Structural and socio-cultural barriers to accessing mental healthcare among Syrian refugees and asylum seekers in Switzerland

Abstract

Background: Due to their experiences of major stressful life events, including postdisplacement stressors, refugees and asylum seekers are vulnerable to developing mental health problems. Yet, despite the availability of specialized mental health services in Western European host countries, refugees and asylum seekers display low mental healthcare utilization. Objective: The aim of this study was to explore structural and socio-cultural barriers to accessing mental healthcare among Syrian refugees and asylum seekers in Switzerland. Method: In this qualitative study, key-informant (KI) interviews with Syrian refugees and asylum seekers, Swiss healthcare providers and other stakeholders (e.g. refugee coordinators or leaders) were conducted in the German-speaking part of Switzerland. Participants were recruited using snowball sampling. Interviews were audiotaped and transcribed, and then analysed using thematic analysis, combining deductive and inductive coding. Results: Findings show that Syrian refugees and asylum seekers face multiple structural and socio-cultural barriers, with socio-cultural barriers being perceived as more pronounced.Syrian key informants, healthcare providers, and other stakeholders identified language, gatekeeper-associated problems, lack of resources, lack of awareness, fear of stigma and a mismatch between the local health system and perceived needs of Syrian refugees and asylum seekers as key barriers to accessing care. Conclusions: The results show that for Syrian refugees and asylum seekers in Switzerland several barriers exist. This is in line with previous findings. A possible solution for the current situation might be to increase the agility of the service system in general and to improve the willingness to embrace innovative paths, rather than adapting mental healthcare services regarding single barriers and needs of a new target population.

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

“…and ¾ of asylum seekers are affected by severe communication difficulties between the patient and health care provider [39]. Frequently, family members or friends serve as lay-interpreters [40], leading to misunderstandings, keeping details secret, and wrong diagnoses [41][42][43].…”

“…However, further barriers, such as stigma of mental disorders and lack of information about mental health treatment, exist [4]. Finally, it was recently reported that specialized mental health treatment services for refugees and asylum seekers are overloaded across Switzerland [34,35,40]. This lack of capacity corresponds with long waitlists for specialized services [34,35,40].…”

“…Finally, it was recently reported that specialized mental health treatment services for refugees and asylum seekers are overloaded across Switzerland [34,35,40]. This lack of capacity corresponds with long waitlists for specialized services [34,35,40]. A recent study suggests that as a result of long waiting times, many refugees and asylum seekers coordinators do not attempt to refer patients to specialized mental health care centers [40].…”

Refugee and Migrant Children’s Mental Healthcare: Serving the Voiceless, Invisible, and the Vulnerable Global Citizens

“…Primary care physicians, pediatricians, and mental health providers can build trust through culturally competent and trauma-informed care, assess for healthcare needs, provide vaccination update and preventative care, and screen for mental health, communicable diseases, disabilities, and other medical health conditions thereby attending to the holistic needs of the vulnerable child and adolescent refugees. Refugee children are less likely to avail pertinent health and social care than non-refugee children peers [ 9 ]. Most host countries offer some kind of health screening for refugees, both child and adult, upon entering the country of destination [ 3 ].…”

“…Early and adequate cognitive, mental, and emotional support for parents suffering from behavioral disorders is thus a vital support for children. Refugees may hesitate to seek mental health help due to a culturally based stigma around mental health issues [ 9 ]. Family separation and parental death drives adolescents to take on parental roles for younger siblings.…”