Mental health, public health and migration
Migration has been a much-discussed issue in recent years, and the rapid growth in numbers of migrants arriving in Europe has necessitated a humanitarian response and put pressure on health systems. Mental health is a key issue for migrants, and is likely to be a long-term feature of health care provision in Europe.
Violation of human rights, persecution and conflict are behind the migration of an increasing proportion of the 77 million international migrants estimated to live in the WHO European Region. A new Health Evidence Network (HEN) report addresses the need to identify good practice for mental health care for these individuals. Entitled “Public health aspects of mental health among migrants and refugees: a review of the evidence on mental health care for refugees, asylum seekers and irregular migrants in the WHO European Region”, the report aims to provide a helpful analysis of available evidence, taking into account research in English and Russian from 69 papers.
Refugees, asylum seekers and irregular migrants encounter risk factors for developing mental disorders before, during and after migration. Before migration they may have been exposed to persecution, traumatic conflict experiences and economic hardship. During migration they may experience physical harm and separation from family members. After migration they may face uncertainty about asylum applications and detention. Factors such as social isolation and unemployment are also associated with poor mental health outcomes.
Do refugees, asylum seekers and irregular migrants suffer a higher prevalence of mental disorders?
Studies reveal a variable prevalence of mental disorders among refugees, asylum seekers and irregular migrants, and individual groups show different characteristics and risk factors. Evidence also demonstrates that some host countries provide more social support and mental health provision than others.
Many mental health disorders occur at similar rates among migrants as they do among host country populations. One exception to this is post-traumatic stress disorder, which migrants experience more often. The prevalence of depression among refugees 5 or more years after resettlement is also higher than that of host populations, and is mainly due to adverse socioeconomic conditions after migration. A study in Sweden found a higher incidence of psychotic disorders in refugees compared with non-refugee migrants and the host population.
Refugees, asylum seekers and irregular migrants all encounter barriers to accessing mental health care. These barriers can be factors such as lack of trust in authorities, differing cultural expectations and poor command of the host-country language. Good practice can overcome barriers by supporting integration, providing outreach services and ensuring that mental health care is integrated with other health provision. Training health care professionals in cultural sensitivity and increasing their awareness of care entitlements can have positive effects, as can providing patients with information on their care entitlement.
Considerations for policy-makers
Policy-makers can strengthen or introduce specific policies regarding mental health care for migrant groups by:
- promoting social integration;
- improving mental health outreach services;
- ensuring strong, uncomplicated links between different health and social services;
- providing information on health care entitlements;
- ensuring sensitivity training for professionals; and
- providing the means to overcome language barriers.