Abstract
BackgroundThe prevalence of psychological complaints is known to be very high in populations of asylum seekers. Despite this, data on the health care system’s ability to adequately meet these high-risk populations’ mental health needs are scarce. This article investigates how well the German outpatient health care system is able to detect and adequately treat them.MethodsTo this end, we combined data from a cross-sectional survey with billing data from the local social welfare office from the year 2015. Using descriptive statistics, the data of the cross-sectional study are used to quantify the psychological health care needs of asylum seekers while the secondary data analysis indicates the actual access to and extent of psychological treatment.ResultsIn the cross-sectional study, 54% of patients were screened positive for symptoms of depression, 41% for symptoms of anxiety disorder and 18% for symptoms of Posttraumatic Stress Disorder. In total, 59% were screened positive for at least one of these three disorders. However, when contrasting these screening-based prevalences with the prevalences based on data from the health care system, a mismatch becomes apparent: According to the social welfare office’s billing data, only 2.6% of asylum seekers received the diagnosis of depression, 1.4% were diagnosed with anxiety disorder and 2.9% with Posttraumatic Stress Disorder (PTSD). In combination, 4.9% were diagnosed with at least one of these three disorders. Overall, less than one tenth of asylum seekers with symptoms of depression, anxiety or PTSD received the corresponding diagnosis by the health care system. Among those who were diagnosed, about 45% received no treatment at all, while 38% were treated with drugs alone. Only 1% of all patients received psychotherapy.ConclusionsPsychological complaints are very common among asylum seekers, yet only a small proportion of this population receives the corresponding diagnoses and treatment. While various factors can contribute to these shortcomings, there is an urgent need to systematically address this deficit and introduce measures to improve mental health care for this high-risk population.
Highlights
A vast number of studies show that psychological problems are highly prevalent in refugee populations all over the world [1,2,3] and in Germany [4,5]
Psychological complaints are very common among asylum seekers, yet only a small proportion of this population receives the corresponding diagnoses and treatment
Depending on their country of origin, they stay at the reception center until the asylum process is completed, or they are transferred to a municipal shelter where they complete the remainder of the process [26]. They have a particular legal status: They are not allowed to work, their access to social benefits is very limited and often restricted to vouchers and/or benefits in kind, and they have no access to the statutory health insurance [13,27]. Their medical needs ought to be covered by §§ 4 and 6 of the Asylum Seekers’ Benefits Act (ASBA), which grants a high degree of discretionary power to the local social welfare office (Sozialamt) [28], the government agency responsible for the payment of welfare subsidies and for the provision for asylum seekers
Summary
A vast number of studies show that psychological problems are highly prevalent in refugee populations all over the world [1,2,3] and in Germany [4,5] (for an explanation of our terminology see Supplement 1). Even after asylum seekers’ arrival in Europe, their psychosocial situation remains burdensome These post-migratory stressors include uncertainty concerning the outcome of asylum claims [12,13,14], poor living conditions in shelters with no privacy and often substandard housing [14,15,16], social marginalization and legally restricted possibilities for family reunion [11], economic hardships due to legal restrictions of access to the labor market and social benefits [17], and the experience of racism and violence [15,18,19]. This article investigates how well the German outpatient health care system is able to detect and adequately treat them
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