Advertisement

Social Psychiatry and Psychiatric Epidemiology

, Volume 48, Issue 1, pp 105–116 | Cite as

Experiences with treating immigrants: a qualitative study in mental health services across 16 European countries

  • Sima Sandhu
  • Neele V. Bjerre
  • Marie Dauvrin
  • Sónia Dias
  • Andrea Gaddini
  • Tim Greacen
  • Elisabeth Ioannidis
  • Ulrike Kluge
  • Natasja K. Jensen
  • Majda Lamkaddem
  • Rosa Puigpinós i Riera
  • Zsigmond Kósa
  • Ulla Wihlman
  • Mindaugas Stankunas
  • Christa Straßmayr
  • Kristian Wahlbeck
  • Marta Welbel
  • Stefan Priebe
Original Paper

Abstract

Purpose

While there has been systematic research on the experiences of immigrant patients in mental health services within certain European countries, little research has explored the experiences of mental health professionals in the delivery of services to immigrants across Europe. This study sought to explore professionals’ experiences of delivering care to immigrants in districts densely populated with immigrants across Europe.

Methods

Forty-eight semi-structured interviews were conducted with mental health care professionals working in 16 European countries. Professionals in each country were recruited from three areas with the highest proportion of immigrants. For the purpose of this study, immigrants were defined as first-generation immigrants born outside the country of current residence, including regular immigrants, irregular immigrants, asylum seekers, refugees and victims of human trafficking. Interviews were transcribed and analysed using thematic analysis.

Results

The interviews highlighted specific challenges to treating immigrants in mental health services across all 16 countries including complications with diagnosis, difficulty in developing trust and increased risk of marginalisation.

Conclusions

Although mental health service delivery varies between and within European countries, consistent challenges exist in the experiences of mental health professionals delivering services in communities with high proportions of immigrants. Improvements to practice should include training in reaching appropriate diagnoses, a focus on building trusting relationships and measures to counter marginalisation.

Keywords

Migrants Mental health services Europe Qualitative 

Notes

Acknowledgments

This study is a part of the EUGATE project funded by the General Directorate of Health and Consumer Protection of the European Union (DG-SANCO). More information on the website: http://www.eugate.org.uk. All authors would like to acknowledge the entire EUGATE research team for their contributions to data collection and management. They also acknowledge the 48 participants for giving their time and for their willingness to share their experiences.

