Implementing a Need-Adapted Stepped-Care Model for Mental Health of Refugees: Preliminary Data of the State-Funded Project “RefuKey”

Abstract

Introduction: Refugees have been shown to be a rather vulnerable population with increased psychiatric morbidity and lack of access to adequate mental health care. By expanding regional psychosocial and psychiatric-psychotherapeutic care structures and adapting psychiatric routine care to refugees’ needs, the state-funded project “refuKey” based in Lower Saxony, Germany, pursues to ease access to mental health care and increase service quality for refugees. A stepped-care treatment model along with intercultural opening of mental health care services is proposed. Methods: The project is subject to a four-part evaluation study. The first part investigates the state of psychiatric routine care for refugees in Lower Saxony by requesting data from all psychiatric clinics, participating and non-participating ones, regarding the numbers of refugee patients, their diagnoses, settings of treatment, etc. The second part explores experiences and work satisfaction of mental health care professionals treating refugees in refuKey cooperation clinics. The third part consists of interviews and focus group discussions with experts regarding challenges in mental health care of refugees and expectations for improvement through refuKey. The fourth part compares mental health parameters like depression, anxiety, traumatization, somatization, psychoticism, quality of life, as well as “pathways-to-care” of refuKey-treated refugees before and after treatment and, in a follow-up, to a non-refuKey-treated refugee control group. Results: RefuKey-treated refugees reported many mental health problems and estimated their mental health burden as high. The symptoms decreased significantly over the course of treatment. Mental health in the refuKey sample was strongly linked to post-migration stressors. Discussion: The state of mental health care for refugees is discussed. Implications for the improvement and the need for adaptation of routine mental health care services are drawn.

Systematic review of factors associated with quality of life of asylum seekers and refugees in high-income countries

“…● Non-significant correlation reported between overall QoL and unemployment Regression model ● Posttraumatic stress symptoms did not significantly predict any of the four domains of QoL ● Gender did not significantly predict physical, psychological or social QoL. ● Depressive symptoms did not significantly predict physical QoL ● Posttraumatic growth did not significantly predict social QoL ● Unemployment did not significantly predict physical, psychological or social QoL Trilesnik et al [ 38 ] Germany Not specified 133 Refugees Cross-sectional Psychosocial counseling centers WHOQOL-BREF WEMWBS, HSCL-25, HTQ, SCL-90, PMLDC, ● Post-migration living difficulties and overall WHOQOL ( r = −.54, p < .001) ● No significant difference between post-treatment and pre-treatment levels of well-being. Von Lersner et al [ 39 ] Germany Bosnia, Serbia, Kosovo, Iraq, Turkey 100 Refugees (Stayers vs.returnees) Cross-sectional Refugee centres, language schools and doctors’ offices.…”

“…Firstly, sample size justification (i.e. power calculation) was only reported by one study [38]. Five studies were unclear regarding sample selection, and one study was unclear regarding taking the sample frame from an appropriate population base [24].…”

“…The two biggest limitations were that all studies lacked statistical precision (e.g. failing to state the confidence Table 2 Quality assessment of the included cross-sectional studies using the AXIS tool [38], 17 = Von Lersner et al [39] Quality met Quality not met Unclear intervals or effect size), and the results cannot be applied to the local population as studies were conducted on very specific samples. There was a shortage of detail regarding follow-up assessmentsthree studies did not provide enough information on non-responders [18,20,33].…”

“…Three of the environmental predictors that were investigated predicted low oQoL; prior mission/residence in a war zone [27], being sick without access to healthcare and long asylum procedures [25,30]. Post-migration living difficulties negatively correlated with oQoL [38]. Similarly, one study found that North Korean refugees resettled in South Korea vs. those resettled in Japan had higher QoL, which the authors interpreted as being due to difficulties adapting to a new culture [31].…”

Gender-Sensitive Peer Counselling Groups in Times of Conflict Reflections on a Self-Help Support Group in Berlin

“…The world currently witnesses a stark increase of refugees who have fled their countries because of war, poverty and persecution (Trilesnik et al, 2019).…”