Language as a Financial Barrier: Language Inequity Restricts Refugees’ Access to Mental Health Care
North Carolina’s Triangle is replete with different languages, each a rich, beautiful thread connecting communities and cultures. As a Master of Social Work Intern at UNC Refugee Wellness, it is a pleasure to hear Dari, Pashto, Swahili, Kinyarwanda, Arabic, and Spanish spoken in a single day. It is also an honor to hold space with refugees. These are people who have been forcibly displaced from their homes in the Democratic Republic of Congo, Afghanistan, Syria, and other nations, often because of violence and human rights abuses. They’ve survived the most severe traumas only to live in a state of migration for months, years, and even decades before the United States invites them here to resettle. Many decide they might benefit from psychotherapy—to unlearn unhelpful coping behaviors, get better sleep, or to share the narrative of their traumatic experiences—but in the United States, the language barrier means their options to seek help are limited.
In a society, a dominant language is a gate keeper, preventing many thousands of people from accessing the resources they need because they don’t know how to ask for it, and can’t pay someone to do so. Few refugees speak English at first, and many live in very low-income households. Even for those who receive Medicaid, it can be difficult to access appropriate help, as few providers offer language interpretation services. According to Medicaid.gov, “states are not required to reimburse providers for the cost of language services, nor are they required to claim related costs to Medicaid/CHIP.” This is where the clinical social workers and Master of Social Work interns at UNC Refugee Mental Health and Wellness come in. We offer free, culturally sensitive mental health care to refugees in Wake, Durham, and Orange Counties.
I studied Spanish in high school and college, and it has come in handy for several clients during my internship at Refugee Wellness. However, that limited language skill is by no means sufficient to do my job. In a given day, I might conduct therapy with clients in Dari, Pashto, Swahili, Kinyarwanda, and Arabic. Some clients speak rare languages, such as Ngama and Sango. To even begin screening these clients for symptoms of depression, anxiety or posttraumatic stress disorder, our program needs to contract with language interpreters for nearly every visit. Sometimes, we can invite an interpreter to meet with us at the client’s home. More often, we dial up interpreters on speakerphones and pass the phone back and forth with clients so we can share in their fears, sorrows, hopes, and insights.
Refugee Wellness and our partners at the Jordan Institute for Families believe all people have a right to mental wellness and culturally competent care. But certain groups are not being served appropriately, and this exacerbates a range of health disparities, including poverty and interpersonal violence. We are committed to language equity for immigrant groups. My colleagues are working on bigger policy advocacy efforts in hopes of encouraging Medicaid and private insurers to help refugees and immigrants access competent mental health care, regardless of whether they work with our program.
Although this is a huge policy issue, we at UNC Refugee Wellness also have an urgent need for funding to cover the cost of interpretation for client sessions and group therapy. After personnel, interpretation is the largest expense in the UNC Refugee Wellness budget. Funding allocations from The U.S. Office of Refugee Resettlement. The interpretation budget runs low ach year, and in some years, the need has exceeded our budget. We always welcome donations to help cover the cost of language interpretation services. A $60 donation covers the cost of one hour of telephonic interpretation for therapy. It’s impactful work. Hundreds of clients have reported a reduction on symptoms after receiving our care, and some have gone on to advocate for their own communities and others. We intend to continue working with refugees, and with your support, we can help even more of these survivors to thrive.