Abstract
Refugees suffer from higher rates of certain mental health problems than non-refugee migrants and the native population of their host country. General practitioners (GPs) in Norway and many other European countries are the first contact person for settled refugees in need of non-emergency medical support. This includes psychiatric support, although GPs are not typically specialists in psychiatry. The aim of this study is to investigate how GPs experience working with refugees suffering from mental health problems, with a specific focus on perceived challenges and facilitators. We conducted semi-structured interviews with 15 GPs working in Norway (7 females). Participants ages ranged from 29 to 67 (M = 41.7 years, SD = 11.1) with work experience ranging from 2 to 39 years (M = 13.6 years, SD = 12.1). Interviews were analysed thematically using the qualitative data analysis computer software package NVivo 12. The main challenges presented by GPs relate to language barriers, mismatched expectations, different understandings of health and illness, and the GP feeling unprepared to work with this patient group. The main facilitating themes related to establishing trust and finding the work meaningful. The themes presented in this study highlight areas of interest for future research, and should inform training programmes to improve health care for both clinicians and refugee patients.
Highlights
General practitioners (GPs) experience a range of challenges that contribute to the perceived complexity of clinical consultations with refugees suffering from mental health problems
This study explored GPs’ perceived challenges and facilitators in clinical consultations with refugees suffering from mental health problems through individual semistructured interviews
Resulting themes are presented under the overarching headings ‘challenges’ and ‘facilitators,’ to indicate participants’ own opinions of whether the issue was a factor that helped or stood in the way of effective consultations
Summary
General practitioners (GPs) experience a range of challenges that contribute to the perceived complexity of clinical consultations with refugees suffering from mental health problems. Studies have suggested that refugees experience higher rates of certain mental health problems such as anxiety, depression (Lindert et al, 2009), and post-traumatic stress disorder (PTSD) than non-refugee migrants or the native population of their host country (Fazel et al, 2005) This may be the case for GP Consultations With Refugee Patients schizophrenia and other non-affective psychoses (Hollander et al, 2016). Clinicians have reported feeling they lack the resources or training to meet the demands placed on them by working with refugees suffering from mental health problems (Jensen et al, 2013; Wylie et al, 2018) This may be partly related to practical challenges such as language barriers, working with interpreters, patients’ illiteracy, and time constraints (Robertshaw et al, 2017). Health care professionals working with patients with a different cultural background have previously reported feelings of distress, overload, and exhaustion as a result of this work (Terraza-Nunez et al, 2011)
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