Position statement Euromed Network on Mental Health and Migration

Abstract

Introduction/contextMigration is one of the most important challenges ofthe XXIst century. Europe in particular has seen a dra-matic rise in migration over the past decade, and allindications suggest that this increase will continue wellinto the future.It is becoming increasingly clear that the mentalhealth needs of migrants require specific attention.Recent reports indicate that migrants are underrepre-sented in mental health care centers, are subject tomore diagnostic error, more coercive measures andinvoluntary treatment, less psychotherapy and less sec-ond generation medication [1,2]. The specific relation-ship between migration and mental health remainsunclear, although a number of protective and risk fac-tors have been identified [3]. What would appear to beclear is that there is a robust relationship betweenmigration and schizophrenia, with odds rations varyingfrom 2 to 8 for individuals from the European commu-nity for the former and Afrocaribbean migrants for thelatter [4]. In addition, research indicates that the chil-dren of immigrants-second generation citizens-also havehigher odds ratios for the development of psychotic andaffective disorders.All of this has implications for psychology and psy-chiatry as a whole. The field of transcultural psychiatryovertly emphasizes the biopsychosocial model: thatmigration overwhelmingly impacts the incidence of schi-zophrenia emphasizes that experience itself, and notsimply biological structure or genetics is involved. Diffi-culties with diagnosis demand reconsideration of exist-ing nosological systems, as reflected, for example, inthe pathway towards the DSM-V and the ICD-11,and treatment issues, be they psychotherapeutic orpharmacological indicate that treatments may need tobe adapted given the cultural and/or ethnic backgroundand migratory experience of the patient [5,6].A clear conclusion is thatthe mental health needs ofimmigrants are not being met [7]. This can be seen atthe two levels identified above and are related to bothprevention and treatment. To that end the Euromednetwork calls for the development of both clinical andinstitutional cultural competence by attending toresearch, training, and advocacy. This human rightsissue which involves considerable suffering implicates alllevels of stakeholders, from individuals to their families,from clinicians to the institutions they work for, tohealth care systems, professional associations, and pro-fessional training programs.ResearchMost all of what we know about migration and mentalhealth comes from research. Although considerablestrides have been made in this area, it is clear that thereremains much to be done. We call for more research tobe facilitated and carried out in this area. It is note-worthy that the vast bulk of psychological and psychia-tric research uses a“gold standard” that is notrepresentative of more than 80% of the world’spopula-tion, which means that much of what we know may beof questionable applicability to the latter, which is parti-cularly true of clinical trials.Indeed, the field of ethnopsychopharmacology clearlydemonstrates that pharmacokinetics and pharmacody-namics are not“universal” but rather vary with thegenetic makeup [6]. Thus treatment, be it pharmacologi-cal or psychological, needs to be investigated at morepopulation specific levels in order to ensure that allpatients receive an optimal quality of care.