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Published in: Social Psychiatry and Psychiatric Epidemiology 1/2013

01-01-2013 | Original Paper

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

Authors: 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

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 1/2013

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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.
Literature
2.
go back to reference Lindert J, Schouler-Ocak M, Heinz A, Priebe S (2008) Mental health, health care utilisation of migrants in Europe. Eur Psychiatry 23:14–20PubMedCrossRef Lindert J, Schouler-Ocak M, Heinz A, Priebe S (2008) Mental health, health care utilisation of migrants in Europe. Eur Psychiatry 23:14–20PubMedCrossRef
3.
go back to reference Norredam M, Nielsen SS, Krasnik A (2009) Migrant utilization of somatic healthcare services in Europe: a systematic review. Eur J Pub Health 20:555–563CrossRef Norredam M, Nielsen SS, Krasnik A (2009) Migrant utilization of somatic healthcare services in Europe: a systematic review. Eur J Pub Health 20:555–563CrossRef
5.
go back to reference Karl-Trummer U, Novak-Zezula S, Metzler B (2010) Access to health care for undocumented migrants in the EU. Eurohealth 16:13–16 Karl-Trummer U, Novak-Zezula S, Metzler B (2010) Access to health care for undocumented migrants in the EU. Eurohealth 16:13–16
6.
go back to reference Bhugra D, Jones P (2001) Migration and mental illness. Adv Psychiatr Treat 7:216–222CrossRef Bhugra D, Jones P (2001) Migration and mental illness. Adv Psychiatr Treat 7:216–222CrossRef
7.
go back to reference 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 1:13PubMedCrossRef 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 1:13PubMedCrossRef
8.
go back to reference Dalgard OS, Thapa SB (2007) Immigration, social integration and mental health in Norway, with focus on gender differences. Clin Pract Epidemiol Ment Health 3:24PubMedCrossRef Dalgard OS, Thapa SB (2007) Immigration, social integration and mental health in Norway, with focus on gender differences. Clin Pract Epidemiol Ment Health 3:24PubMedCrossRef
9.
go back to reference Eisenbruch M (1991) From post-traumatic stress disorder to cultural bereavement: diagnosis of Southeast Asian refugees. Soc Sci Med 33:673–680PubMedCrossRef Eisenbruch M (1991) From post-traumatic stress disorder to cultural bereavement: diagnosis of Southeast Asian refugees. Soc Sci Med 33:673–680PubMedCrossRef
10.
go back to reference 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 43:121–131PubMedCrossRef 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 43:121–131PubMedCrossRef
11.
go back to reference Caldwell-Harris CL, Ayçiçegi A (2006) When personality and culture clash: the psychological distress of allocentrics in a collectivist culture. Transcult Psychiatry 43:331–361PubMedCrossRef Caldwell-Harris CL, Ayçiçegi A (2006) When personality and culture clash: the psychological distress of allocentrics in a collectivist culture. Transcult Psychiatry 43:331–361PubMedCrossRef
12.
go back to reference 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, Luxembourg 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, Luxembourg
13.
go back to reference Wanner P (2002) Migration trends in Europe. European population papers series no. 7, council of Europe, Strasbourg Wanner P (2002) Migration trends in Europe. European population papers series no. 7, council of Europe, Strasbourg
14.
go back to reference Sipavicieno A, Kanopiene V (1999) Foreign labour in Lithuania: immigration, employment and illegal work. International Migration Papers, Geneva Sipavicieno A, Kanopiene V (1999) Foreign labour in Lithuania: immigration, employment and illegal work. International Migration Papers, Geneva
15.
go back to reference 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, Budapest 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, Budapest
16.
go back to reference Eurostat and DG EMPL (2010) Commission staff working report: demographic report. European Commission, Brussels Eurostat and DG EMPL (2010) Commission staff working report: demographic report. European Commission, Brussels
17.
go back to reference 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 CT 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 CT
18.
go back to reference 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 31:815–825PubMedCrossRef 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 31:815–825PubMedCrossRef
19.
go back to reference 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 9:307PubMedCrossRef 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 9:307PubMedCrossRef
20.
go back to reference Knipscheer JW, Kleber RJ (2001) Help-seeking attitudes and utilization patterns for mental health problems of Surinamese migrants in the Netherlands. J Cons Psychol 48:28–38CrossRef Knipscheer JW, Kleber RJ (2001) Help-seeking attitudes and utilization patterns for mental health problems of Surinamese migrants in the Netherlands. J Cons Psychol 48:28–38CrossRef
21.
go back to reference 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 44:188–197PubMedCrossRef 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 44:188–197PubMedCrossRef
22.
go back to reference 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 63:766–772 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 63:766–772
23.
