Utah Health and Human Rights Project's "Important Concepts in Determining Torture Status."

The stories of refugees in the first stage of adjustment are well documented. They are about striving to meet life's basic needs: food, shelter, employment and school.

But once a refugee has been here awhile, once he or she has met those basic needs, that's when doctors see deep-seated emotional issues. And it is in this second stage of adjustment where Utah refugees sometimes plunge through the cracks.

"It's been devastating for some of our people to continue on with their lives," said Lina Smith, a longtime advocate for refugees in Utah.

Consider the extreme case of a refugee from Togo.

As a prisoner in his home country, the man's eyes were held open for hours at a time, and he was forced to look at the sun. He was blind when he got to Utah.

It's hard for officials to know what percentage of refugees end up in mental health care at Valley Mental Health or the Utah Health and Human Rights Project's torture treatment group.

The "Pathways to Recovery" schedule of classes at Valley Mental Health, illustrates the breadth of issues faced by refugees.

"Distress Tolerance," "Grief and Loss," "Understanding Hallucinations." Other classes are specifically for refugees from former Yugoslavian countries and for Vietnamese. There are also classes on self-esteem, anger management, parenting, health living and cultural awareness.

The notion of addressing mental health concerns among refugees is a sensitive, complicated issue for doctors.

In most cases, it is physical health problems that open the door to mental health treatment.

Refugees undergo a complete health screening within 30 days of landing in Utah. Drs. Paul Swoboda and Mara Rabin at the Salt Lake Family Health Center conduct the exams.

They test for communicable diseases such as tuberculosis, HIV and syphilis. The also look for parasites.

TB is typically latent and isn't going to spread, Swoboda said. Only once in a while, he said, does a refugee test positive for a sexually transmitted disease.