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Working Group on Providing Mental Health Care for Refugees and Migrants

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About

The WPA Working Group on Mental Health Care for Refugees and Migrants has been tasked with the following:

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  1. To identify issues relevant to provision of mental health care for forcibly displaced people, refugees and migrants across the world and to develop recommendations for WPA’s involvement in forcibly displaced people, refugee and migrant mental health research, education and mental health system development.

  2. To identify member societies, institutions and individuals interested and willing to participate in WPA’s programs of forcibly displaced people, refugee and migrant mental health research, education and mental health system development.

  3. To liaise with the other WPA Action Plan Working Groups with a view to promoting the inclusion of forcibly displaced people, refugee and migrant mental health in the work of these groups. For further background information about the working group, see below.

Members

Working Group Leadership Team
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Chair: Professor Dr. Meryam Schouler-Ocak, Germany

Professor for Intercultural Psychiatry and Psychotherapy

Board member of the European Psychiatric Association (EPA)

Chair of Section on Transcultural Psychiatry of World Psychiatric Association (WPA-TPS)

Co-opted Board member of World Association of Cultural Psychiatry (WACP)

Chair of Section of Intercultural Psychiatry and Psychotherapy, Migration of German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN)

President of the German-Turkish Association for Psychiatry, Psychotherapy and Psychosocial Health (DTGPP)

Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany

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E-mail: meryam.schouler-ocak@charite.de

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Marianne C. Kastrup, Denmark

Specialist in Psychiatry Former Treasurer World Association Social Psychiatry (WASP) Former Secretary General European Psychiatric Association (EPA)

Former Member Executive Committee World Psychiatric Association (WPA)

www.marianneckastrup.dk

 

E-mail: email: d121304@dadlnet.dk www.marianneckastrup.dk

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Professor Levent Küey, Turkey

Associate Professor of Psychiatry, Istanbul Bilgi University, Istanbul, Turkey

European Psychiatric Association former Board Member (EPA) (2015 – 2019)

World Psychiatric Association former Secretary General (WPA) (2008 -2014)

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E-mail: kueyl@superonline.com

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Professor Roberto Lewis-Fernández, USA

President of World Association of Cultural Psychiatry (WACP)

Professor of Clinical Psychiatry, Columbia College of Physicians & Surgeons

Director, Center of Excellence for Cultural Competence, New York State Psychiatric Institute
Co-Director, Anxiety Disorders Clinic, New York State Psychiatric Institute
Director, Hispanic Treatment Program, New York State Psychiatric Institute
Lecturer on Global Health and Social Medicine, Harvard University

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E-mail: Roberto.Lewis@nyspi.columbia.edu

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Professor Harry Minas, Australia

Head of Global and Cultural Mental Health Unit

Centre for Mental Health

Melbourne School of Population and Global Health

The University of Melbourne

Board member, World Association for Psychosocial Rehabilitation (WAPR)

Chair, WAPR Migration Mental Health Taskforce

Chair, WAPR Taskforce on Collaborating Centres for Research and Training

Editor-in-Chief International Journal of Mental Health Systems https://ijmhs.biomedcentral.com/

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E-mail: h.minas@unimelb.edu.au

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Professor Solomon Rataemane, Sounth Africa

Head of Department for Psychiatry

Sefako Makgatho Health Sciences University (SMU)

President: African Association of Psychiatrists and Allied Professions 2014 - 2017

WPA Zone 14 (Sub-Sahara) Representative (2008 - 2014)

WPA Section Chair: Conflict Management & Conflict Resolution (2011 - 2017)

Fellow of the American Psychiatric Association (FAPA)

Secretary General - World Association of Psychosocial Rehabilitation (WAPR)

Member of Standing Committee on Health of ASSAF (Academy of Sciences of South Africa)

Chairperson: Ministerial Advisory Committee on Mental Health

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E-mail: srataema@gmail.com

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Hans Rohlof, The Netherlands

Board member and Treasurer of the World Association of Cultural Psychiatry (WACP)

