As tens of thousands of evacuees from Afghanistan continue to be resettled across the U.S. this winter, anticipating and responding to their mental health needs remain paramount. The APA Position Statement on the Role of Psychiatrists in Addressing Care for People Affected by Forced Displacement recognizes the expertise psychiatrists have to help relieve the suffering of this population.

State agencies continue to coordinate with humanitarian organizations to provide basic services, including mental health counseling. This includes local chapters of organizations APA members are involved with such as Catholic Charities, Lutheran Immigration and Refugee Services and those affiliated with the National Consortium of Torture Treatment Programs. A directory of humanitarian organizations in each state is available from the U.S. Refugee Processing Center and key state contacts for refugee services are available from the U.S. Office of Refugee Resettlement.

Meanwhile, the APA Council on Children, Adolescents, and Their Families and the Committee on Psychiatric Dimensions of Disaster have identified considerations for psychiatrists and other mental health clinicians who may be preparing to address the needs of Afghan evacuees in their community.

• Preparation: Prepare your team to work with new Afghan arrivals and connect them to community resources. Recognize the broad range of reactions different groups may experience beyond mental disorders and negative reactions, while keeping in mind that it may take time for this population to overcome stigma and feel safe sharing their feelings. Additional considerations are outlined in the APA Mental Health Facts on Refugees, Asylum-seekers, and Survivors of Forced Displacement.
• Cultural Education: Learn about the Afghan culture. Understand how they explain their illness and familiarize yourself with tools that could address their cultural needs.
• Culturally Sensitive Care: Work with Afghan refugees should avoid generalizations, stereotypes, bias, prejudice or misconceptions, focusing on each patient and family at a time and using language of respect and self-determination to avoid pathologizing individuals.
• Language: While Dari and Pashto are the official and most widely spoken languages, there are many languages spoken in Afghanistan. Translators or interpreters are essential and may also function as cultural consultants. Resources should be understandable by different groups and available in different languages.
• Trust: Families may mistrust authority figures and need extra time and sensitivity to establish a therapeutic relationship. Building a therapeutic alliance, setting achievable goals, utilizing a strengths-based approach, encouraging community building, and celebrating culture of origin and religion/spirituality, can help establish trust and improve outcomes.
• Special Needs: Continue to address the special needs of this population including, but not limited to, the elderly, children, those with medical conditions, LGBTQ+, and those isolated due to nuclear families left behind or lost due to the conflict. The Cultural Formulation Interview (CFI) and CFI online modules addressing immigrants and refugees, as well as the AACAP Practice Parameter for Cultural Competence in Child and Adolescent Psychiatric Practice, are helpful tools.
• Trauma: Acknowledge the trauma families are experiencing after decades of civil war and the intergenerational/transgenerational nature of this trauma. Provide education about common responses to trauma, so they do not feel they are atypical for experiencing their symptoms. Tragic events, whether or not directly experienced, can promulgate distressing and overwhelming emotions, such as anger, sadness, or anxiety. Connecting with a support system or loved ones can reduce this level of distress. Work with Afghan refugees should be family-centered and family inclusive. The National Child Traumatic Stress Network provides helpful information and resources.
• Systems: Clinical care for Afghan refugees should ideally take place in locations close to where other Afghan families are living. Educate the host community about the needs of these individuals and families. Peer support is an important resource that gives people within communities the opportunity to support fellow Afghans, veterans, and others who have shared experiences. Learning and utilizing these shared experiences creates an environment that makes people feel valued, important, and safe.

Additionally, members of the APA district branch, Society of Uniformed Service Psychiatrists, provide compassionate and culturally informed care to military service members and are supporting the humanitarian needs of thousands of Afghan evacuees at U.S. military bases.

It is important to ensure positive management practices are in place, such as checking in on the well-being of personnel and providing access to care, to help sustain the workforce during this time. For more information, see the APA press release highlighting available crisis services and resources.

Contributors: APA Council on Children, Adolescents, and Their Families, Council on International Psychiatry and Global Health, Committee on Psychiatric Dimensions of Disaster, Society of Uniformed Service Psychiatrists, Office of District Branch and State Association Relations, Office of International Affairs.