References

  1. 1.
    Bhugra D (2004) Migration and mental health. Acta Psychiatr Scand 109:243–258PubMedCrossRefGoogle Scholar
  2. 2.
    Lindert J, Schouler-Ocak M, Heinz A, Priebe S (2008) Mental health, health care utilisation of migrants in Europe. Eur Psychiatry 23:14–20PubMedCrossRefGoogle Scholar
  3. 3.
    Norredam M, Nielsen SS, Krasnik A (2009) Migrant utilization of somatic healthcare services in Europe: a systematic review. Eur J Pub Health 20:555–563CrossRefGoogle Scholar
  4. 4.
    Eugate (2010) Eugate database on policy and legislation. http://www.eugate.org.uk/outcomes/index.html. Accessed 15 August 2011
  5. 5.
    Karl-Trummer U, Novak-Zezula S, Metzler B (2010) Access to health care for undocumented migrants in the EU. Eurohealth 16:13–16Google Scholar
  6. 6.
    Bhugra D, Jones P (2001) Migration and mental illness. Adv Psychiatr Treat 7:216–222CrossRefGoogle Scholar
  7. 7.
    Carta MG, Bernal M, Hardoy MC, Haro-Abad JM, the “Report on Mental Health in Europe” working group (2005) Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1). Clin Pract Epidemiol Ment Health 1:13PubMedCrossRefGoogle Scholar
  8. 8.
    Dalgard OS, Thapa SB (2007) Immigration, social integration and mental health in Norway, with focus on gender differences. Clin Pract Epidemiol Ment Health 3:24PubMedCrossRefGoogle Scholar
  9. 9.
    Eisenbruch M (1991) From post-traumatic stress disorder to cultural bereavement: diagnosis of Southeast Asian refugees. Soc Sci Med 33:673–680PubMedCrossRefGoogle Scholar
  10. 10.
    Lindencrona F, Ekblad S, Hauff E (2008) Mental health of recently resettled refugees from the Middle East in Sweden: the impact of pre-resettlement trauma, resettlement stress and capacity to handle stress. Soc Psychiatry Psychiatr Epidemiol 43:121–131PubMedCrossRefGoogle Scholar
  11. 11.
    Caldwell-Harris CL, Ayçiçegi A (2006) When personality and culture clash: the psychological distress of allocentrics in a collectivist culture. Transcult Psychiatry 43:331–361PubMedCrossRefGoogle Scholar
  12. 12.
    Herm A (2008) Recent migration trends: citizens of EU-27 Member States become ever more mobile while EU remains attractive to non-EU citizens. DG Eurostat-Statistics in Focus, LuxembourgGoogle Scholar
  13. 13.
    Wanner P (2002) Migration trends in Europe. European population papers series no. 7, council of Europe, StrasbourgGoogle Scholar
  14. 14.
    Sipavicieno A, Kanopiene V (1999) Foreign labour in Lithuania: immigration, employment and illegal work. International Migration Papers, GenevaGoogle Scholar
  15. 15.
    Melegh A, Kondratieva E, Salmenhaara P, Forsander A, Hablicsek L, Hegyesi A (2004) Globalisation, ethnicity and international migration, the comparison of Finland, Hungary and Russia: working papers on population, family and welfare (7). HCSO Demographic Research Institute, BudapestGoogle Scholar
  16. 16.
    Eurostat and DG EMPL (2010) Commission staff working report: demographic report. European Commission, BrusselsGoogle Scholar
  17. 17.
    Al-Issa I (2000) The mental healthy of Muslim immigrants in Europe. In: Al-Junun (ed) Mental illness in the Islamic world. International Universities Press, Madison CTGoogle Scholar
  18. 18.
    Bhui K, Bhugra D, Goldberg D, Dunn G, Desai M (2001) Cultural influences on the prevalence of common mental disorder, general practitioners’ assessments and help-seeking among Punjabi and English people visiting their general practitioner. Psychol Med 31:815–825PubMedCrossRefGoogle Scholar
  19. 19.
    Fassaert T, de Wit MAS, Verhoeff AP, Tuinebreijer WC, Gorissen WHM, Beekman ATF, Dekker J (2009) Uptake of health services for common mental disorders by first-generation Turkish and Moroccan migrants in the Netherlands. BMC Public Health 9:307PubMedCrossRefGoogle Scholar
  20. 20.
