THE EFFECT OF MANDATORY PROLONGED DETENTION ON THE MENTAL HEALTH OF ASYLUM SEEKERS AND REFUGEES

2016 ◽  
Vol 3 (2) ◽  
pp. 188 ◽  
2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Costa ◽  
L Biddle ◽  
C Mühling ◽  
K Bozorgmehr

Abstract Background Changes in the subjective social status (SSS) of migrants, specifically between the pre- and post-migratory movement, can be a relevant determinant of their mental health condition. This study analyzed the effect of downward subjective social mobility to the mental health of asylum seekers and refugees (ASR) in Germany. Methods Through a random sampling procedure, 560 adult ASR (18+ years) were recruited across 58 collective accommodation centers in Germanys' 3rd largest state (2018). SSS was assessed with the MacArthur social ladder (10-rungs), in reference to the participants' position in the country of origin and in Germany. Quality of Life (QoL, measured with EUROHIS-QOL), anxiety (General Anxiety Disorder-2) and depressive symptoms (Patient Health Questionnaire-2), were considered as mental health outcomes. Generalized linear regression models were fitted to measure associations between changes in SSS and each outcome. Results A loss of 3 or more steps in SSS from origin to Germany (compared to no-change) was significantly associated with poorer scores in QoL (B, standardized coefficient= -2.679, standard error, se = 1.351, p = 0.047), with more symptoms of depression (B = 1.156, se = 0.389, p = 0.003) and anxiety (B = 0.971, se = 0.432, p = 0.025), in models adjusted for SSS in the country of origin. The strength and direction of associations was unaltered after further adjusting for sex, age, educational level and time since arrival, although the coefficient for QoL was non-significant for those declaring a 3-step downward mobility (B= -2.494, se = 1.351, p = 0.066 for QoL; B = 1.048, se = 0.393, p = 0.008 for depression; and B = 1.006, se = 0.438, p = 0.022 for anxiety). Discussion The results suggest that interventions should focus on those experiencing social downward mobility and not only prioritize individuals with low social status. Early integration efforts and intersectoral measures to counter social downward mobility could prevent poor mental health among ASR. Key messages We analysed the impact to the quality of life and mental health of asylum seekers and refugees, of a change in subjective social status from country of origin to Germany. Asylum seekers and refugees residing in Germany, who perceived a downward social status mobility following their migration process, are at risk for poorer mental health.


Author(s):  
Rachel Tribe ◽  
Angelina Jalonen

This chapter reviews the socio-political environment and legal factors that provide the context and influence the lived experience of many refugees and asylum seekers. These factors are considered in relation to flight, arrival, and settlement in a new country. How these contextual factors may impact upon refugees and asylum seekers, their sense of identity, and mental health will be reviewed. The chapter reflects upon the possible challenges faced by many refugees and asylum seekers, as well as arguing that the strengths, resilience, and coping strategies that many asylum seekers and refugees exhibit need to be adequately considered by clinicians, if a meaningful service is to be provided. The importance of clinicians being culturally curious and listening to service users’ meaning-making is vital. An overview of some other issues that clinicians may need to consider is provided. The chapter contains a number of case studies to illustrate the related issues.


Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Matthias Knefel ◽  
Viktoria Kantor ◽  
Andrew A. Nicholson ◽  
Jennifer Schiess-Jokanovic ◽  
Dina Weindl ◽  
...  

Abstract Background Asylum seekers and refugees are at great risk for developing mental disorders. Afghan refugees are a particularly vulnerable group with a low average education and mental health literacy level. Traumatic experiences and hardship before and during migration are predictive of mental health problems. However, post-migration living difficulties (PMLDs) also account for a large proportion of mental distress in such populations, which, critically, are not sufficiently considered in treatment protocols and research investigations. Indeed, the evidence base for the treatment of refugees and asylum seekers is sparse and limited mainly to trauma-specific treatments, where refugees may likely suffer from other mental health problems such as depression or anxiety. Methods/design This trial is the first evaluation of a short-term, transdiagnostic treatment protocol for treatment-seeking Afghan refugees which addresses mental health problems and PMLDs while using an adapted version of the Problem Management Plus (PM+) protocol. Here, we will investigate the efficacy of an intervention manual with a prospective, single-center, randomized, assessor-blind, two-group trial among refugees who are on a waiting list for professional mental health treatment. Furthermore, we will investigate participants’ subjective experiences with the intervention manual via in-depth interviews. One hundred twenty people will be assessed and randomly allocated to either the intervention arm or a treatment-as-usual arm. Clinical psychologists will conduct the treatment, and the sessions will take place with a Dari interpreter. The protocol consists of six 90-min sessions. The primary endpoint is the general symptom distress measure, assessed with the General Health Questionnaire 28 (GHQ-28). Secondary endpoints are the Post-Migration Living Difficulties Checklist (PMLDC), the International Trauma Questionnaire (ITQ), the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), the Psychological Outcome Profile (PSYCHLOPS), service and health care use (assessed with several items), and the Immigrant Integration Index (IPL-12). Discussion This trial may provide substantial evidence for a brief transdiagnostic psychological intervention. Here, we intend to contribute to the treatment of mental health problems among Afghan refugees. The assessment of subjective experience with this treatment manual, as well as the evaluation of its clinical applicability, may optimize treatment acceptance and outcomes across a wide range of mental health problems among refugees. Trial registration German Clinical Trials Register (DRKS) registration number: DRKS00016538. Universal Trial Number: U1111-1226-3285. Registered on January 7, 2019. https://www.drks.de/drks_web/setLocale_EN.do


