As a social worker in Seattle, Beth Farmer knew that tens of thousands of refugees were coming to the United States from war-torn countries such as Burma, Iraq, Afghanistan, Sudan, and Somalia. Most had witnessed horrific violence and experienced severe trauma, yet the concept of “mental health” was foreign in many of these cultures. How could she help these refugees obtain emotional support that could help them to resettle successfully?

“Refugees come from tremendously difficult situations, witnessing loved ones killed in bombings, living through unimaginable suffering, and then experiencing deprivation in refugee camps. They get a tremendous opportunity to build a new life in the United States, but the past is still with them,” said Farmer, who launched the Pathways to Wellness project in Seattle to improve delivery of mental health care services to refugees. Upon arrival, the nearly 80,000 refugees who come to the United States each year are screened for diseases, but until recently, according to Farmer, mental health was rarely included.

For her creativity and commitment to helping refugees cope with mental-health issues, Farmer has been named one of 10 recipients of the Robert Wood Johnson Foundation Community Health Leaders Award for 2012. The award honors exceptional men and women who have overcome significant obstacles to tackle some of the most challenging health and health care problems facing their communities. Farmer will receive the award during a ceremony in San Antonio on October 17.

As a graduate student, Farmer recognized the need to detect mental health issues in refugees so they could be connected to the care they needed. She worked with a psychiatrist and others to develop a screening tool in collaboration with refugee communities. “A lot of Burmese, Bhutanese and Iraqis are coming into the United States as refugees right now. Many of the Iraqis worked with the American military, so they are targeted for killing,” Farmer said. “These are very different cultures and languages, and we needed to make sure that each translation was right according to language and culture.”

Farmer convened focus groups from refugee communities to discuss translations and meanings, and to come to consensus on the script for the screening tool. The tool was then field- tested by public health nurses, who found that it rarely added more than 10 minutes to health care screenings. Farmer’s work resulted in a short assessment tool that is culturally competent in assessing symptoms of anxiety and depression in refugee populations from a variety of countries.

The Pathways screening tool is already integrated into refugee screening in King County, Washington. That pilot program screened 251 people and found 30 percent in significant distress; 70 percent of those accepted support. Today, about 70 percent of the 1,800 refugees coming into Seattle’s King County will be screened. The tool is also used in Arizona, Maryland, Florida, Idaho, Oregon, and Maine.

Farmer also had to find ways to decrease the stigma around mental illness. “In some of these countries, mental health care is very antiquated. The vision that comes to people’s minds is being chained up and locked away,” she said. Farmer also pointed out that the western approach to mental health, where “you look someone in the eye and talk to them about how they are feeling,” can contradict cultural norms where it is rude to look at someone directly and feelings are not discussed.

“I am so proud of our country for offering a refuge to the world’s most vulnerable. It embodies all of the values we hold dear as a nation,” said Farmer. She is also inspired and motivated by the strength, hope and resiliency the refugees embody. “Refugees are incredible survivors. They come here after experiencing unspeakable horrors, and then they’re expected to hit the ground running, find a job, and pay back the cost of their travel to the United States. I am in awe of them and feel so lucky to work with them.” 

Janice Ford Griffin, national program director for Community Health Leaders, said the selection committee honored Farmer for her determination to help refugees get the mental-health services they need. “Beth Farmer understands the importance of addressing the mental health issues of refugees as uniquely integral with their physical health. She has enabled health professionals from many disciplines to have mutually respectful peer relationships with immigrants, and has fostered good communication. This has allowed immigrants to improve their health, their quality of life, and their ability to contribute to their new homeland.”

Tom Medina, chief of the Office of Refugee and Immigrant Assistance in the Department of Social and Health Services for the state of Washington, praised Farmer’s efforts. “The development and validation of a culturally sensitive mental health screening tool was difficult, but critically needed to identify those who need treatment. Thanks to Beth’s tireless efforts, the project has been successfully implemented and is now recognized nationally as a best practice,” he said.

The Robert Wood Johnson Foundation has honored more than 200 Community Health Leaders since 1993. The work of the nine other 2012 recipients includes culturally appropriate care for Native Alaskan elders; a community initiative to reduce opioid abuse and drug overdoses in Wilkes County, N.C.; a program to prevent and treat cancer among medically underserved populations in South Carolina’s Low Country region; a free healthcare clinic for the working poor in Little Rock, Ark.; a cancer-awareness and treatment program for African immigrants in the Washington, D.C., area; support services for Latino survivors of sexual violence in Philadelphia; a project to promote healthy lifestyles and safe working conditions for immigrant workers in Los Angeles; an initiative to prevent childhood obesity in Garfield, N.J.; and an outreach program to assist older adults living at home in California’s Sierra Nevada Mountains.

For details on how to submit a nomination, including eligibility requirements and selection criteria, visit www.communityhealthleaders.org.

Beth Farmer, MSW

Beth Farmer, MSW

International Counseling and Community Services Program Director, Pathways to Wellness Project, Lutheran Community Services Northwest, Seattle