As refugees continue to arrive in Germany fleeing war, violence, and natural disasters, many carry deep psychological trauma, according to Miriam Biermann, chief psychologist at the Clinic for Psychosomatics and Psychotherapeutic Medicine at the Central Institute of Mental Health (ZI) in Mannheim. Germany must rethink how it delivers mental health care to refugees, Biermann argues.

"Most people recover from traumatic experiences on their own, but a significant minority -- particularly children and adolescents -- develop post-traumatic stress disorder," Biermann said in an interview with the Catholic News Agency (KNA). In young people, the rate of PTSD after a traumatic event is around 16 percent, and symptoms may not appear until years later, she added.

Cultural barriers to mental health care

One of the biggest obstacles facing refugees in Germany is cultural differences in how psychological symptoms are viewed and treated, according to Biermann.

“In Western cultures, we’re used to discussing mental health and even difficult topics like sexual violence. In other cultures, that’s often not the case,” said Biermann. “Language barriers and stigma make it much harder for many people to seek help. 

To address these challenges, Biermann calls for a greater focus on culturally sensitive and accessible mental health services. "We need transcultural care -- with psychotherapists who speak the same language and understand the cultural background of their patients. That’s how we reach people who otherwise remain isolated in their trauma."

Read AlsoUK study: Asylum claims system should not re-traumatize migrants

Trauma can be invisible but long-lasting

Some symptoms of PTSD may include flashbacks, intrusive thoughts, avoidance of reminders, and constant anxiety. In children and teenagers, trauma may also manifest through aggressive or anxious behaviour, social withdrawal, self-harm, or substance abuse, the psychologist explained.

Biermann stressed that the development of PTSD depends on a mix of genetic and environmental factors. "Supportive relationships and a stable environment play a major role in whether someone recovers or becomes psychologically unwell," she said.

Read AlsoRefugees are stigmatized in Germany, psychologists say

Early intervention not always best

Contrary to earlier beliefs, immediate psychological debriefing after traumatic events may do more harm than good. "We used to think people needed to talk right away. But forced group sessions after events like car accidents have shown little benefit—and can even be harmful," Biermann explained.

Today, experts advocate for a "watchful waiting" approach. People should be given access to support services but not pressured into using them immediately, Biermann believes. "What’s important is that they know help is available, and that professionals check in over time to see how they’re doing."

As Germany continues to provide refuge to people from around the world, mental health professionals like Biermann say culturally competent care isn’t just a recommendation -- it’s a necessity.

With KNA