By Tarryn Mento
Research shows refugees are at a high risk for mental disorders, and some may inadvertently pass those symptoms on to their kids. But because of cultural stigmas and language challenges, they may not be fully addressed. This can delay engagement in the local economy, or worse, result in suicide. Some among San Diego’s Somali population — one of the largest in the country — say it’s that worst-case scenario that’s giving them concern.
Four members of the East African community who have lost loved ones to suicide discussed the topic to combat the culture’s stigma against psychological disorders and raise awareness about behavioral health needs.
Munira Ali lost her older brother to suicide in 2009. She said part of the problem is staying silent.
“We don’t really talk about it when the suicide occurs in the community — of course we grieve, of course we go to the graves, but I feel like there’s no larger discussion at the end of the day,” said Ali, a common surname in the community.
Munisa Ali — no relation — said the community’s negative perception of mental illness is also part of the challenge. She said her husband, a refugee and father to her seven children, denied his diagnosis before he died by suicide in 2011.
“When we say, ‘This person has mental illness,’ in Somali, we interpret that: ‘This person is extremely crazy,’” she said.
Liban Ali, also no relation, lost his younger brother to suicide in 2016. He said his family had approached the 20-year-old about behavioral changes they had noticed, but he resisted the discussion. They didn’t suspect that he’d die by suicide that night.
“If the families have that training, we could help those kids. We could understand what they’re going through, what the sign is,” he said.
Last year, Abdinur Jama said he lost his oldest son to suicide. He said his son had actually received a mental health assessment and was placed on medication, but it wasn’t enough.
“We have to find the root of the problem,” he said in Somali through a translator. “Once we know what the root of the problem is then we can start a discussion and involve the wider community to have that discussion.”
Word of self-inflicted deaths travels fast through the tight-knit community. The group counted eight suicides, mostly young men, in eight years plus some attempts, but cite only anecdotal evidence. Another death occurred late last year in Orange County, they said. The figure is significantly smaller than the county’s annual suicide rate, which is 13 per 100,000, while San Diego’s Somali population is estimated at 20,000 to 30,000. However, UC San Diego Global Health Division Chief Wael Al-Delaimy said the number points to a larger problem.
“If it’s that severe, then there’s a lot under that that is hidden of mental illnesses,” said Al-Delaimy.
His past research on nearly 200 Somali women found some who experienced trauma and suffered from mental illness transferred coping challenges on to their children. The epidemiologist, originally a physician from Iraq, is seeking funding to further examine the mental health challenges in San Diego’s East African community and identify intervention strategies.
“Whatever we learn from this community could be applied to other communities,” said Al-Delaimy, who is also working with primary care doctors in Jordan to help treat refugees.
San Diego has resettled refugees for decades, including those from other conflict areas, such as Iraq and Syria. A UC San Diego study flagged mental health needs as a top concern among the region’s refugee population in 2007. Nearly 10 years later, the issue of unmet mental health needs was raised again in a report by nonprofit Nile Sisters Development Initiative.
Alfredo Aguirre, San Diego County Behavioral Health Services director, said he is aware of the mental health needs among the region’s diverse refugee population, but that the agency doesn’t have the staff to provide culturally and linguistically adequate care.
“We struggle with our more significant other languages, like Spanish for example, and so when we talk about even more specific — and there’s so many languages as you know that’s represented through all of the African countries,” he said.
He said bipartisan legislation introduced in the California State Senate would help address this. The bill, authored by State Senators Joel Anderson, R-Santee, and Jim Beall, D-San Jose, would establish certification for peer specialists — community members who have experience with mental illness and can serve as a liaison with refugee populations. Under the bill, the service could also be covered by Medi-Cal. SB 906 is expected to go before the health committee on March 14.
At the local level, Aguirre said the county is working to expand an existing artistic therapy program to also serve East African youth.
“Over the next couple of years we’ll be able to enhance it for this population, and we’re hoping at the end of the day to be able to sustain it,” he said.
In the meantime, the four Somali community members whose brothers, son and husband died by suicide say they want their interviews to help start a community-wide discussion about the issue and shed the stigma associated with mental health care.
“We hope that this is the beginning,” Liban Ali said.
Some organizations have already taken steps to help, but they say more resources are needed. Somali Family Service of San Diego holds community workshops that include discussions on mental health. Nile Sisters coordinated stakeholder meetings and launched a public toolkit on behavioral health resources.