Board member and Treasurer of the Dutch Division of Transcultural Psychiatry

Secretary of the Johannes Wier Foundation on Health Care and Human Rights Former

Chair of the Section on Transcultural Psychiatry of World Psychiatric Association (WPA-TPS)

Consultant Psychiatrist and Psychotherapist, M.D., Ph.D. Transparant GGZ,

Transparant Mental Health Institute

https://transparant-leiden.nl/

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E-mail: hrohlof@gmail.com

Deliverables

  1. Symposium, workshop, forum, other type of meeting:

    • Symposia at the WPA scientific meetings (all 3 years)

    • Courses at the WPA scientific meetings (all 3 years)

    • Thematic congress on forcibly displaced people, refugee and migrant mental health (2nd year)

  2. Webinar(s): all 3 years

    • Working with migrants and refugees - why do we need cultural competence?

 This webinar took place on the 4th November and focused on cultural competence and discussed why it is needed in 

 working with migrant and refugee patients. You can read the webinar report here.

  1. ​Position papers, reports, guidelines:

    • Identification and implementation of a comprehensive review of existing guidelines on provision of mental health services for forcibly displaced people, refugees and migrants (to be finalized by the end of 2nd year)

    • Guidelines for psychiatrists and mental health workers (to be finalized by the end of 3rd year)

  2. Digital/online, print version documents:

    • All material produced to be uploaded on the special section of the WPA website (e.g., “Forcibly Displaced People, Refugee and Migrant Mental Health”)

  3. Articles in journals, books:

    • Article: Review of studies focusing on provision of mental health services for forcibly displaced people, refugees and migrants (to be finalised by the end of 1st year)

    • Article: Report on the published research on existing service provision guidelines (to be finalised by the end of the 2nd year)

    • A WPA Book on provision of mental health services for forcibly displaced people, refugees and migrants (to be delivered to the publishing house by the end of the 3rd year)

  4. Research protocols and studies:

    • Research: A questionnaire-based research project with the contribution of the WPA Member Societies to reveal the current global situation concerning provision of mental health services for forcibly displaced people, refugees and migrants (to be finalised by the end of 1st year)

  5. Training programmes:

    • Preparing educational material for WPA membership

  6. Collaboration with other organisations working in this field:

    • Joint publications with relevant professional associations

    • Joint symposia at the WPA scientific meetings

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Background

Due to expanding globalisation and a growing number of intra-national and international conflicts, the number of people moving across national and international borders is rapidly increasing. It is crucial that policymakers, mental health professionals, and other service providers address the health and psychosocial needs of these people for whom they are responsible, including their mental health.

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Migration is an important risk factor for mental disorders. People moving across national and international borders may face adverse conditions before, during, and after migration(1-7). Prior to migration, they may have been exposed to deprivation, persecution, violence, imprisonment, human rights violations, including sexual harassment and even torture(2, 8). Greater exposure to pre-migration traumatic experiences is consistently associated with depression, PTSD, and anxiety among migrants and refugees. Post-migration stress factors, including poor socio-economic resources, may have an even greater impact on mental health than pre-migration factors; these include lack of integration, unemployment, absent educational opportunities, family separation, language difficulties, limited social networks, and unclear residence status. These factors are particularly associated with depression risk(9) and may have greater impact on psychosis risk than pre-migratory stressors(10). Further risk factors in new communities can include social exclusion, stigma and discrimination(11). Post-migratory stressors also contribute to the development of trauma sequelae(12). The rate of mental disorders was described as twice as high among refugees than among economic migrants(13). Thus, there is an urgent need for large-scale interventions to address psychiatric disorders in refugees and forcibly displaced persons after displacement(14).

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The situation of forcibly displaced persons and migrants are worsened by the COVID-19 pandemic, which is having a major impact on public mental health. Fear of infection, the physical and mental sequelae of being infected, as well as grief and posttraumatic reactions upon the loss of loved ones increase the risk for mental health problems. The quarantine, physical distancing, and lockdown measures used to combat the epidemic also result in additional stresses that can worsen mental health, including social isolation, loneliness, loss of employment, financial crises, changes in the working environment, and concern over an uncertain future(15). Worry and uncertainty can precipitate or worsen acute depressive and anxiety symptoms and can increase the risk for serious mental illness, including panic and other anxiety disorders, mood disorders, and trauma-induced disorders(16, 17).