    Knipscheer JW, Kleber RJ (2001) Help-seeking attitudes and utilization patterns for mental health problems of Surinamese migrants in the Netherlands. J Cons Psychol 48:28–38CrossRefGoogle Scholar
  21. 21.
    Levecque K, Lodewyckx I, Bracke P (2008) Psychological distress, depression and generalised anxiety in Turkish and Moroccan immigrants in Belgium: a general population study. Soc Psychiatry Psychiatr Epidemiol 44:188–197PubMedCrossRefGoogle Scholar
  22. 22.
    Llácer A, Del Amo J, García-Fulgueiras A, Ibáňez-Rojo V, García-Pino R, Jarrín I, Díaz D, Fernández-Liria, García-Ortuzar, V, Mazarrassa L, Rodríguez-Arenas, Zunzunegui, MV (2009) Discrimination and mental health in Ecuadorian immigrants in Spain. J Epidemiol Community Health 63:766–772Google Scholar
  23. 23.
    Monteiro AP (2009) Stress vulnerability and mental health in Eastern Europe immigrants in Portugal. Eur Psychiatry 24:S1256CrossRefGoogle Scholar
  24. 24.
    Singhammer J, Bancila D (2011) Associations between stressful events and self-reported mental health problems among non-Western immigrants in Denmark. J Immigr Minor Health 13:371–378PubMedCrossRefGoogle Scholar
  25. 25.
    Tinghog P, Al-Saffar S, Carstensen J, Nordenfelt L (2010) The association of immigrant- and non-immigrant specific factors with mental ill health among immigrants in Sweden. Int J Soc Psychiatry 56:74–93PubMedCrossRefGoogle Scholar
  26. 26.
    Priebe S, Sandhu S, Dias S, Gaddini A, Greacen T, Ioannidis E, Kluge U, Krasnik A, Lamkaddem M, Lorant V, Puigpinós i Riera R, Sarvary A, Soares JJF, Stankunas M, Straßmayr C, Wahlbeck K, Welbel M, Bogic M (2011) Good practice in health care for migrants: views and experiences of care professionals in 16 European countries. BMC Public Health 11:187Google Scholar
  27. 27.
    Priebe S, Bogic M, Ádány R, Bjerre NV, Dauvrin M, Devillé W, Dias S, Gaddini A, Greacen T, Kluge U, Ioannidis E, Jensen NK, Puigpinós i Riera R, Soares JJF, Stankunas M, Straßmayr C, Wahlbeck K, Welbel M, McCabe R (2011) Good practice in emergency care: views from practitioners. In: Rechel B, Mladovsky P, Devillé W, Rijks B, Petrova-Benedict R, McKee M (eds) Migration and health in Europe (European observatory on health). Open University Press, MaidenheadGoogle Scholar
  28. 28.
    Hsieh HF, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15:1277–1288PubMedCrossRefGoogle Scholar
  29. 29.
    Patton MQ (2002) Qualitative research and evaluation methods. Sage, Thousand Oaks, CAGoogle Scholar
  30. 30.
    Silverman D (2001) Interpreting qualitative data: methods for analysing talk, text and interaction. Sage, LondonGoogle Scholar
  31. 31.
    Blignault I, Ponzio V, Rong Y, Eisenbruch M (2008) A qualitative study of barriers to mental health services utilisation among migrants from mainland China in South-East Sydney. Int J Soc Psychiatry 54:180–190PubMedCrossRefGoogle Scholar
  32. 32.
    Nedeau L, Measham T (2005) Immigrants and mental health services: increasing collaboration with other service providers. Can Child Adolesc Psychiatry Rev 14:73–76Google Scholar
  33. 33.
    Chen AW, Kazanjian A, Wong H (2009) Why do Chinese Canadians not consult mental health services: health status, language or culture? Transcult Psychiatry 46:623–641PubMedCrossRefGoogle Scholar
  34. 34.
    De Jong JTVM, Van Ommeren M (2005) Mental health services in a multicultural society: interculturalisation and its quality surveillance. Transcult Psychiatry 42:437–456PubMedCrossRefGoogle Scholar
  35. 35.
    Sue DW, Bingham RP, Porché-Burke L, Vasquez M (1999) The diversification of psychology: a multicultural revolution. Am Psychol 54:1061PubMedCrossRefGoogle Scholar
  36. 36.
    Palmer D (2007) Caught between inequality and stigma: the impact of psychosocial factors and stigma on the mental health of Somali forced migrants in the London borough of Camden. Divers Health Soc Care 4:177–192Google Scholar
  37. 37.
