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Nowak AC, Hornberg C. [Experiences of people with refugee backgrounds in utilising healthcare in Germany-findings from a qualitative study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1117-1125. [PMID: 36445459 PMCID: PMC10539425 DOI: 10.1007/s00103-022-03614-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Refugees and asylum seekers face a variety of legal, structural, administrative, cultural and linguistic barriers in accessing healthcare. However, there is currently a lack of available data on the health needs of refugees and asylum seekers. In particular, their subjective experience in accessing healthcare has not been considered sufficiently. AIM OF THE STUDY This paper explores the subjective experiences of refugees and asylum seekers in accessing and using healthcare. Strategies for dealing with potential challenges are presented. METHODS The recruitment of interview partners was based on a quantitative cross-sectional study collected as part of a study on the health of refugees (FlüGe health study). Persons who agreed to be contacted again were contacted by telephone. A heterogeneous sub-sample (n = 18) with regard to age, gender, nationality, health status and utilisation behaviour was interviewed using interpreter-supported problem-centred interviews. Data were analysed using a deductive-inductive approach. RESULTS AND DISCUSSION The migration-insensitive healthcare for refugees and asylum seekers is characterised by language barriers, disorientation, experiences of rejection, mistreatment and structural barriers. Experiences of foreignness in the healthcare system can lead to delayed care seeking or underusage of healthcare systems. At the same time, individual strategies by refugees, asylum seekers and healthcare providers are used in order to meet these challenges.
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Affiliation(s)
- Anna Christina Nowak
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstr. 25, 33615, Bielefeld, Deutschland.
| | - Claudia Hornberg
- Medizinische Fakultät OWL, Sustainable Environmental Health Sciences, Universität Bielefeld, Bielefeld, Deutschland
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Gottlieb N, Siegel M. Associations between physical and mental health and the utilization of ambulatory and emergency healthcare among asylum-seekers: results from a cross-sectional survey in Berlin, Germany. Int J Equity Health 2023; 22:99. [PMID: 37221582 DOI: 10.1186/s12939-023-01914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Despite a high burden of chronic and mental illness, asylum-seekers show low utilization of ambulatory specialist healthcare. Forgoing timely healthcare when facing access barriers may direct them toward emergency care. This paper examines interrelations of physical and mental health and utilization of ambulatory and emergency care, and explicitly addresses associations between the different types of care. METHODS A structural equation model was applied to a sample of n = 136 asylum-seekers living in accommodation centers in Berlin, Germany. Utilization patterns of emergency care (outcome) and physical and mental ambulatory care (endogenous predictors) were estimated, while controlling for age, gender, chronic conditions, bodily pain, depression, anxiety, length of stay in Germany (exogenous predictors) and self-rated health (endogenous predictor). RESULTS Associations were observed between ambulatory care utilization and poor self-rated health (0.207, CI: 0.05; 0.364), chronic illness (0.096, CI: 0.017; 0.175) and bodily pain (0.019, CI: 0.002; 0.036); between mental healthcare utilization and anxiety (0.202, CI: 0.051; 0.352); and between emergency care utilization and poor self-rated health (0.621, CI: 0.059; 1.183), chronic illness (0.287, CI: 0.012; 0.563), mental healthcare utilization (0.842, CI: 0.148; 1.535) and anxiety (0.790, CI: 0.141; 1.438) (values in parentheses show estimated regression coefficients and 95% confidence intervals). We found no associations between the utilization of ambulatory and emergency care. CONCLUSIONS Our study generates mixed results concerning associations between healthcare needs and ambulatory and emergency care utilization among asylum-seekers. We found no evidence that low utilization of ambulatory care contributes to emergency care utilization; neither did we find evidence that ambulatory treatment obviates the need to seek emergency care. Our results indicate that higher physical healthcare needs and anxiety are associated with more utilization of both ambulatory and emergency care; whereas healthcare needs related to depression tend to remain unmet. Both the undirected and under-utilization of health services may reflect navigation and accessibility issues. To facilitate more needs-based and effective healthcare utilization and thus contribute to health equity, support services such as interpretation and care navigation as well as outreach are warranted.
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Affiliation(s)
- Nora Gottlieb
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, PO Box 10 01 31, 33501, Bielefeld, Germany.
- Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni 135, 10623, Berlin, Germany.
| | - Martin Siegel
- Department of Empirical Health Economics, Technische Universität Berlin, Strasse des 17. Juni 135, 10623, Berlin, Germany
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Tham SG, Hunt IM, Turnbull P, Appleby L, Kapur N, Knipe D. Suicide among psychiatric patients who migrated to the UK: a national clinical survey. EClinicalMedicine 2023; 57:101859. [PMID: 36895802 PMCID: PMC9989630 DOI: 10.1016/j.eclinm.2023.101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Within the UK, limited research has examined migration and suicide risk. To assist with tailoring mental health care to the needs of different migrant groups, it is important to identify the clinical profile and antecedents to suicide. METHODS We focussed on two groups of migrants: those resident in the UK for less than 5 years (recent migrants) and those seeking permission to stay in the UK. Data on mental health patients who died by suicide in the UK between 2011 and 2019 were obtained as part of the National Confidential Inquiry into Suicide and Safety in Mental Health. FINDINGS 13,948 patients died by suicide between 2011 and 2019: 593 were recent migrants with 48 seeking permission to stay in the UK. The overall suicide rate between 2011 and 2017 for patients seeking to stay was 23.8/100,000 (95% CI 17.3-32.1). There was some uncertainty around this estimate but it appeared higher than the general population suicide rate of 10.6/100,000 population (95% CI 10.5-10.7; p = .0001) for the same period. A higher proportion of migrants were from an ethnic minority group (15% recent migrants vs. 70% seeking to remain vs. 7% non-migrants) and more were viewed as at low long-term risk of suicide (63% recent migrants vs. 76% seeking to remain vs. 57% non-migrants). A higher proportion of recent migrants died within three months of discharge from psychiatric in-patient care (19% vs. 14%) compared to non-migrants. Proportionally more patients seeking to remain had a diagnosis of schizophrenia and other delusional disorders (31% vs. 15%) and more had experienced recent life events compared to non-migrants (71% vs. 51%). INTERPRETATION A higher proportion of migrants had severe or acute illness at the time of their suicide. This may be linked to a range of serious stressors and/or lack of connection with services that could have identified signs of illness early. However, clinicians often viewed these patients as low risk. Mental health services should consider the breadth of stressors migrants may face and adopt a multi-agency approach to suicide prevention. FUNDING The Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Su-Gwan Tham
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
- Corresponding author. National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
| | - Isabelle M. Hunt
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Duleeka Knipe
- Population Health Sciences, University of Bristol, Bristol, UK
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Dropout from Mental Health Treatment Among Asylum-Seekers in Israel: A Retrospective Chart Study. J Immigr Minor Health 2022; 25:539-547. [DOI: 10.1007/s10903-022-01427-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
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Nowak AC, Namer Y, Hornberg C. Health Care for Refugees in Europe: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031278. [PMID: 35162300 PMCID: PMC8834962 DOI: 10.3390/ijerph19031278] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/08/2022] [Accepted: 01/19/2022] [Indexed: 12/31/2022]
Abstract
Background: Accessing and using health care in European countries pose major challenges for asylum seekers and refugees due to legal, linguistic, administrative, and knowledge barriers. This scoping review will systematically describe the literature regarding health care for asylum seekers and refugees in high-income European countries, and the experiences that they have in accessing and using health care. Methods: Three databases in the field of public health were systematically searched, from which 1665 studies were selected for title and abstract screening, and 69 full texts were screened for eligibility by the main author. Of these studies, 44 were included in this systematic review. A narrative synthesis was undertaken. Results: Barriers in access to health care are highly prevalent in refugee populations, and can lead to underusage, misuse of health care, and higher costs. The qualitative results suggest that too little attention is paid to the living situations of refugees. This is especially true in access to care, and in the doctor-patient interaction. This can lead to a gap between needs and care. Conclusions: Although the problems refugees and asylum seekers face in accessing health care in high-income European countries have long been documented, little has changed over time. Living conditions are a key determinant for accessing health care.
