Early Retirement Pensions and Lack of Trauma Treatment are Inextricably Linked

If refugees are to participate and succeed in the labour market, early detection of trauma and timely treatment is key

NOTE: Most links go to sources in Danish

The Danish Employers' Association and a number of right-wing voices are currently outraged that people with so-called "non-Western" backgrounds fill statistics on early retirement. But if you look at where those people come from, it makes perfect sense: they originate from war-torn countries such as Iraq, Ex-Yugoslavia, Afghanistan, Armenia, Lebanon, Somalia, etc.
 
They come from war, hunger, torture and disaster, they have risked everything to get to safety and it has left its mark. In Denmark, their traumas have often not been diagnosed and treated. It should not surprise anyone that these people with serious mental and physical issues cannot work to the same extent as everyone else, and it should not at all lead to the unfounded claim that it is "too easy" to be granted early retirement. Actually, they have much more in common with deployed soldiers who have been in war and have become permanently ill from it. Are we surprised when Danish veterans from Iraq and Afghanistan cannot work full-time or angry when they receive early retirement as a result of their suffering?
 
When you end up on early retirement, it is the result of a long and grueling process in which it is established that your ability to work is significantly and permanently reduced. The fact that a number of refugees end up precisely there is largely about the lack of trauma treatment, which leads to a life permanently outside the labour market. If we want to give refugees the opportunity to live up to the demands we as a society make of them, we should therefore ensure rapid detection of trauma and timely treatment. That is far from the case today.

Case: Jamilla

Jamilla survived the civil war in Somalia and arrived in Denmark in 1993. She had witnessed death, violence and famine, but fought her way to safety:

"When I arrived at the asylum center, I was given a warm winter jacket, and people were so nice to me. But no one asked how I was doing, and I didn't talk to anyone about the things I had experienced. I was fine, I was young, and I had escaped."

But even though Jamilla left the war, the war did not leave her. Now, 30 years after fleeing her home country, her life is turned upside down by the trauma of what she went through. She cannot sleep at night, suffers from chronic headaches and constant pain in her body, racing thoughts and anxiety, is always nervous and on edge, and isolates herself socially. She used to work, but she can no longer do that. She used to participate in community activities, but that is also over. She has become a shell of the person she once was. She is now being treated at a PTSD clinic and might not ever be able to work again.

"Now I wake up at night with nightmares and sweating. I think about terrible things. Sometimes I suddenly get very scared if there is a loud noise or someone shouting— then I can be afraid for several days afterward."

The trauma reaction caught Jamilla by surprise. But it should not have caught the system by surprise. It is well known that traumatic experiences can leave scars on the soul, and without treatment, they can worsen over time. Yet, Jamilla is just one out of thousands of refugees in Denmark who were never offered thorough screening or timely treatment. Had she been assessed right from the start, treated much earlier, and had access to supportive communities, her life could look very different today. Now, early retirement pension is her only option.

Flight, trauma, and well-being

Many refugees arrive in Denmark with experiences that can lead to serious conditions like PTSD. It is estimated that one in three refugees in Denmark suffers from trauma due to war, flight and torture, and according to the Danish Institute for Human Rights, up to 50% may have been subjected to torture. Trauma disorders such as PTSD can make it impossible to hold down a job, and the condition is so severe that treatment is necessary for a good and dignified life. Treatment may not cure everyone, but many can improve enough to function in a normal daily life, which also reduces the risk of transmitting inherited trauma to their children.

In addition to the trauma from their home countries and the flight here, many refugees experience what is known as "exile stress" — intense stress related to the difficult task of settling in a new country with all the concerns about residency, safety, finances, unemployment, loneliness, identity loss, broken relationships, grief, loss, language barriers, and lack of networks. This can make it an insurmountable task to live up to the demands placed on them and can have a devastating effect on refugees' mental health. The Paradigm Shift and short-term residence permits have led to deep fear and insecurity for refugees, which has immense significance in this context.

It can take a long time before trauma develops into full-fledged trauma disorders. And that is why it is absolutely crucial that screening takes place quickly when refugees arrive in the country, and that their experiences are thoroughly mapped and the help they need is identified. For thousands of refugees in Denmark, this is simply not the case, as exemplified by Jamilla.

