Case Study:

Working with traumatised

refugees and asylum seekers

„Traumainformed practice with refugees and

asylum seekers“
(Modul 4.2)
Table of content

Case Study...................................................................................................................1

1. What are the areas that need to be taken into account to arrive at a
comprehensive understanding of Mustafa’s mental health?
....................................1

2. How could you, in your role as a social worker, support Mustafa in taking care of
his mental health?
....................................................................................................2

3. What might be effective ways to address his possible fear of mental health
stigmatisation?
.........................................................................................................4

Bibliography .................................................................................................................5
Case Study

Mustafa is a 40 year old Syrian Kurd male who arrived in Germany in November
2021. He is married to Fatima and has 2 children, 10 and 5 years old who did not
leave Syria with him. His family is currently living in their home village in Northern
Syria in an area controlled by Kurd forces. However, given the advances made by the
Syrian government’s military forces, Mustafa is very concerned about his family’s
safety. Although a year has passed since his arrival in Germany, Mustafa is still
awaiting the result of his asylum application and therefore his legal status is that of
an asylum seeker. He has been living at a refugee centre in Munich since his arrival
and has been receiving regular German lessons. Mustafa has been looking for
regular employment since his arrival, but so far, he has not been successful in
securing stable employment and has only found short-term work. Furthermore, his
German is still of a basic level and this is further limiting the job openings available
for him.
You work as a social worker at the centre where Mustafa is residing and you are
tasked with supporting him and helping him make the transition out of the centre.
Whilst there is no fixed duration for a refugee’s stay at the centre, usually the aim is
for a resident to move on after 18 months. You have now been following Mustafa for
3 months and it is becoming clear to you that his mental health is deteriorating. He
has stopped going out of the centre during the day, he looks tired and tense most of
the time and is taking less care of his appearance. Until now your questions about his
well-being have been met with brief answers and reassurance about him doing fine.
You sense that he is not comfortable speaking about mental health and once Mustafa
told you “Don’t worry about me, I am not crazy”. He has however disclosed he is
constantly worrying about his family especially when, for whatever reason, he is not
able to reach them by phone.

1. What are the areas that need to be taken into account to arrive at a
comprehensive understanding of Mustafa’s mental health?

As Kurds, Mustafa and his family belong to an ethnic minority that was already
exposed to systematic discrimination for many years. Since 2011 the political
situation is devastating due to the escalating civil war with the authoritarian Assad

1
regime on one side and the aggressive Turkish government on the other. For this
reason, the refuge must have been a special challenge for him. In addition, it is a
great distance that he has overcome from Syria to Germany. It is therefore very likely
that he was not only threatened by violence and constant danger to his life in his
home country but also during his refuge. Exposure to trauma, loss of homeland,
insecurity about his family, the long wait because of his legal status, poor german
language skills, life in the refugee centre, no employment… these could be all
traumatic circumstances that can lead to several mental health issues such as
anxiety disorder, depression or post-tramatic stress disorder (PTSD).
Psychological: First I need to find out which are the mental and emotional effects of
trauma on him as an individual. There are a variety of psychological effects Mustafa
could suffer from due to his accumulated experiences. Such as isolation, nightmares,
poor appetite, aggression and several more.
Social: In addition, I do not yet know the impact of trauma on his relationships and
social functioning. In the same way I do not know about his social origin and level of
education.
Cultural: Nor do I know the influence of his cultural norms and values on the
experience of trauma. But due to leaving his home country and letting behind his
family he might suffer of a loss of identity.
Spiritual: There might also be a spiritual impact of the trauma which could affect his faith and
beliefs.
Historical: Not foreseeable now are the long-term effects of trauma on his life,
including the effects of transgenerational trauma.

2. How could you, in your role as a social worker, support Mustafa in

taking care of his mental health?

As mentioned at the beginning, it is important to find out what symptoms are

bothering Mustafa. How long have they lasted? What are the connections between
these symptoms and what are the effects? Are there signs that he might be
endangering himself or others? Once you have clarity on this, many things can be
done to support Mustafa. Only one thing must be clear: I cannot help him speed up
the decision on his residence status and I cannot bring his family to Germany.