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Affiliation(s)
- Anna Christina Nowak
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
- Correspondence:
| | - Yudit Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany;
| | - Claudia Hornberg
- Department of Sustainable Environmental Health Sciences, Faculty of Medicine, Bielefeld University, 33615 Bielefeld, Germany;
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Ahmadinia H, Eriksson-Backa K, Nikou S. Health-seeking behaviours of immigrants, asylum seekers and refugees in Europe: a systematic review of peer-reviewed articles. JOURNAL OF DOCUMENTATION 2021. [DOI: 10.1108/jd-10-2020-0168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeImmigrants, asylum seekers and refugees living in Europe face a number of challenges in accessing or using health information and healthcare services available in their host countries. To resolve these issues and deliver the necessary services, providers must take a comprehensive approach to better understand the types of health information and healthcare services that these individuals need, seek and use. Therefore, the purpose of this paper is to develop that comprehensive approach.Design/methodology/approachIn this paper, a systematic literature review of peer-reviewed publications was performed, with 3.013 articles collected from various databases. A total of 57 qualifying papers on studies conducted in Europe were included in the review after applying the predefined inclusion and exclusion requirements, screening processes and eliminating duplicates. The information seeking and communication model (ISCM) was used in the analysis.FindingsThe findings revealed that while many health information and healthcare services are accessible in Europe for immigrants, asylum seekers and refugees, many of these individuals are unaware of their existence or how to access them. While our findings do not specify what health-related information these groups need, use or seek, they do suggest the importance and value of providing mental health, sexual health and HIV, as well as pregnancy and childbirth information and services. Furthermore, according to our results, health information services should be fact-based, easy to understand and raise awareness about healthcare structure and services available in Europe for this vulnerable population.Practical implicationsThis study has a range of practical implications, including (1) highlighting the need for mental health and behavioural health services and (2) stressing the value of addressing cultural context and religious values while investigating (health) information seeking of people with foreign background.Originality/valueThis is one of the first studies to systematically review and examine the behaviour of immigrants, asylum seekers and refugees in relation to health information and healthcare services in the European context.
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Barriers to Accessing and Negotiating Mental Health Services in Asylum Seeking and Refugee Populations: The Application of the Candidacy Framework. J Immigr Minor Health 2020; 22:156-174. [PMID: 31444614 PMCID: PMC6952341 DOI: 10.1007/s10903-019-00929-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This review brought together research investigating barriers asylum seekers and refugees (AS&R) face in accessing and negotiating mental health (MH) services. The candidacy framework (CF) was used as synthesizing argument to conceptualize barriers to services (Dixon-Woods et al. in BMC Med Res Methodol 6:35, 2006). Five databases were systematically searched. Twenty-three studies were included and analyzed using the CF. The seven stages of the framework were differentiated into two broader processes-access and negotiation of services. Comparatively more data was available on barriers to access than negotiation of services. The Identification of Candidacy (access) and Appearances at Services (negotiation) were the most widely discussed stages in terms of barriers to MH care. The stage that was least discussed was Adjudications (negotiation). The CF is useful to understand inter-related barriers to MH care experienced by AS&R. A holistic approach is needed to overcome these barriers together with further research investigating understudied areas of candidacy.
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Kiselev N, Morina N, Schick M, Watzke B, Schnyder U, Pfaltz MC. Barriers to access to outpatient mental health care for refugees and asylum seekers in Switzerland: the therapist's view. BMC Psychiatry 2020; 20:378. [PMID: 32680485 PMCID: PMC7366894 DOI: 10.1186/s12888-020-02783-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND More than 120,000 refugees and asylum seekers are currently living in Switzerland. The prevalence of mental disorders among this population is significantly higher than that in the general population. While effective treatment options and cross-cultural, specialized treatment centers exist, they tend to be overloaded by their target populations. General outpatient primary health care providers might be able to compensate for the lack of specialized treatment slots. To date, however, it is unknown how often and under what conditions (e.g., length of waiting lists) refugees and asylum seekers are treated outside of specialized centers and whether there are barriers that prevent providers in outpatient settings from treating more patients in this subgroup. The present study aimed to assess the challenges and barriers faced by psychiatrists and psychotherapists working in outpatient settings in Switzerland in treating refugees and asylum seekers to determine the potential capacity of this group to provide mental health care. METHODS An online survey was conducted during the winter of 2017/2018. The survey was constructed in three official languages and took 10-15 min to complete. Spearman's correlations, Mann-Whitney U-Tests, and Chi-squared tests were conducted to analyze the data. RESULTS Eight hundred and sixty-seven (N = 867) psychotherapists and psychiatrists working in outpatient settings completed the survey: 43% of them reported having treated between 1 and 9 refugees or asylum seekers in the past 12 months, and a further 13% reported treating 10 or more. Interpreters were used for almost every other patient with a refugee or asylum-seeker background. At the same time, the funding of interpreters, as well as the funding of treatment in general, were reported to be the biggest hurdles to treating more refugees and asylum seekers. CONCLUSIONS Given the low number of patients rejected for capacity reasons (between 2 and 5%) and the median waiting times for the admission of new patients ranging between 2 and 3 weeks, outpatient primary mental health care providers might treat more refugees and asylum seekers and relieve specialized treatment centers. However, barriers such as lack of funding of interpreters seem to hinder them. Appropriate steps by the authorities are needed to improve the current situation.