2016 ◽  
Vol 13 (2) ◽  
pp. 30-32 ◽  
Author(s):  
Piyal Sen

Global events like wars and natural disasters have led to the refugee population reaching numbers not seen since the Second World War. Attitudes to asylum have hardened, with the potential to compromise the mental health needs of asylum seekers and refugees. The challenges in providing mental healthcare for asylum seekers and refugees include working with the uncertainties of immigration status and cultural differences. Ways to meet the challenges include cultural competency training, availability of interpreters and cultural brokers as well as appropriately adapting modes of therapy. Service delivery should support adjustment to life in a foreign country. Never has the need been greater for psychiatrists to play a leadership role in the area.


Author(s):  
Domenico Giacco

Abstract Aims High heterogeneity was found in the prevalence rates of mental disorders in adult asylum seekers and refugees in high-income countries. This may be related to different problems. Among them, there is a changing exposure to risk and protective factors for mental health at different phases of these people's life before migration, and during the migratory journey and resettlement. This study aimed at identifying and distinguishing time points in which distinct risk and protective factors for the mental health of asylum seekers and refugees may occur. Methods Systematic review and narrative synthesis. A systematic search was carried out for the period January 2017–August 2019, given the existence of systematic reviews of the evidence up to January 2017. Results Two hundred and fifty-two studies were identified with our search and 31 studies were included. The critical time points identified are: (a) before the travel; (b) during the travel; (c) at initial settlement in the host country; (d) when attempting to integrate in the host country; (e) when the immigration status is challenged or revoked. Some factors such as sense of belonging in the host country can be risk factors or protective factors depending on the time point. Conclusions These five critical time points can guide the development and selection of well-timed preventive and treatment interventions. They could also be used to stratify samples in epidemiological studies and meta-analyses. At present, we know much more on risk factors than on protective factors. Knowing more about protective factors may inform the development of interventions to foster them.


2016 ◽  
Vol 3 ◽  
Author(s):  
S. M. Doherty ◽  
R. Craig ◽  
M. Gardani ◽  
T. M. McMillan

Objective.Individuals who seek asylum are frequently fleeing violent persecution and may experience head injury (HI). However, little is known about the prevalence of HI in asylum seekers and refugees (ASR) despite the potential for HI to significantly affect cognitive and emotional functioning and to compromise asylum outcomes. This preliminary study investigates the prevalence of HI in ASR referred to a complex psychological trauma service.Method.Participants were 115 adult ASR referred to a community psychological trauma service with moderate to severe mental health problems associated with psychological trauma. They were screened for a history of HI using a questionnaire developed for the study. Interpreters were used when required.Results.The overall prevalence of HI was 51%. At least 38% of those with HI had a moderate–severe HI that could cause persisting disability. In 53% of those with HI, the cause was torture, human trafficking or domestic violence. Repeat HI can have cumulative effects on function; it was common, and was reported in 68% of those with HI. An injury to the head was not known to mental health clinicians prior to screening in 64% of cases.Conclusion.The emotional and cognitive consequences of HI in ASR may increase the vulnerability of this disadvantaged group, and can be associated with neurobehavioural problems affecting daily life and may compromise asylum outcomes. Routine screening for HI in ASR is needed, as are links to neuropsychology and brain injury services for advice, assessment and intervention.


2011 ◽  
Vol 26 (S2) ◽  
pp. 452-452
Author(s):  
A. Datta ◽  
J. Frewen

IntroductionAsylum seekers and refugees (ASR) are commonly portrayed as opportunists who came to Ireland to fraudulently scrounge off the Irish public. Such views and the consequent exclusion and discrimination they experience can aggravate their mental health risks and reduce their willingness to seek professional help.ObjectivesTo identify the mental health risks faced by ASR and outline specific measures to improve their situation.AimsThrough available hardcopy and online literature1/Assess and evaluate impact of asylum seeking and refugee integration process on ASR psychiatric problems in Ireland.2/Assess and evaluate knowledge and understanding of ASR mental health status; effects of segregation from local communities due to living in isolated ‘centres’ and no employment entitlement; communication and cultural integration difficulties; impact of exclusion and/or (racial) discrimination; apprehension of alien mental health system and treatment process; differing outcome expectations held by ASR and mental health specialists; and fear of being stigmatised by peers.MethodsRigorous review of relevant and applicable hardcopy and internet literature in English language since 2000.ResultsASR mental health problems associated are generally multi-dimensional. In addition to ‘normal’ stresses, many ASR are haunted by past hardships, experience exclusion and integration difficulties and endure a highly stressful asylum process.ConclusionASR require additional, specifically targeted mental health assistance and services that respect and understand their particular needs. Mental health services should work with the asylum process and other relevant socio-economic sectors to develop programmes to tackle potential ASR mental health concerns.


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