Mental health of irregular migrants in Sweden

1
Mental health of irregular migrants in Sweden

• Alexis Gainza Solenzal
• Licensed psychologist
• Group leader of the Rosengrenska Psychiatric team
• styrelsen_at_rosengrenska.org
• www.rosengrenska.org

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Background The Rosengrenska foundation

• Rosengrenska was founded in 1998 with three
  initial goals
• To revoke Rosengrenska
• To spread knowledge about the health care needs
  and rights of irregular migrants
• To offer health care to irregular migrants

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Background The Rosengrenska foundation

• From 1998 - 2004/2005 telephone-coordinated
  network of health care personnel.
• In 2004/2005 Rosengrenska opened the clinic that
  still exists today, one evening per week (most
  weeks).
• In the years 2008 2015 the clinic was run in
  cooperation with the Swedish Red Cross.
• September, 2015 the clinic is once again run
  solely on a voluntary basis.

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Background irregular migrants

• Irregular migrants are people who stay in Sweden
  without the necessary authorization or documents
  required under immigration regulations
• People who, for a variety of reasons, never seek
  asylum.
• People who have been denied asylum and who have
  received their deportation notice.
• People who stay in Sweden even though their
  temporary visa or temporary residence permit has
  expired.
• Children who are born as irregular migrants by
  having parents who are irregular migrants.

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Background Mental health among irregular
migrants

• A comparative survey study in the Netherlands
  showed that irregular migrants reported a high
  level of psychological distress but received less
  treatment than other migrants.
• Teunissen, van den Bosch, van Bavel, van den
  Driessen Mareeuw, van den Muijsenbergh, van
  Weel-Baumgarten van Weel, 2014
• A French comparative study showed that irregular
  migrants reported worse somatic and mental health
  issues than any other migrants.
• Jolivet, Cadot, Florence, Lesieur, Lebas
  Chauvin, 2012
• In an ongoing Swedish interview study irregular
  migrants report that they often need to
  prioritize buying food and paying for living
  accommodations rather than getting treatment for
  them and their children.
• Ascher Andersson

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Background Mental health among Rosengrenskas
patients

• In the beginning, focus on bodily illnesses.
• Some patients returned to the clinic many times.
• Psychosomatic, and/or psychiatric ailments?
• Counselors, psychologists and psychiatrists were
  recruited to provide supportive talks.

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Screening of mental health at Rosengrenska

• Under-reporting of mental health issues was
  suspected
• A semi-structured intake interview was
  developed.
• Including questions related to sleep, occurrence
  of nightmares, anxiety and depression.

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Screening of mental health at Rosengrenska

• Between February 2013 and June 2014, 288
  respondents 232 came because of bodily illness
• 30 came because of mental health issues
• 23 came for other reasons
• 91 of the patients who were at Rosengrenska due
  to bodily issues also reported at least one
  symptom of mental health problems. Over 25 had
  all four symptoms that were screened for.
• A high demand of counseling, by the end of 2013 a
  queue of 60 patients

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New legislation facilitates access to health care

• Since July 2013 irregular migrants who are 18
  years and older have the same right to health
  care as asylum seekers.
• Health care that cannot be postponed
• The bulk of the cost is paid for by the state.
  Patient fees mostly varies between 5-30.
• All children in Sweden have the same right to
  health care

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Obstacles to mental health care despite new
legislation

• A gradual shift from providing health care to
  referring patients to the regular Swedish health
  care facilities.
• Patients with mental health problems returned to
  Rosengrenska in a higher degree than patients
  with bodily illnesses.
• Patients with mental health issues reported
  mistreatment and/or lack of knowledge about the
  new legislation in the regular health care system.

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Psychological assessment of mental health at
Rosengrenska

• A group of psychologists began offering
  assessment interviews to patients reporting
  mental health issues.
• The interview is structured to cover suspected
  psychiatric diagnoses, need of further
  assessment/treatment, heredity, alcohol and/or
  drug abuse, bodily status, psychiatric status and
  assessment of suicidality.
• The assessment takes between 30 90 minutes
  depending on the complexity of the case.

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Referrals and follow-up

• After one year over 60 written referrals had been
  sent to different mental health care providers.
• Children were not assessed individually,
  referrals were sent following the description of
  the parent.
• All sent referrals were registered to facilitate
  follow-up.
• A referral confirmation was added to the
  structured referral.
• A new group was formed to systematically request
  referral confirmations and answers.

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Results of sent referrals Mental health care
providers
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Results of sent referrals Psychiatric symptoms
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Results of sent referrals Initial obstacles
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Results of sent referrals Established health care
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Treating mental health among irregular migrants

• Common misconception that irregular migrants
  mental health cannot be treated due to ongoing
  traumas and a difficult life situation.
• Psychotherapeutic treatment shows good results
• Best support for trauma focused CBT and Narrative
  exposure therapy
• Solobodin de Jong, 2015
• Good results for narrative exposure therapy when
  treating PTSD with comorbid depression.
• Stenmark et al., 2013
•  Swedish interview study with irregular migrants
  in psychodynamic psychotherapy Patients reported
  improved physical and psychological health,
  Improved sleep, improved trust and experienced
  therapy as a support in their roles as parents.
• Nord, 2014
• Pilot study of EMDR in a refugee camp in Syria
  shows promising results of treating PTSD.
• Acarturk et al., 2015

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The psychiatric team of Rosengrenska

• Counselors, assessment psychologists,
  psychiatrists and psychology students.
• The objective for the supportive talks has
  changed drastically. Today counseling is
  time-limited and focused on motivating the
  patient to seek help in the regular mental health
  system.
• A decline in psychological assessments has been
  noticed during the last 6 months.

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Psychosocial needs

• As access to mental health care in Sweden is
  improving for irregular migrants, the
  psychosocial needs become more evident
• Poverty, homelessness, famine, Swedish-language-ed
  ucation and access to preschools for the younger
  children.

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Mental health of irregular migrants in Sweden

• Alexis Gainza Solenzal
• Licensed psychologist
• Group leader of the Rosengrenska Psychiatric team
• styrelsen_at_rosengrenska.org
• www.rosengrenska.org