Access to Refugee and Migrant Mental Health Care Services during the First Six Months of the COVID-19 Pandemic: A Canadian Refugee Clinician Survey

Abstract

The COVID-19 pandemic has had a major impact on the mental health of refugees and migrants. This study aimed to assess refugee clinician perspectives on mental health care during the COVID-19 pandemic, specifically access to and delivery of community mental health care services. We utilized a mixed methods design. We surveyed members of a national network of Canadian clinicians caring for refugees and migrants. Seventy-seven clinicians with experience caring for refugee populations, representing an 84% response rate, participated in the online survey, 11 of whom also participated in semi-structured interviews. We report three major themes: exacerbation of mental health issues and inequities in social determinants of health, and decreased access to integrated primary care and community migrant services. Clinicians reported major challenges delivering care during the first 6 months of the pandemic related to access to care and providing virtual care. Clinicians described perspectives on improving the management of refugee mental health, including increasing access to community resources and virtual care. The majority of clinicians reported that technology-assisted psychotherapy appears feasible to arrange, acceptable and may increase health equity for their refugee patients. However, major limitations of virtual care included technological barriers, communication and global mental health issues, and privacy concerns. In summary, the COVID-19 pandemic has exacerbated social and health inequities within refugee and migrant populations in Canada and challenged the way mental health care is traditionally delivered. However, the pandemic has provided new avenues for the delivery of care virtually, albeit not without additional and unique barriers.

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

“…A total of 53 articles met the inclusion criteria for analysis (Figure 1). Of the 53 articles selected, 37 analyzed changes in realized access applying quantitative methods , through the analysis of medical records (Table 1), 8 analyzed changes in potential access [83][84][85][86][87][88][89][90] via surveys of different population groups, except for one that did the same via analysis of medical records [90] (Table 2), 7 used qualitative methods to analyze the impact on potential access [91][92][93][94][95][96][97] (Table 3), and, finally, 1 study analyzed changes in both realized and potential access [98] using mixed methods (analysis of medical records and semi-structured interviews). Only six of the studies that explored changes in potential access included professionals from the health centers analyzed as a study population, [87,89,92,93,97,98], while the rest focused on patients or the general population.…”

“…With regard to the type of service, of the studies on realized access, 5 focused on health services in general [46][47][48][49][50]; 12 on emergencies [51][52][53][54][55][56][57][58][59][60][61][62] (of which 5 were related to pediatric emergencies [56][57][58]60,61]); 15 on secondary care (SC) (outpatient visits, hospital admissions, etc., for nephrology [63], oncology [64,65], pediatrics [66], psychiatry [67,68], rehabilitation [69], respiratory diseases [70], sexual and reproductive health (SRH) [71,[73][74][75], and traumatology [78,79]); two on primary care (PC) [80,81]; one on preventive services [82]. Of the studies on potential access, 1 focused on health services in general [91], 13 on SC (endocrinology [83], rare diseases [86], pediatrics [84], psychiatry [85], SRH …”

“…In terms of geographical area, 19 studies were conducted in European countries [47,51,53,55,57,62,64,[67][68][69][70]75,79,83,84,88,90,92,95], 9 in North American countries [49,58,59,77,78,80,82,85,86], 9 in Sub-Saharan Africa [46,48,71,72,76,87,93,94,98], 3 in Latin America [60,91,96], 5 in the East Asia-Pacific region [50,56,61,66,81], 3 in South Asia [63,65,74], 2 in the North Africa-Middle East region [52], and, lastly, 3 studies covered various regions…”

Difficulties faced by older Rohingya (forcibly displaced Myanmar nationals) adults in accessing medical services amid the COVID-19 pandemic in Bangladesh

“… 39 Our study’s finding broadly corroborates a study carried out among Syrian refugees in Turkey, which indicates that refugees with depression and anxiety were likely to experience difficulties accessing sufficient healthcare services. 40 Older Rohingya adults’ feeling of loneliness may be due to the challenges the COVID-19 pandemic brought to refugees, including lockdowns, self-isolation/quarantine, 36 limited social networks, inadequate connection with family members and limited social and psychological support. 41–43 Moreover, stigma, racism and discrimination are postulated to increase loneliness in refugees worldwide.…”

“… 41–43 Moreover, stigma, racism and discrimination are postulated to increase loneliness in refugees worldwide. 36 42 44 Therefore, it is vital to strengthen the measures to improve the communication between people within the camps as well as with people beyond the camps.…”