Presentation Information
[SY-97-03]Institutional Distrust among Refugee Patients: Practical Lessons for Building Rapport
*Kohei Kishi (Yotsuya Yui Clinic & Ushiku Immigration Detention Facilliy, Japan(Japan))
Keywords:
refugee patient,rapport,PTSD
Refugees who have endured state-sponsored persecution frequently transfer their distrust of authority onto Japanese public systems, including medical services. In routine psychiatric practice at an clinic, two anonymised cases illustrate how this stance complicates rapport and treatment adherence. In the first case, a patient projected harmful authority onto the psychiatrist, responded with anger, and refused disclose the information. In the second, clear explanation of Japan’s health-care system combined with rapid symptom relief through medication fostered a therapeutic bond and successfully led to psychologist-delivered counselling. Across both cases, three structural barriers consistently obstructed engagement: (1) complex PTSD from past persecution and current disrespect, (2) deep-rooted distrust of authority figures including clinicians, and (3) limited access to culturally and linguistically appropriate care. Keys to building rapport included: (1) creating a sense of safety (2) conducting patient-led consultations that focus on subjective distress, and (3) providing rapid symptom relief while visualising progress through simple, objective metrics.