Ten years of tracking mental health in refugee primary health care settings: an updated analysis of data from UNHCR’s Health Information System (2009–2018)

Abstract

Background This study examines mental, neurological, and substance use (MNS) service usage within refugee camp primary health care facilities in low- and middle-income countries (LMICs) by analyzing surveillance data from the United Nations High Commissioner for Refugees Health Information System (HIS). Such information is crucial for efforts to strengthen MNS services in primary health care settings for refugees in LMICs. Methods Data on 744,036 MNS visits were collected from 175 refugee camps across 24 countries between 2009 and 2018. The HIS documented primary health care visits for seven MNS categories: epilepsy/seizures, alcohol/substance use disorders, mental retardation/intellectual disability, psychotic disorders, severe emotional disorders, medically unexplained somatic complaints, and other psychological complaints. Combined data were stratified by 2-year period, country, sex, and age group. These data were then integrated with camp population data to generate MNS service utilization rates, calculated as MNS visits per 1000 persons per month. Results MNS service utilization rates remained broadly consistent throughout the 10-year period, with rates across all camps hovering around 2–3 visits per 1000 persons per month. The largest proportion of MNS visits were attributable to epilepsy/seizures (44.4%) and psychotic disorders (21.8%). There were wide variations in MNS service utilization rates and few consistent patterns over time at the country level. Across the 10 years, females had higher MNS service utilization rates than males, and rates were lower among children under five compared to those five and older. Conclusions Despite increased efforts to integrate MNS services into refugee primary health care settings over the past 10 years, there does not appear to be an increase in overall service utilization rates for MNS disorders within these settings. Healthcare service utilization rates are particularly low for common mental disorders such as depression, anxiety, post-traumatic stress disorder, and substance use. This may be related to different health-seeking behaviors for these disorders and because psychological services are often offered outside of formal health settings and consequently do not report to the HIS. Sustained and equitable investment to improve identification and holistic management of MNS disorders in refugee settings should remain a priority.

“Of course, you get depression in this situation”: Explanatory Models (EMs) among Afghan refugees in camps in Northern Greece

“…In line with previous research [ 68 ] the interviews with females showed scepticism toward mental health professionals unfamiliar with their background. This might illuminate recent research showing that healthcare service utilization rates among refugees in camps are particularly low for common mental disorders [ 11 ]. Nonetheless, more females than males mentioned mental health care services as help seeking source for psychological distress.…”

“…Health systems in camps must manage a wide range of mental, neurological and substance use problems [ 8 ]. While access to health services may often be limited, cultural variations in explanations of illnesses and preferred coping strategies and help-seeking paths may also constitute significant barriers to providing mental health services to refugees [ 9 – 11 ]. As Rasmussen, Katoni [ 12 ] point out, to treat, one must communicate, and to communicate well, one must understand the local explanatory models (EMs).…”

Mental health services should acknowledge and respect refugee social and cultural values to increase update/use

“…Fine et al ’s retrospective analysis4 examines the extent to which mental health (particularly mental, neurological and substance use (MNS)) service utilisation has changed over the 10-year analysis period. The analysis included data from 175 refugee camps in 24 countries, where the number of MNS visits was compared with camp population, in relation to gender, age group and country.…”

A Minimum Service Package (MSP) to improve response to mental health and psychosocial needs in emergency situations

“…Over the years, attention to mental health and psychosocial support in emergencies has grown remarkably 4 . Mental health has now become a routine part of primary health care interven tions in humanitarian settings 5 . The accumulation of evidence around a suite of brief scalable psychological interventions tai lored to the needs of people affected by emergencies has fueled optimism that we can effectively treat common mental health conditions with relatively modest means 6,7 .…”

“…Social determinants of health include not only individual characteristics (e.g., income, highest completed edu cation) but also structural determinants and social arrangements (e.g., class location). Recent studies suggest that important rela tionships between genetic risk and social context may be present even at the neighborhood level (e.g., collective efficacy) 5 , and the influence of sociocultural context is likely to be greater at higher levels (e.g., racialized minority vs. dominant majority; nations with plentiful vs. scarce resources). Consequently, GWEIS limited to the narrow range captured by standard biological measures of the "exposome" will also be rather uninformative in this regard.…”