Counseling help for refugees offered at a St. Paul clinic

Roselawn Clinic joined forces with CVT, forming a team that offers refugee mental health services. From left to right: case manager Christi Johnson, therapist Jeff Walter, case manager Novia Josih and interpreter Pawwah Toe. (submitted photo)

Many Karen immigrants dealing with aftereffects of brutal treatment in Myanmar

Jill Yanish
Review staff

After seeking refuge in the U.S. from the war-torn country of Burma, now known as Myanmar, Pawwah Toe, like many other Karen immigrants, settled in Minnesota.

Moving from an impoverished country to one of the world’s richest was a significant cultural shock for many of the refugees, Toe said.

The Karen also have lingering trauma from the brutal treatment they endured during the civil wars in their homeland.

These combined stresses prompted Toe to advocate for better mental health services for her people.

Her message has been heard.

A clinic within a clinic

HealthEast Care System and the Center for Victims of Torture (CVT) partnered on a three-year project to provide on-site mental health services to refugees at the HealthEast Roselawn Clinic in Maplewood.

The project — Healing Hearts, Creating Hope: Exploring the Efficacy of Integrated Mental Health Services for New Refugees — launched in May and is designed to study if providing on-site mental health services for refugees can improve patient outcomes, reduce health costs and serve as a model to be replicated.

Minnesota’s need for mental health services

Minnesota is home to the largest population of Karen outside Southeast Asia, according to a report by the Council on Asian Pacific Minnesotans.

CVT, a Minnesota-based international nonprofit dedicated to healing survivors of violence, has documented that about 30 percent of Karen refugees are torture survivors and up to 80 percent are secondary survivors. A large number of these refugees suffer from mental health problems, such as posttraumatic stress disorder and major depressive disorder.

Alison Beckman, CVT project manager and clinical supervisor, sees the need for embedded mental health services.

“There are huge barriers for refugees to get mental health services because of all sorts of reasons - transportation, language, practitioners who may not be well versed in doing cross-cultural work, etc.,” Beckman said.

The project’s design

HealthEast has worked with CVT to provide mental health screenings for newly arrived refugees since 2010. The new project has expanded these services to include two case managers and a psychotherapist from CVT at the Roselawn clinic.

Physicians can refer refugee patients who exhibit symptoms of mental health issues to the project.

“It’s really exciting to be able to have mental health resources that are able to handle the language difference and all the war trauma,” said Dr. Shana Sniffen, a family practice physician at the Maplewood HealthEast office. “It’s a nice collaboration to have embedded here.”

A cultural clash of the mind

Toe, an interpreter and Karen liaison at the Roselawn clinic, embraces the new project. She said her culture conceptualizes mental health differently than in the United States, and it often goes untreated.

An element of the project is to educate refugees about mental health and overcome the culture’s stigma about receiving treatment.

“They feel something different, but they don’t know (how to identify it),” Toe said. “Here, they can explain it and understand themselves. It’s something in their body they didn’t know, but someone can help them understand.”

Looking toward a brighter future

Beckman said the refugee population’s mental health needs were unmet. She views the Roselawn clinic as an ideal place to provide and test the on-site services because refugees are already receiving primary health care services there, and the clinic has a longstanding history in providing culturally competent care to the Karen.

In three years, CVT will look at the data to determine if the model of care is effective and sustainable. If proven successful, CVT will consider expanding services and determine if there is a need to permanently stay at the Roselawn clinic.

Despite the novelty of the project, Sniffen already foresees success.

“I can’t imagine it’s not going to be very helpful,” Sniffen said. “It’s just my gut feeling as a doctor. I’m thrilled to have the services here.”

The project is funded by grants from The John and Ruth Huss Fund of the St. Paul Foundation, The St. Paul Foundation, F.R. Bigelow Foundation and The Jacob and Valeria Langeloth Foundation.

Jill Yanish can be reached at or at 651-748-7825.

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