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Affiliation(s)
- Nikolai Kiselev
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Naser Morina
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Matthis Schick
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Birgit Watzke
- grid.7400.30000 0004 1937 0650Department of Clinical Psychology and Psychotherapy Research, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- grid.7400.30000 0004 1937 0650Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Monique C. Pfaltz
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Medical Faculty, University of Zurich, Zurich, Switzerland
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Kiselev N, Pfaltz M, Haas F, Schick M, Kappen M, Sijbrandij M, De Graaff AM, Bird M, Hansen P, Ventevogel P, Fuhr DC, Schnyder U, Morina N. Structural and socio-cultural barriers to accessing mental healthcare among Syrian refugees and asylum seekers in Switzerland. Eur J Psychotraumatol 2020; 11:1717825. [PMID: 32128044 PMCID: PMC7034440 DOI: 10.1080/20008198.2020.1717825] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/26/2019] [Accepted: 01/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background: Due to their experiences of major stressful life events, including post-displacement stressors, refugees and asylum seekers are vulnerable to developing mental health problems. Yet, despite the availability of specialized mental health services in Western European host countries, refugees and asylum seekers display low mental healthcare utilization. Objective: The aim of this study was to explore structural and socio-cultural barriers to accessing mental healthcare among Syrian refugees and asylum seekers in Switzerland. Method: In this qualitative study, key-informant (KI) interviews with Syrian refugees and asylum seekers, Swiss healthcare providers and other stakeholders (e.g. refugee coordinators or leaders) were conducted in the German-speaking part of Switzerland. Participants were recruited using snowball sampling. Interviews were audiotaped and transcribed, and then analysed using thematic analysis, combining deductive and inductive coding. Results: Findings show that Syrian refugees and asylum seekers face multiple structural and socio-cultural barriers, with socio-cultural barriers being perceived as more pronounced. Syrian key informants, healthcare providers, and other stakeholders identified language, gatekeeper-associated problems, lack of resources, lack of awareness, fear of stigma and a mismatch between the local health system and perceived needs of Syrian refugees and asylum seekers as key barriers to accessing care. Conclusions: The results show that for Syrian refugees and asylum seekers in Switzerland several barriers exist. This is in line with previous findings. A possible solution for the current situation might be to increase the agility of the service system in general and to improve the willingness to embrace innovative paths, rather than adapting mental healthcare services regarding single barriers and needs of a new target population.
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Affiliation(s)
- Nikolai Kiselev
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Monique Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Florence Haas
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marie Kappen
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam and Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Anne M De Graaff
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam and Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Martha Bird
- Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Pernille Hansen
- Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Daniela C Fuhr
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
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Satinsky E, Fuhr DC, Woodward A, Sondorp E, Roberts B. Mental health care utilisation and access among refugees and asylum seekers in Europe: A systematic review. Health Policy 2019; 123:851-863. [PMID: 30850148 DOI: 10.1016/j.healthpol.2019.02.007] [Citation(s) in RCA: 207] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Refugees and asylum seekers often have increased mental health needs, yet may face barriers in accessing mental health and psychosocial support (MHPSS) services in destination countries. The aim of this systematic review is to examine evidence on MHPSS service utilisation and access among refugees and asylum seekers in European Union Single Market countries. METHODS Four peer-reviewed and eight grey literature databases were searched for quantitative and qualitative literature from 2007 to 2017. Access was categorised according to Penchansky and Thomas' framework and descriptive analyses were conducted. Quality of studies was assessed by the Newcastle-Ottawa scale and the Critical Appraisal Skills Programme checklist. RESULTS Twenty-seven articles were included. The findings suggest inadequate MHPSS utilisation. Major barriers to accessing care included language, help-seeking behaviours, lack of awareness, stigma, and negative attitudes towards and by providers. CONCLUSIONS Refugees and asylum seekers have high mental health needs but under-utilise services in European host countries. This underutilisation may be explained by cultural-specific barriers which need to be tackled to increase treatment demand. Training health providers on cultural models of mental illness may facilitate appropriate identification, referral, and care. Based on these findings, it is crucial to review policies regarding MHPSS provision across the EU.
