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.
Highlights
Refugees have been shown to be a rather vulnerable population with increased psychiatric morbidity and lack of access to adequate mental health care
The study’s objective is to evaluate the efficacy of the project by answering the following three questions: First, do refugees have better access to mental health care as a result of the project? Better access is defined by an increase in the number of refugee patients treated in participating psychiatric clinics and psychosocial counseling centers (PCCs) as well as an increase in referrals between these institutions
Is there a decrease in re-hospitalization rates of refugees in participating psychiatric clinics, as well as a significant improvement of the mental state of refuKey-treated refugees as compared to nonrefuKey-treated refugees? Third, is there a decrease of work-related strain in mental health care professionals working with refugees over the course of the project in participating psychiatric clinics?
Summary
Refugees have been shown to be a rather vulnerable population with increased psychiatric morbidity and lack of access to adequate mental health care. Several studies have shown an elevated risk for mental disorders in samples of refugees [3,4,5]. A recent meta-analysis on refugee mental health reported increased prevalence rates for posttraumatic stress disorder (PTSD; 4.4–86%), depression (2.3–80%), and anxiety disorders (20.3–88%) [3]. Compared to studies with small sample sizes, studies of higher methodological quality with large sample sizes generally report lower prevalence rates of mental disorders in refugees [3, 4]. Even though prevalence rates should be interpreted with caution due to the heterogeneity of study designs and sample characteristics, there is evidence that refugees constitute a vulnerable population with about 10 times increased risk of PTSD in comparison to the host countries’ native population [e.g., Refs. Recent studies further report that risk of developing psychotic disorders is higher for refugees than non-refugee migrants [7, 8]
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