How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

Abstract

BackgroundRefugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems.MethodsThe study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis.ResultsOne of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms.ConclusionGeneral practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this study suggest that the development of conversational models for general practitioners including points to be aware of in the treatment of refugee patients may serve as a support in the management of refugee patients in primary care.

Challenges of Refugee Health Care: Perspectives of Medical Interpreters, Case Managers, and Pharmacists

“…24,26 Clinicians frequently have very limited knowledge of a refugee's trauma history and mental health background, and no guidance on how to approach these patients. 27 Thus, establishing trust in these contexts requires time, quality interpretation, and provider education regarding their patients' past experiences and cultural background 12,28 and, as highlighted by Kaplan et al, is prerequisite for meeting needs of disadvantaged populations.…”

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries

“…Other structural barriers to access to mental health care for refugees in European health care systems may include gatekeeping mechanisms that mean that a referral from primary care professionals such as general practitioners (GPs) is required for access to most secondary care services (OECD/EU, 2016). The level and extent of training for primary care professionals in both mental and refugee health will influence care pathways and access to care (Jensen, Norredam, Priebe, & Krasnik, 2013). Even in countries with considerable mental health services, the lack of Arabic-speaking health providers and interpreter services often hinders access to appropriate mental health care.…”

Digital communication between clinician and patient and the impact on marginalised groups: a realist review in general practice

“…This was experienced by refugees and asylum seekers, and people with mental health problems. The barriers identified were language barriers affecting the appointment booking and consultation, [44][45][46][47][48][49][50][51][52][53][54][55][56] problematic access to professional interpreters, 44,[48][49][50]52,[57][58][59] confidentiality fears with both professional and informal interpreters, 44,49,58 and lack of discourse to describe mental health concerns. 60,61 Digital clinical communication will not change the ability of these disadvantaged groups in communicating with health professionals, with the exception being language translation.…”