go back to reference Monteiro AP (2009) Stress vulnerability and mental health in Eastern Europe immigrants in Portugal. Eur Psychiatry 24:S1256CrossRef Monteiro AP (2009) Stress vulnerability and mental health in Eastern Europe immigrants in Portugal. Eur Psychiatry 24:S1256CrossRef
24.
go back to reference 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 13:371–378PubMedCrossRef 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 13:371–378PubMedCrossRef
25.
go back to reference 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 56:74–93PubMedCrossRef 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 56:74–93PubMedCrossRef
26.
go back to reference 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 11:187 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 11:187
27.
go back to reference 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, Maidenhead 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, Maidenhead
28.
go back to reference Hsieh HF, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15:1277–1288PubMedCrossRef Hsieh HF, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15:1277–1288PubMedCrossRef
29.
go back to reference Patton MQ (2002) Qualitative research and evaluation methods. Sage, Thousand Oaks, CA Patton MQ (2002) Qualitative research and evaluation methods. Sage, Thousand Oaks, CA
30.
go back to reference Silverman D (2001) Interpreting qualitative data: methods for analysing talk, text and interaction. Sage, London Silverman D (2001) Interpreting qualitative data: methods for analysing talk, text and interaction. Sage, London
31.
go back to reference 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 54:180–190PubMedCrossRef 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 54:180–190PubMedCrossRef
32.
go back to reference Nedeau L, Measham T (2005) Immigrants and mental health services: increasing collaboration with other service providers. Can Child Adolesc Psychiatry Rev 14:73–76 Nedeau L, Measham T (2005) Immigrants and mental health services: increasing collaboration with other service providers. Can Child Adolesc Psychiatry Rev 14:73–76
33.
go back to reference Chen AW, Kazanjian A, Wong H (2009) Why do Chinese Canadians not consult mental health services: health status, language or culture? Transcult Psychiatry 46:623–641PubMedCrossRef Chen AW, Kazanjian A, Wong H (2009) Why do Chinese Canadians not consult mental health services: health status, language or culture? Transcult Psychiatry 46:623–641PubMedCrossRef
34.
go back to reference De Jong JTVM, Van Ommeren M (2005) Mental health services in a multicultural society: interculturalisation and its quality surveillance. Transcult Psychiatry 42:437–456PubMedCrossRef De Jong JTVM, Van Ommeren M (2005) Mental health services in a multicultural society: interculturalisation and its quality surveillance. Transcult Psychiatry 42:437–456PubMedCrossRef
35.
go back to reference Sue DW, Bingham RP, Porché-Burke L, Vasquez M (1999) The diversification of psychology: a multicultural revolution. Am Psychol 54:1061PubMedCrossRef Sue DW, Bingham RP, Porché-Burke L, Vasquez M (1999) The diversification of psychology: a multicultural revolution. Am Psychol 54:1061PubMedCrossRef
36.
go back to reference 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 4:177–192 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 4:177–192
37.
go back to reference Fenta H, Hyman I, Noh S (2006) Mental health service utilization by Ethiopian immigrants and refugees in Toronto. J Nerv Ment Disease 194:925–934CrossRef Fenta H, Hyman I, Noh S (2006) Mental health service utilization by Ethiopian immigrants and refugees in Toronto. J Nerv Ment Disease 194:925–934CrossRef
38.
go back to reference Pumariega AJ, Rothe E, Pumariega JB (2005) Mental health of immigrants and refugees. Commun Ment Health J 41:581–597CrossRef Pumariega AJ, Rothe E, Pumariega JB (2005) Mental health of immigrants and refugees. Commun Ment Health J 41:581–597CrossRef
39.
go back to reference 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 78:160–165CrossRef 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 78:160–165CrossRef
40.
go back to reference 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 77:273–278CrossRef 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 77:273–278CrossRef
41.
go back to reference Abbott MW, Wong S, Williams M, Au M, Young W (1998) Chinese migrants’ mental health and adjustment to life in New Zealand. Transcult Psychiatry 33:13–21 Abbott MW, Wong S, Williams M, Au M, Young W (1998) Chinese migrants’ mental health and adjustment to life in New Zealand. Transcult Psychiatry 33:13–21
42.
go back to reference 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 6:182PubMedCrossRef 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 6:182PubMedCrossRef
43.
go back to reference 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 11:699PubMedCrossRef 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 11:699PubMedCrossRef
44.
go back to reference 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 11:154PubMedCrossRef 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 11:154PubMedCrossRef
Metadata
Title
Experiences with treating immigrants: a qualitative study in mental health services across 16 European countries
Authors
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
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 1/2013
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-012-0528-3

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