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Affiliation(s)
- Emily Satinsky
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Health Services Research and Policy, 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, United Kingdom.
| | - Daniela C Fuhr
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Health Services Research and Policy, 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, United Kingdom
| | - Aniek Woodward
- KIT Health, KIT Royal Tropical Institute, Amsterdam, the Netherlands
| | - Egbert Sondorp
- KIT Health, KIT Royal Tropical Institute, Amsterdam, the Netherlands
| | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Health Services Research and Policy, 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, United Kingdom
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Werneke U. Conference proceedings of the 4th Masterclass Psychiatry: Transcultural Psychiatry - Diagnostics and Treatment, Luleå, Sweden, 22-23 February 2018 (Region Norrbotten in collaboration with the Maudsley Hospital and Tavistock Clinic London). Nord J Psychiatry 2018:1-33. [PMID: 30547691 DOI: 10.1080/08039488.2018.1481525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/23/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND According to estimates from the European Commission, Europe has experienced the greatest mass movement of people since the Second World War. More than one million refugees and migrants have arrived in the European Union in the past few years. Mental health and primary care professionals are more likely than ever to meet patients from different cultures and backgrounds. AIMS To equip mental health and primary care professionals with transcultural skills to deal with patients from unfamiliar backgrounds. METHOD Lectures and case discussions to explore the latest advances in the diagnosis and treatment of serious mental health problems in a transcultural context. RESULTS Lectures covered transcultural aspects of mental health problems, treatment in different cultural and ethnic contexts, and assessment of risk factors for self-harm and harm in migrant populations. CONCLUSIONS Clinicians require a sound grounding in transcultural skills to confidently and empathically deal with patients from unfamiliar backgrounds.
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Affiliation(s)
- Ursula Werneke
- a Department of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit , Umeå University , Umeå , Sweden
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Abstract
BACKGROUND Mental health services in Sweden are confronted with globalization and refugee migration from conflict- and war-torn countries. AIM To discuss how clinicians in Sweden can deal with a series of challenges in a changing globalized society, ranging from difficulties of overcoming barriers to help seeking to difficulties of identifying trauma and finding culturally adapted clinical tools. METHOD Case vignettes are presented to exemplify challenges. Different approaches developed to support clinicians are presented. RESULTS The concepts of patient centered care and shared decision-making as well as the cultural formulation interview, are recommended to explore the significance of culture and context in psychiatric assessments. Acknowledging relational aspects of care and of paying attention to the patients' social worlds in clinical work is also essential. CONCLUSIONS The article includes recommendations for training as well as an appeal for the involvement of the wider society in the work to guarantee equitable and high-quality mental health services for some of the most vulnerable patient groups in society.
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Affiliation(s)
- Sofie Bäärnhielm
- a Department of Clinical Neuroscience , Karolinska Institute , Stockholm , Sweden
| | - Maria Sundvall
- b Transcultural Centre, Stockholm County Council , Stockholm , Sweden
- c Department of Learning, Informatics, Management and Ethics , Karolinska Institute , Stockholm , Sweden
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Biringer E, Hartveit M, Sundfør B, Ruud T, Borg M. Continuity of care as experienced by mental health service users - a qualitative study. BMC Health Serv Res 2017; 17:763. [PMID: 29162112 PMCID: PMC5698968 DOI: 10.1186/s12913-017-2719-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 11/09/2017] [Indexed: 12/20/2022] Open
Abstract
Background People who struggle with mental health problems can provide valuable insight into understanding and improving the coordination of mental health and welfare services. The aims of the study were to explore service users’ experiences and perceptions of continuity of care within and across services relevant to personal recovery, to elicit which dimensions of continuity of care are most essential to service users, and to generate ideas for improving service users’ experiences of continuity of care. Methods In the context of a hermeneutic-phenomenological approach, ten service users at a community mental health centre were interviewed about their experiences of continuity of care in and across services. Eight of these were re-interviewed two years later. A collaborative research approach was adopted. Data were analysed by means of a data-driven stepwise approach in line with thematic analysis. Results Following the analysis five themes representing experiences of continuity of care were developed. Each theme ranged from poor to good experiences of continuity of care: Relationship – from experiencing frequent setbacks and anxiety due to breaks in relationships, to feeling safe in an ongoing personal relationship; Timeliness – from experiencing frustrating waiting times with worsening of problems, to getting help when needed; Mutuality – from having a one-sided struggle, to a situation in which both professionals and service users take initiatives; Choice – from not having the opportunity to make practical arrangements within the context of one’s everyday life, to having an array of support options to choose from; Knowledge – from feeling confused and insecure because one does not know what is happening, to feeling safe because one is informed about what is going to happen. Participants provided a range of suggestions for improving experiences of continuity of care. Conclusions A discrepancy between aspects of continuity that are essential for service users and their experiences of actual practice was revealed. The valid evidence generated in the present collaborative study therefore offers knowledge to policy makers, professionals and service users that may be of help in their future efforts in orienting primary care, mental health, addiction and welfare services towards recovery. Electronic supplementary material The online version of this article (10.1186/s12913-017-2719-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eva Biringer
- Helse Fonna Local Health Authority, P.O. Box 2170, N-5504, Haugesund, Norway.