    Fenta H, Hyman I, Noh S (2006) Mental health service utilization by Ethiopian immigrants and refugees in Toronto. J Nerv Ment Disease 194:925–934CrossRefGoogle Scholar
  38. 38.
    Pumariega AJ, Rothe E, Pumariega JB (2005) Mental health of immigrants and refugees. Commun Ment Health J 41:581–597CrossRefGoogle Scholar
  39. 39.
    Farahi N, Nordholm L, Mattsson B, Hellström M (2010) Experiences of Kurdish war-wounded refugees in communication with Swedish authorities through interpreter. Patient Educ Couns 78:160–165CrossRefGoogle Scholar
  40. 40.
    Knipscheer JW, Kleber RJ (2004) The importance of ethnic similarity in the therapist-patient dyad among Surinamese migrants in Dutch mental health care. Psycholog Psychother 77:273–278CrossRefGoogle Scholar
  41. 41.
    Abbott MW, Wong S, Williams M, Au M, Young W (1998) Chinese migrants’ mental health and adjustment to life in New Zealand. Transcult Psychiatry 33:13–21Google Scholar
  42. 42.
    Syed HR, Dalgard OS, Dalen I, Claussen B, Hussain A, Selmer R, Ahlberg N (2006) Psychosocial factors and distress: a comparison between ethnic Norwegians and ethnic Pakistanis in Oslo, Norway. BMC Public Health 6:182PubMedCrossRefGoogle Scholar
  43. 43.
    Devillé W, Greacen T, Bogic M, Dauvrin M, Dias S, Gaddini A, Jensen NK, Karamanidou C, Kluge U, Mertaniemi R, Puigpinós i Riera R, Sarvary A, Soares JJF, Stankunas M, Straßmayr C, Wahlbeck K, Welbel M, Priebe S (2011) Health care for immigrants in Europe: is there still consensus among country experts about principles of good practice? A Delphi study. BMC Public Health 11:699PubMedCrossRefGoogle Scholar
  44. 44.
    Jensen NK, Norredam M, Draebel T, Bogic M, Priebe S, Krasnik A (2011) Providing medical care for undocumented migrants in Denmark: what are the challenges for health professionals? BMC Health Serv Res 11:154PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Sima Sandhu
    • 1
  • Neele V. Bjerre
    • 1
  • Marie Dauvrin
    • 2
  • Sónia Dias
    • 3
  • Andrea Gaddini
    • 4
  • Tim Greacen
    • 5
  • Elisabeth Ioannidis
    • 6
  • Ulrike Kluge
    • 7
  • Natasja K. Jensen
    • 8
  • Majda Lamkaddem
    • 9
  • Rosa Puigpinós i Riera
    • 10
  • Zsigmond Kósa
    • 11
  • Ulla Wihlman
    • 12
  • Mindaugas Stankunas
    • 13
    • 14
  • Christa Straßmayr
    • 15
  • Kristian Wahlbeck
    • 16
  • Marta Welbel
    • 17
  • Stefan Priebe
    • 1
  1. 1.Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Newham Centre for Mental HealthQueen Mary University of LondonLondonUK
  2. 2.Institute of Health and SocietyUniversité catholique de LouvainBrusselsBelgium
  3. 3.Institute of Hygiene and Tropical MedicineUniversidade Nova de LisboaLisbonPortugal
  4. 4.Public Health Agency for the Lazio RegionRomeItaly
  5. 5.Etablissement public de santé Maison BlancheParisFrance
  6. 6.Department of SociologyNational School of Public HealthAthensGreece
  7. 7.Clinic for Psychiatry and PsychotherapyCharité-University Medicine Berlin, CCMBerlinGermany
  8. 8.Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public HealthUniversity of CopenhagenCopenhagen KDenmark
  9. 9.Academic Medical Centre, Department of Public HealthUniversity of AmsterdamAmsterdamThe Netherlands
  10. 10.Agency of Public Health of BarcelonaBarcelonaSpain
  11. 11.Faculty of HealthUniversity of DebrecenNyíregyházaHungary
  12. 12.Department of Public Health Sciences, Section for Social MedicineKarolinska InstituteStockholmSweden
  13. 13.Department of Health ManagementLithuanian University of Health SciencesKaunasLithuania
  14. 14.School of Public HealthGriffith UniversitySouthportAustralia
  15. 15.Ludwig Boltzmann Institute for Social PsychiatryViennaAustria
  16. 16.Department for Mental Health and Substance Abuse ServicesNational Institute for Health and Welfare (THL)HelsinkiFinland
  17. 17.Institute of Psychiatry and NeurologyWarsawPoland

Personalised recommendations