2
This is tragic and I can understand that this situation disempowers one. But as long
as he does nothing for his mental health and does not even admit to his problems, it
will most likely only get worse until he can’t just ignore it anymore. So, I would try to
provide a safe and supportive environment for Mustafa to express himself and his
feelings. To do this, I would listen to him without judging him and support him
emotionally by understanding his situation. He is the specialist of his situation. I listen
to him, show him through non-verbal signals, open questions about his needs, fears
and concerns, and paraphrasing that I try to get a sense of what he is going through.
I would also offer him regular meetings to be able to build a helping relationship with
him.
It is also important to encourage him to have healthy lifestyle habits. This includes
simple things like some exercise, eating regularly or just trying to get enough sleep.
But it becomes equally important to find out what he really enjoys doing, to maybe
help him to connect with local associations. Where he can meet people of all origins
who may be able to provide also some kind of emotional and practical support. It is
also easier to learn the language and it could be useful for his job search. Maybe
there are also volunteers with whom he can meet to learn German. Perhaps an
appointment for application preparation would also be helpful, if he agrees.
He needs to develop coping skills to manage stress and difficult emotions, such as
relaxation techniques, sports or just talking to other trustworthy person in his life
about his feelings.
In the conversation, I would try to help Mustafa reframe negative thoughts and focus
on his strengths. Just to help him gain back some control in his life. This is essential
because the forced fleeing from one's home country often causes a feeling of
powerlessness. When someone feels powerless, it is difficult to set and achieve own
goals. To get back on track, he needs a bit of empowerment and clear goals with a
long-term perspective (stable mental state, long-term employment and
accommodation).
Additionally it would be good to help him develop a functioning strategy to cope as
well as possible when his family is not available by phone. Or is there even a way to
avoid the fear for one's family? Are there times that can be arranged when the family
can be reached on a regular basis? If he wants to, I would also give him informations
about where to find mental health services such as counselling centres, support
groups or psychiatrists that can help him cope with his experiences.

3
3. What might be effective ways to address his possible fear of mental
health stigmatisation?
Above all I would like to find out if he is afraid of a social stigma or if he stigmatises
himself. It might be strong cultural and religious beliefs that lead to that fear of
stigmatisation due to mental health issues. I do belief that it’s very important to
respect where Mustafa is coming from. Since he is here now I also think that it is my
responsibility to provide the needed emotional support in the already elaborated
patient and non-judgmental environment. That means to show empathy and
understanding of the trauma he has experienced, which of course has impact on him
and his behavior within his environment. After we worked together for 3 month now I
do belief that we’ve got some kind of a trusting working relationship so I would try to
start talking about mental health problems. Giving informations about our current
western understanding of mental health in general and how traumatic experiences
can effect our health. Seen as some kind of invitation to an open dialogue I would ask
him if he wants to tell me something about the way he looks on mental health
problems. Almost regardless of what he answers, I would share with him my thoughts
on the subject. This is that mental health problems are a natural reaction to great
demands in life. None of those affected are simply crazy. That therefore a large
number of people have mental health issues. The symptoms only vary in nature and
intensity. And that people who fulfil the medical criteria of a mental disorder are not
defined by it. With the support of professionals many people with problems lead a
completely "normal" life.

4
Bibliography

Burleson, B.R. (2008). What counts as effective emotional support? Exploration of individual and
situational differences.

JRS Europe. (2010). Becoming vulnerable in detention. The Devas Project.

Kleinmann, A. (1988). The illness narratives: Suffering, healing and the human condition. NY: Basic
Book.

Lauber, C., & Roessler, W. (2007). Stigma towards people with mental illness in developing countries
in Asia. Int Rev Psychiatry, 19(2), 157-178.

National Institute of Mental Health, NIMH (2012). The numbers count: Mental disorders in America.

Robjant, K., Hassan, R., & Katona, C. (2009). Mental health implications of detaining asylum seekers:
Systematic review. BJPsych, 194, 306-312.