Mental health care for refugees is tricky. These three Philly providers found an answer in group settings.

Sanaz Yaghmai sat on her yoga mat in the dimly lit basement of the Northeast Regional Library on a recent evening. In a circle with her, a group of women sat on their own yoga mats. But Yaghmai wasn’t leading a normal yoga class: She was leading a trauma-informed yoga support group for refugee women from Afghanistan.

A “Certified Welcoming” city, Philadelphia has a significant immigrant population: 15% of the city, according to most recent census figures. And as more immigrants and refugees resettle in Philadelphia, many service providers have been focusing on how to provide mental health care for our newcomers. One effective approach they found: support groups.

“When there’s a sense of community and connectedness, it ultimately helps in offering a soft landing space for folks to arrive to, to be heard, to be seen,” said Yaghmai, a psychotherapist who leads yoga support groups for Afghans of Philadelphia who may have experienced trauma. “That allows for people to see that they’re not alone. It ultimately helps us in healing.”

It wasn’t until she was a young adult that Nary Kith began to understand that her parents had been struggling with mental health her entire life.

Growing up, Kith often witnessed anxiety, hypervigilance, constant worrying, and sadness in her parents, who are refugees from Cambodia. But going into the mental health field in college was what made Kith able to identify specific symptoms and better understand her parents. She has dedicated her career to serving people such as her parents, becoming a therapist and founding the nonprofit KITHS to support Southeast Asian refugees and immigrants.

“I was able to go into the field and have informal conversations with my parents so they could understand what those symptoms meant, why they are exhibiting certain behaviors — because they didn’t make sense of it, either,” said Kith. “They never talked about the war.”

About one out of three asylum seekers and refugees experiences high rates of depression, anxiety and PTSD, according to research by the American Psychiatric Association. Those mental health struggles are attributed not only to PTSD from violence they may have escaped, but also the current challenges they face building lives in a new country, such as racism, immigration status, isolation and loneliness, or financial challenges.

» READ MORE: She kept losing her eyesight, and no one knew why. Then a doctor asked about her mental health.

Many of those mental health struggles go untreated for a variety of reasons, including stigma and lack of education about mental health in their cultures (for example, there’s no term for “mental health” in Kith’s native language, Khmer), and lack of cultural competency and language access across the mental health field in their resettled countries.

“My concern is that we’re just putting them in these boxes of refugee identity,” said Yaghmai. “There are some things that are important to be mindful of, but if we only see them through that lens of their refugee identity, we’re missing so much.”

When the coronavirus pandemic hit the region, the African Family Health Organization (AFAHO) knew that isolation would take a particular toll on the African and Caribbean immigrants and refugees it serves. So the nonprofit organization started conducting wellness calls with community members by Zoom.

“These wellness calls turned into support groups where people were sharing what they were going through, and how they were coping or managing, and it became a really beneficial space,” said Oni Richards, executive director of AFAHO.

» READ MORE: How three Philly groups are raising mental-health awareness in immigrant communities

“Sometimes you feel isolated, like you’re the only person going through this,” she continued. “But when you hear about other people experiencing the same thing, it makes you more comfortable disclosing your issues. And by sharing, you’re able to figure out different coping skills.”

The group format is also particularly helpful because immigrants and refugees from certain cultures are used to having tight-knit community in their home countries. When they resettle in the United States, they’re missing that community, and are dealing with more instances of stress.

“Sometimes you feel isolated, like you’re the only person going through this.”

While support groups have been extremely helpful in serving these communities, providers must still proceed with caution because of the stigma surrounding mental health.

“We don’t say, ‘Come to this group to learn more about mental health symptoms,’ we say, ‘Come to this support group so you can learn why you worry so much about your children,’” said Kith. “If you translate mental health, the Cambodian refugee population will equate that as ‘I’m crazy’… they’ll shut down.”

During the height of the Syrian refugee crisis, Yaghmai traveled to Greece to work with Afghan refugees. Instead of providing one-on-one therapy, she structured a support group that consisted of trauma-informed yoga and mindfulness practices, as well as prompted dialogue.

It was “really encouraging the participants to get in touch with their bodies,” Yaghmai said. “And that really allowed for us to create a space where the women started feeling more comfortable opening up.”

Yaghmai knew, going into it, that the women were coming from a culture where mental health was not spoken of openly, and where people often didn’t air their dirty laundry. Add to that the shame that is felt by survivors of traumatic experiences, and providing that mental health care becomes even more complex. But Yaghmai found that the group setting aided the participants’ healing process.

“One of the key factors of a support group is that building of togetherness.”

“One of the key factors of a support group is that building of togetherness,” Yaghmai said. “When we hear other folks share their stories, and then we see that we are not alone in our struggles, that ultimately chips away at that feeling of shame and ‘Why did this happen to me?’”

As Yaghmai continues to provide support groups for refugee women in Philadelphia, a quote from writer Ann Voskamp lingers in the back of her mind: “Shame dies when stories are told in safe places.”