Barriers to access to outpatient mental health care for refugees and asylum seekers in Switzerland: the therapist’s view

Abstract

Background: More than 120,000 refugees and asylum seekers are currently living in Switzerland. The prevalence of mental disorders among this population is significantly higher than that in the general population. While effective treatment options and cross-cultural, specialized treatment centers exist, they tend to be overloaded by their target populations. General outpatient primary health care providers might be able to compensate for the lack of specialized treatment slots. To date, however, it is unknown how often and under what conditions (e.g., length of waiting lists) refugees and asylum seekers are treated outside of specialized centers and whether there are barriers that prevent providers in outpatient settings from treating more patients in this subgroup. The present study aimed to assess the challenges and barriers faced by psychiatrists and psychotherapists working in outpatient settings in Switzerland in treating refugees and asylum seekers to determine the potential capacity of this group to provide mental health care. Methods: An online survey was conducted during the winter of 2017/2018. The survey was constructed in three official languages and took 10-15 min to complete. Spearman's correlations, Mann-Whitney U-Tests, and Chisquared tests were conducted to analyze the data. Results: Eight hundred and sixty-seven (N = 867) psychotherapists and psychiatrists working in outpatient settings completed the survey: 43% of them reported having treated between 1 and 9 refugees or asylum seekers in the past 12 months, and a further 13% reported treating 10 or more. Interpreters were used for almost every other patient with a refugee or asylum-seeker background. At the same time, the funding of interpreters, as well as the funding of treatment in general, were reported to be the biggest hurdles to treating more refugees and asylum seekers. Conclusions: Given the low number of patients rejected for capacity reasons (between 2 and 5%) and the median waiting times for the admission of new patients ranging between 2 and 3 weeks, outpatient primary mental health care providers might treat more refugees and asylum seekers and relieve specialized treatment centers. However, barriers such as lack of funding of interpreters seem to hinder them. Appropriate steps by the authorities are needed to improve the current situation.

Experiences of psychotherapists working with refugees in Germany: a qualitative study

“…Respondents identified three main challenges: a mismatch between refugee clients’ expectations towards psychotherapy, and what they could realistically do for them; diverging belief systems as to the etiology of the clients’ problems; and communication barriers. This largely echoes the few existing studies on psychotherapists’ experiences [ 15 , 26 , 31 – 33 ]. In response to these challenges, respondents reported good experiences with spending time educating patients on the role and process of psychotherapy; with trying to understand, remaining open to, and actively utilizing resources aligned with the client’s belief system; and in part also with the use of translators, although almost half of the respondents preferred using non-verbal communication over the use of translators.…”

“…In contrast to the fairly elaborate literature on barriers in access to psychotherapy and on the general effectiveness of psychotherapy with refugees, little research has been done on how psychotherapists, who often are not specifically trained in working with refugee clients [ 28 ], experience the cross-cultural psychotherapeutic process, which we define as a therapeutic encounter between a psychotherapist and a client of different cultural backgrounds. The little available research highlights issues such as communication difficulties, differences in illness attribution belief systems, differences in expectations towards treatment, and issues related to trust as main challenges [ 15 , 26 , 31 – 33 ].…”

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

“…We did not find any single study on older refugees in Bangladesh and other countries to compare this finding with. However, existing studies conducted among younger Rohingya refugees in Bangladesh, 19 child refugees in England, 29 refugees and asylum seekers in Switzerland 30 and Syrian refugees in Germany 31 reported several barriers associated with refugees’ access to medicine and routine healthcare, including poor literacy of older refugees, 19 language and legal barriers and travel costs. 32 Furthermore, several studies indicated that limited long-term clinical care facilities for older individuals, limited/unavailability of medicines, inadequate knowledge about available services and healthcare system, inadequate ‘cultural competence of the healthcare providers, age-related self-stigma and financial constraints were the primary reasons that refugees experienced difficulties in accessing medical services.…”

Cultural adaptation of Hap-pas-Hapi, an internet and mobile-based intervention for the treatment of psychological distress among Albanian migrants in Switzerland and Germany

“…Although specialized mental health services are available in high-income countries, data from several studies have identified limited access of migrants to mental health care utilization. Findings indicate that structural and cultural factors (in particular immigrant status, economic status, language, reliance on family members for support, stigma, or varying assumptions about mental illness) may limit access to treatment ( Dow, 2011 ; Kayrouz et al, 2015b ; Kirmayer et al, 2007 ; Kiselev et al, 2020b , Kiselev et al, 2020a ; Ugarte Bustamante et al, 2020 ). But also in low- and middle-income countries there is growing interest in delivering psychological interventions to culturally diverse populations, in order to narrow the large treatment gap for common mental disorders ( Alonso et al, 2018 ; Bäärnhielm et al, 2017 ; Cuijpers et al, 2018 ; van't Hof et al, 2020 ).…”