Better detection, faster treatment, more support

For Jamilla, it took 30 years before she received treatment for PTSD. Thirty years during which her symptoms worsened, and her ability to contribute and thrive became smaller and smaller. Data from DIGNITY show that, on average, it takes 15 years for a trauma-affected refugee in Denmark to get treatment, but many never reach that point. Early detection and timely treatment should be possible, considering how few refugees Denmark receives compared to other countries.

Often, early detection of trauma already fails in the asylum phase, where refugees do not have the same access to health services as other citizens, which is the first barrier to timely treatment. At the asylum centers, newly arrived refugees are offered a standardised conversation and examination, but their health data is not sufficiently transferred to municipalities when they leave the asylum center. In municipalities, they are met with a healthcare system that does not understand their trauma issues and does not engage with them—or take them seriously. Read more about these issues in the FACTS article on refugees and mental health here.

Many doctors and researchers point out that there is poor knowledge of refugees' specific trauma issues in the healthcare system, which significantly delays detection. In fact, many general practitioners completely avoid talking to refugees about the horrific things they have experienced and continue to experience. Furthermore, refugee patients are often misunderstood, or their symptom descriptions are interpreted as "ethnic pain"—a phenomenon that does not actually exist but covers for doctors' lack of understanding of what their patients with ethnic minority backgrounds are trying to communicate. The podcast 'A Seat At The Table' has an episode about this deeply problematic concept.

According to institutions that work specifically with trauma-affected refugees, such as the Immigrant Medical Clinic and DIGNITY, the answer is clear: early identification of trauma and better access to treatment options is the way forward — and the only way forward. Still, effective and dignified systems are waiting to be established, and there seems to be no political willingness to strengthen the area: trauma-affected refugees, for example, are nowhere to be found in the government's recent proposal for a dignity reform for the most vulnerable members of society.

Supporting communities can also be an important element in increasing well-being and recovery: experiencing other people being supportive and empathetic makes it easier to have courage in life, dare to ask for help and succeed in getting well. Danish Refugee Council and the Red Cross both offer psychosocial interventions and social communities for refugees, where volunteers work in a trauma-informed manner, helping individuals integrate into groups and supporting their well-being.

Trauma treatment and work ability are connected

Think back to Jamilla. Is she and other traumatized refugees outside the labor market just exploiting the system? No. Because the numbers cannot be compared with healthy and fit Danes who have never been exposed to traumatizing experiences.

Nikolai Cerisier Roitmann, who is head of DIGNITY's psychotraumatic clinic, recently said in a radio programme in which Refugees Welcome's chairwoman Michala Bendixen also participated:

"The ones we see are people who are very devastated by what they have been through. These are people trying to get things together, trying to be something for their children, trying to establish a new life in a new country they don't know. And who carry things in their luggage that are difficult to live with. […] After all, many of them want to work and want to be integrated and spend their time on something meaningful and contribute to society. But they find it incredibly difficult to get started and keep going because they are so bothered by their symptoms.”
 
The Integration Act stipulates that all new arrivals must be employed within the first year, and employment among refugees also increases year by year. But employment within a year is of course rarely possible if you suffer from a serious trauma burden. Research has also shown that a larger proportion of those who get into work quickly lose their attachment to the labor market again later. It can, among other things, be because untreated trauma flares up, as in Jamilla's case.

Integration begins with healing invisible wounds


At Refugees Welcome, we still have yet to meet a person who does not want to be an active part of society. On the contrary, refugees come here with dreams of contributing and participating, and with qualities, skills, and competencies that our society needs. Therefore, it is both an economic and moral problem that we allow so many to become chronically ill with trauma-related conditions and then scold them for their position in our labour market.

The fact that many refugees end up on early retirement pensions is largely due to political priorities. When trauma treatment is not prioritised, the consequence is a health underclass, where poor treatment structures keep a group of people in distress, illness, unemployment, and social exclusion. This is expensive for society and devastating for the individual. We become — both economically and morally — a poorer society if we do not take care of those who are the most disadvantaged among us.


Therefore, earlier identification of trauma and timely treatment should be politically prioritised. This should be followed up by better access to services that promote mental health and well-being among refugees so that we as a society can ensure each individual a minimum of well-being and dignity — just as we demand for other population groups with serious illnesses.

Interested in reading more? Find our FACTS page on refugees and mental health here.