Some die young. Some make it to a safe haven. And then what? The current prognosis is that Sweden will host over 33 000 lone asylum seeking minors this year. And who knows how many next year? Although this is a badge of honor for Sweden because it means that it is the best country in the world to be a child in, it entails a responsibility that goes beyond providing for the housing, physical health and safety of these adolescents. The exposure to traumatic events is unanimous in these youth and many of them experience posttraumatic stress symptoms, depression, and anxiety.
Make no mistake. These young boys and girls are strong, they have seen and experienced things that would brake down elite soldiers and they still get up, go to school, try to make friends and hope for a better future. They are resilient and work very hard to learn a new language, customs, and build themselves a life, which they often accomplish (reference in Swedish on labour market participation).
But some are haunted by events of the past in a way that severely affects their mental health. Intrusive pictures keep entering their minds, however hard they try not to focus on those bad memories. It’s hard for them to fall asleep, they twist and turn in bed. Even if they do long to sleep they dread nightmares that are bound to come. They wake with a startle, in agonising fear, sweaty, breathless, hurt and alone. Then it starts all over again: the unwelcome images and thoughts, the trying to push them away, the impossibility of NOT thinking about it all, the feeling that they are going mad.
Sometimes, flashbacks also come during the day. It often catches them off guard, the images forcing themselves into their thoughts, images of wrecked bodies, shootings, explosions, the brutality of war, the cruelty of mankind. Loud sounds startle them and certain situations or places, or even smells, work as triggers for bad memories so they try their best to avoid these things. Their bodies are constantly alert: ready to run away from danger, jumpy, suspicious.
This is all very hard to see for many adults, especially when they cannot offer comfort or relief. Personnel working at the special care homes under the auspices of social services (HVB-hem), where many of these children live in Sweden, have no education about post-traumatic stress and are offered no support. They are left to their own devices when the night settles in and anxiety vibrates in the air, occasionally interrupted by muffled cries.
What’s worse is that longitudinal follow-up shows that these mental health problems will not simply disappear over time. Research done on asylum-seeking children in Scandinavia suggests that a significant proportion of those who have experienced war trauma develop persistent post-traumatic stress disorder (PTSD), depression, and anxiety. This is also true for children who come with their families, but unaccompanied minors lack parental support in coping with their traumas, so their needs are even more dire.
Luckily, there is a program called Teaching Recovery Techniques, developed by the Children and War Foundation in Norway. It was developed for use in low-income countries. So its low cost and pragmatic approach to training and distribution comes very handy now when we have a problem of such magnitude at our doorstep.
Teaching Recovery Techniques is a cognitive behaviour therapy based program, focusing on techniques that help children gain control over their intrusive memories, nightmares, arousal, and their tendency to avoid triggers. There is also some basic psychoeducation about the nature of posttraumatic stress and the physical symptoms often experienced.
The program can be delivered by people without previous experience of psychological work as a first line of treatment for posttraumatic stress symptoms. It comprises five 1,5 hour sessions in a group. For children who still have severe problems after TrT, more specialised interventions are needed.
I hope that my town, Uppsala, will show leadership in Sweden by being first with implementing TrT in the special care homes. I have brought their attention to the program and offered my support in its evaluation. As with all new methods or old methods in new settings, care should be taken to evaluate what works best and to always avoid harm.
Right now, however, harm is done by untreated symptoms and by adults who unintentionally make matters worse. They advise these youngsters not to think too much about the past (try hard NOT to think of a red flower for 30 seconds and see how you go) and help them avoid triggers to keep them calm (when they in fact need to be carefully exposed to triggers).
Some die young (the link will take you to the Swedish singer Laleh’s song, performed at the memorial concert for the victims of the Utoya shooting in Norway). Some make it and we should do our best, not based on “common sense” or amateur psychobabble, but evidence, to help them make use of their enormous strength for the benefit of their futures, their families and society.
We know that apart from attending to trauma-related symptoms, social support, strong peer relations and low levels of daily hassles are factors that predict good outcomes. So let’s all get to work!