“During their flight to Germany, Yezidi women who escaped Isis captivity experienced flashbacks and panic attacks. The close confines of the airplanes triggered memories of their captivity.”

The refugee crisis has dominated headlines for the last year. However, one angle of the crisis – a particularly crucial one – appears to have been overlooked: mental health.

In honour of Mental Health Awareness Week, the IPF is shining a light on the effects of mental health disorders on refugees coming into Germany – one of the focus points of the European refugee crisis.

Refugees are most likely to experience post-traumatic stress disorder (PTSD), as well as depression. More often than not, these conditions are experienced simultaneously.

Furthermore, one in five child refugees in Germany suffer from PTSD – a figure 15 times higher than that for children born in Germany. While Germany has been commended for their acceptance and treatment of refugees, what are they doing to address the mental effects of the trauma these people have been through?

Once refugees have been in Germany for at least 15 months, they are then covered by the country’s health insurance scheme. While this includes psychotherapeutic treatment in principle, experts told the IPF that the number of  treatment spaces is limited and the average waiting period for an initial psychotherapist consultation is at least three months.

But what about the refugees who aren’t covered by Germany’s health insurance scheme yet? To find out more about the mental health facilities available to refugees in Germany, the IPF spoke to Kay Funke-Kaiser from the Federal Chamber of Psychotherapists (BPtK), who have been at the forefront of this issue.

“The extent to which a case of PTSD is treated lies at the discretion of the authorities, who frequently reject applications for the psychotherapeutic treatment of refugees.”

Kay explained that for the first 15 months in Germany, refugees receive benefits under the Asylum Seekers Benefit Act. This gives them access to medical and psychotherapeutic treatment – but only in cases of “acute suffering” or “life-threatening illnesses”. Psychology experts have criticised the fact that mental disorders are only treated in “exceptional cases”, and only after a rarely successful application process.

The IPF speaks to Kay about some of the major issues with Germany’s mental health facilities for asylum seekers.

Taking mental disorders seriously

One of the things BPtK is calling on the government to do is to recognise mental disorders as “acute illnesses that requires treatment”. They also urge the government to include psychotherapeutic treatment in the Asylum Seekers Benefits Act, which doesn’t recognise it at the moment. Kay explained why this is a problem:

“Around 40% of refugees suffering from secondary illnesses due to psychological trauma have considered taking their own lives.”

Furthermore, BPtK have insisted that when a refugee applies for mental disorder treatment, this diagnosis should be performed by a qualified psychiatrist or psychotherapist and, in the case of a positive diagnosis, the treatment must be approved.

Deporting those who suffer from post-traumatic stress disorders

In February 2016, German Parliament introduced the “Asylum Package II”, which does not include sufferers of PTSD on the list of acute illnesses that are immune to deportation. The BPtK is now calling for serious and life-threatening mental disorders to be handled as illnesses that preclude the possibility of deportation.

“It should not be permissible to deport refugees who are suffering from PTSD. Sending these people back to the place where they suffered their traumatic experiences is extremely stressful psychologically, and particularly perilous.”

Kay told the IPF that through the Asylum Package II, the federal government claimed that mental disorders are “difficult to diagnose and verify”. However, BPtK disagrees.

“For these illnesses there exists scientific, consensus-based and thoroughly verifiable diagnostic criteria. Qualified physicians and psychotherapists are able to distinguish between authentic or “faked” mental disorders”.

Conditions in Germany that trigger PTSD for refugees

While the trauma of experiencing a war zone or leaving their homes is enough to trigger forms of PTSD, Kay explained that the mental health of refugees is also influenced by factors they face in Germany.

Some of the things that further deteriorate the mental health of refugees include delays in processing asylum applications, fears of being deported, lack of work permits, obstacles to health care facilities and social services, language barriers, lack of affordable housing, as well as experiencing discrimination from some locals.

“Above all, psychologically traumatised refugees need to feel safe, cared for, and to be free from fear. Attacks on refugee shelters can directly reactivate the terror that the inhabitants have experienced, and lead to severe anxiety and panic attacks.”

She went on to tell a story about a group of Yezidi women who had escaped captivity from Isis terrorists, explaining that during their flight to Germany they experienced flashbacks and panic attacks, which included palpitations, shortness of breath, dizziness and fear of death. The enclosed space had triggered negative memories from their past.

Long term effects of ignoring refugees’ mental health

Kay explained that children potentially suffer from the worst long-term effects. In Germany, it is often them who have interpret for their parents who don’t speak the language. This puts pressure on them and they are forced to experience a sudden reversal of traditional family roles, which can be psychologically stressful.

“Mental disorders can greatly complicate the integration of refugees.”

When children and adolescents experience forms of depression and secondary illnesses due to psychological trauma, this has a serious impact on their success in school – and in the long run.

Adult refugees who suffer from PTSD also experience trouble integrating into life in their host country, which could have a severe effect on Germany as a whole as the system bends under the pressure of an increasing number of dependants – and not enough people using their skills to contribute to society.

“Adults suffering from acute mental disorders are not capable of coping with daily life, of learning a new language, or of working.”