Five key themes for improved mental health care for refugees and migrants

Five key themes for improved mental health care for refugees and migrants (who.int)

On World Mental Health Day, the World Health Organization (WHO) is releasing a new report entitled Mental health of refugees and migrants: risk and protective factors and access to care, outlining the latest global evidence on main factors influencing the mental health of refugees and migrants and their access to care. This is fifth report of the Global evidence review on health and migration (GEHM).

Around 1 in 8 people globally live with a mental health condition. Refugees and migrants are particularly vulnerable, as they can be exposed to various stress factors and challenges, which affect their mental health and well-being both during their journeys and on arrival. The prevalence of common mental disorders such as depression, anxiety and post-traumatic stress disorder (PTSD) tends to be higher among migrants and refugees than among host populations. Girls and women on the move have a higher risk of depression and anxiety.

“Good mental health and well-being is a right for all, including for refugees and migrants,” said Dr Santino Severoni, Director of the WHO’s Department of Health and Migration. “This report will support and strengthen health systems’ responses to the mental health needs of refugees and migrants so that they can receive quality mental health care and support in ways they find accessible, acceptable, and affordable.”

The report summarizes different risk factors and barriers refugee and migrant groups experience and outlines five key themes to be addressed in order to improve their access to mental health care:

• Community support: Evidence shows that being part of a community with a shared background and attending school are associated with lower rates of mental disorders.
• Basic needs and security. For example, an insecure legal status can contribute to poor mental health.
• Stigma: experiences of racism and discrimination are consistently associated with adverse mental health outcomes.
• Adversity and trauma. For example, extended detention is associated with increased rates of depression and PTSD.
• Access to services. Refugees and migrants often do not prioritize their mental health because they are not aware of the services available free of charge or do not accept health care due to language barriers and concerns around confidentiality.

“Refugees and migrants face many unique stressors and challenges. This report sets out the urgent need for robust policies and legislation, rooted within stronger health systems, to meet the mental health care needs of refugees and migrants,” said Dévora Kestel, WHO Director for Mental Health and Substance Use.

Urgent action needed by policymakers

Based on the findings of the review, this GEHM puts forward a series of actions for consideration by Governments, policymakers, and programme managers in Ministries of Health and other ministries, cutting across all the five thematic areas outlined:

• Promote refugees’ and migrants’ participation in society and reduce discrimination by adopting refugee- and migrant-sensitive mental health policies.
• Address the non-medical factors that impact mental health in migration policies and prioritize basic needs, such as food, housing, safety, and education or employment. This means, for example, using settings other than detention facilities to assess the health status of refugees and migrants.
• Train health workers to assess and treat mental health conditions among refugees and migrants and strengthen the capacity of other relevant professionals (e.g., migration officers, social workers, or teachers) to recognize and support those with mental health conditions.
• Offer choices about the delivery of mental health services, for example, the location, service provider, referral pathway, and treatment approach to make access to care possible and acceptable.
• Safeguard the human rights of all refugees and migrants regardless of their legal status with national and international policies and criminal justice measures that protect these populations from discrimination and violence.
• Strengthen community capacity for and access to mental health care by providing information about services, engaging with migrant groups, and offering community-based referral pathways. For example, orientation to critical services and entitlements on arrival in the destination country will be key.

Developed by the WHO’s Department of Health and Migration in collaboration with the Department of Mental Health and Substance Use, this GEHM also identifies critical gaps to be addressed in future research.