| | - Miriam Hartveit
- Helse Fonna Local Health Authority, P.O. Box 2170, N-5504, Haugesund, Norway
| | - Bengt Sundfør
- Regional Research Network on Mood Disorders (MoodNet), Haukeland University Hospital, Division of Mental Health, P.O. Box 1400, N-5021, Bergen, Norway
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, P.O. Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, Blindern, N-0318, Oslo, Norway
| | - Marit Borg
- Faculty of Health Sciences, University College of Southeast Norway, Papirbredden, Drammen kunnskapspark, Grønland 58, 3045, Drammen, Norway
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14
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Matsea T, Ryke E, Weyers M. Assessing mental health services in a rural setting: Service providers’ perspective. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2017. [DOI: 10.1080/00207411.2017.1377805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Thabisa Matsea
- Social Work, School for Psycho-social Behavioural Sciences: Social Work Division, North-West University, Potchefstroom, South Africa
| | - Elma Ryke
- Social Work, School for Psycho-social Behavioural Sciences: Social Work Division, North-West University, Potchefstroom, South Africa
| | - Mike Weyers
- Social Work, School for Psycho-social Behavioural Sciences: Social Work Division, North-West University, Potchefstroom, South Africa
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15
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Weaver N, Coffey M, Hewitt J. Concepts, models and measurement of continuity of care in mental health services: A systematic appraisal of the literature. J Psychiatr Ment Health Nurs 2017; 24:431-450. [PMID: 28319308 DOI: 10.1111/jpm.12387] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Care continuity is considered to be a cornerstone of modern mental health care. As community mental health services have become increasingly fragmented and complex, the crucial criterion for best quality care has become the degree to which treatment delivered by separate services and professionals is continuous and well coordinated. However, clarification of the key elements of continuity has proved challenging and a consensus has not been reached. Recent research has shown significant levels of variation in the quality of care coordination across England and Wales, with potentially detrimental consequences for individuals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Studies on care continuity identified in this review are grouped into three categories: studies defining concepts of care continuity, studies providing models of continuity and studies describing development of questionnaires about care continuity. There are many similarities and parallels between concepts of continuity described in the studies under review. Therefore, there is potential for developing a consensus on the nature of care continuity as a multidimensional concept. The priority placed upon the patient's experience of care continuity is identified as a major focus in these studies. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A consensus on the nature of care continuity would benefit both theory and practice in mental health nursing. It would provide a firmer foundation for new research seeking to improve continuity for people using services, and enable mental health nurses working as care coordinators to have a better understanding of the elements of their role that are most effective. ABSTRACT Introduction The increased complexity of community mental health services, and associated fragmentation of traditional dividing lines between services, has underscored the centrality of care continuity and coordination in modern mental health care. However, clarification of the key features of the care continuity concept has proved difficult and a consensus has not been reached. Aim/Question This review draws together and critically examines latest evidence concerning concepts, models and scales based on a multidimensional understanding of care continuity. Method Databases ASSIA, PubMed, MEDLINE and Cochrane were searched for papers dating from January 2005 to July 2016, of which 21 articles met the inclusion criteria. These were subjected to quality appraisal based on CASP and COSMIN checklists. Studies were grouped into three thematic categories describing concepts, models and scales of care continuity. Results/Discussion Synthesis indicated correspondence between independent, multidimensional models of care continuity, providing greater clarity regarding the essential features of the concept. Association, although not causation, between care continuity factors and health outcomes is supported by current evidence. Implications for practice Clarification of care continuity in mental health services may enable nurses working as care coordinators to develop a better understanding of key elements of their role, and provide guidance for future service development.
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Affiliation(s)
- N Weaver
- Public Health, Policy and Social Sciences, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - M Coffey
- Public Health, Policy and Social Sciences, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - J Hewitt
- Public Health, Policy and Social Sciences, College of Human and Health Sciences, Swansea University, Swansea, UK
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