Mental health care for irregular migrants in Europe: Barriers and how they are overcome
1 Ludwig Boltzmann Institute for Social Psychiatry, Lazarettgasse 14A-912, 1090 Vienna, Austria
2 Unit for Social and Community Psychiatry, Queen Mary University of London, London E13, 8SP Mile End Road, London, UK
3 Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Al Prof Hernani Monteiro, 4200-319, Porto, Portugal
4 Health Promotion Research Centre, National University of Ireland Galway, University Road, Galway, Ireland
5 Madrid Salud, Calle Juan Esplandiú nº 13, 28007 Madrid, Spain
6 National Institute for Health Development, 1096 Budapest Nagyvárad tér 2, Budapest, Hungary
7 Laziosanità ASP - Public Health Agency, Lazio Region, Via di S. Costanza 53, 00198 Rome, Italy
8 Laboratoire de recherche, Etablissement public de santé Maison Blanche, 18 rue Rémy de Gourmont, 75019 Paris, France
9 Department of Psychiatry, 1st Faculty of Medicine, Charles University, Ke Karlovu 11/12000, Prague, Czech Republic
10 Clinic for Psychiatry and Psychotherapy, Charité, University Medicine Berlin, CCM, Charitéplatz 1, 10117 Berlin, Germany
11 Institute of Psychiatry and Neurology, ul. Sobieskiego 9, 02-957 Warsaw, Poland
12 Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle- aux-Champs, 30.05, B-1200 Bruxelles, Belgium
13 Academic Medical Center, University of Amsterdam, Meibergdreef 5, Room PA1-156, 1105 AZ Amsterdam, The Netherlands
14 Department of Public Health Sciences, Karolinska Institute, Norrbacka, SE-171 76 Stockholm, Sweden and Department of Public Health Sciences, Mid Sweden University, SE-851 70 Sundsvall, Sweden
BMC Public Health 2012, 12:367 doi:10.1186/1471-2458-12-367Published: 20 May 2012
Irregular migrants (IMs) are exposed to a wide range of risk factors for developing mental health problems. However, little is known about whether and how they receive mental health care across European countries. The aims of this study were (1) to identify barriers to mental health care for IMs, and (2) to explore ways by which these barriers are overcome in practice.
Data from semi-structured interviews with 25 experts in the field of mental health care for IMs in the capital cities of 14 European countries were analysed using thematic analysis.
Experts reported a range of barriers to mental health care for IMs. These include the absence of legal entitlements to health care in some countries or a lack of awareness of such entitlements, administrative obstacles, a shortage of culturally sensitive care, the complexity of the social needs of IMs, and their fear of being reported and deported. These barriers can be partly overcome by networks of committed professionals and supportive services. NGOs have become important initial points of contact for IMs, providing mental health care themselves or referring IMs to other suitable services. However, these services are often confronted with the ethical dilemma of either acting according to the legislation and institutional rules or providing care for humanitarian reasons, which involves the risk of acting illegally and providing care without authorisation.
Even in countries where access to health care is legally possible for IMs, various other barriers remain. Some of these are common to all migrants, whilst others are specific for IMs. Attempts at improving mental health care for IMs should consider barriers beyond legal entitlement, including communicating information about entitlement to mental health care professionals and patients, providing culturally sensitive care and ensuring sufficient resources.