellbeing. 

UM: The United Nations High Commission on Refugees (UNHCR) estimates that there are, worldwide, about 35 million refugees today – more than at any time since the end of World War II. They have been displaced by armed conflicts, natural disasters, collapsed economies, and climate change, among other causes. From your perspective, how does what New York is experiencing fit into that bigger picture?

Brown: You’re right that this is part of a much larger issue throughout the world, and it has been going on for some time. I think there are a lot of excellent local organizations providing critical support and access to care and I hope we can find ways to knowledge-share and engage with other partners across cities who are similarly seeing a surge in individuals arriving to the US and other countries. 

Additionally, we need much more coordination across cities delivering mental health support to refugees and immigrants. It is common for such people to cross multiple borders within and across countries, and often people do not have continuity of care across their journeys. There are a number of impressive strategies being implemented across US cities. I hope we can see more communication and collaboration among those cities. 

UM:  You actually got into community mental health while working with Californians affected by environmental harms in their towns and neighborhoods. Broadly speaking, how should we understand and address the psychic effects that the full range of economic and social hardships and injustices can have on disadvantaged communities?

Brown: While the last decade or two has focused on the biological predictors of mental health there is now greater recognition that social determinants play a major role in wellbeing. That is, access to education, safety, discrimination, employment, etc., appear to matter equally if not even more than more intrinsic factors. 

UM: Final question: Based on what you’ve learned in your work, what direction is providing community mental health likely to take going forward – and what do you think others in your field should be doing?

Brown: My team and I have the modest goal of transforming mental healthcare in New York City and in other parts of the US through the integration of interventions that can be delivered by non-mental health specialists to members of their community. 

We believe we can overcome many of the barriers to care, and the ongoing stigma associated with seeking such care, by working with trusted members of the community. This means that we are re-imagining who provides care and how systems are rolled out to support communities in need. We hope to see this idea become integrated into a broad range of services that organizations provide. 

Adam Brown is an associate professor of psychology, vice-provost for research at The New School for Social Research, and director of the Global Mental Health and Trauma Lab at NSSR.

Photo by: Humanitarian Emergency Response and Relief Centers