 

Individuals with mental illness are one of the most vulnerable groups to COVID-19 because of the limitations imposed by their mental illness and their limited access to quality health care. They often are at increased risk of infection because their living conditions do not allow them to maintain basic hygiene and social distancing(18). Refugees and forcibly displaced persons with mental health problems are at especially high risk. As many as 80% of refugees live in low- and middle-income countries, where their access to quality mental health care is even more limited than before their displacement. They need enormous global support to cope with a rapidly evolving crisis(19), including in accessing physical and mental health care and in carrying out adequate preventive measures against infection. Elevated risk of adverse psychological effects including among healthcare workers, particularly those exposed to infected patients, was one of the key findings of a recent meta-analysis(20). The SARS-CoV-2 virus disregards all borders.

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Our global response must not overlook forcibly displaced people, refugees and migrants(19).

References

  1. Butler M, Warfa N, Khatib Y, Bhui K. Migration and common mental disorder: an improvement in mental health over time? Int Rev Psychiatry. 2015 Feb;27(1):51-63.

  2. Bhugra D, Gupta S, Schouler-Ocak M, Graeff-Calliess I, Deakin NA, Qureshi A, Dales J, Moussaoui D, Kastrup M, Tarricone I, Till A, Bassi M, Carta M. EPA Guidance mental health care of migrants. Eur Psychiatry. 2014 Feb;29(2):107-15.

  3. Jesuthasan J, Sönmez E, Abels I, Kurmeyer C, Gutermann J, Kimbel R, Krüger A, Niklewski G, Richter K, Stangier U, Wollny A, Zier U, Oertelt-Prigione1 S, Schouler-Ocak1 M. Near-death experiences, attacks by family members, and absence of health care in their home countries affect the quality of life of refugee women in Germany: a multi-region, cross-sectional, gender-sensitive study. BMC Med. 2018 Feb 1;16(1):15

  4. Rasmussen A, Nguyen L, Wilkinson J, Raghavan S, Vundla S, Miller KE. et al. Rates and impact of trauma and current stressors among Darfuri refugees in eastern Chad. Am J Orthopsychiatry. 2010;80(2):227–236.

  5. Meryam Schouler-Ocak, Cornelis J Laban, Sofie Bäärnhielm, Marianne C Kastrup, Simon Dein, Ronald Wintrob (2018). WPA-TPS – Refugee, asylum seeker and immigrant patients over the globe. In Fountoulakis/Javed (editors). Advances in Psychiatry, Springer; Pp. 637-655

  6. Meryam Schouler-Ocak , Marianne C Kastrup, Mrugesh Vaishnav, Afzal Javed. Mental health of migrants. Indian J Psychiatry May-Jun 2020;62(3):242-246.

  7. Brandt L, Henssler J, Müller M, Wall S, Gabel D, Heinz A. Risk of Psychosis Among Refugees: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019 Aug 14;76(11):1133-40.

  8. Bhugra D. Migration and mental health. Acta Psychiatr Scand 2004;109(4):243-58.

  9. Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC Int Health Hum Rights. 2015 Oct 28;15:29.

  10. Bourque F, van der Ven E, Malla A. A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychol Med. 2011 May;41(5):897-910.

  11. Bhui K, Stansfeld S, McKenzie K, Karlsen S, Nazroo J, Weich S. Racial/ethnic discrimination and common mental disorders among workers: findings from the EMPIRIC Study of Ethnic Minority Groups in the United Kingdom. Am J Public Health. 2005 Mar;95(3):496-501.

  12. Wen Chen, Li Ling, Andre M N Renzaho. Building a new life in Australia: an analysis of the first wave of the longitudinal study of humanitarian migrants in Australia to assess the association between social integration and self-rated health. BMJ Open 2017 Mar 15;7(3):e014313.

  13. Lindert J, Ehrenstein OS, Priebe S, Mielck A, Brähler E. Depression and anxiety in labor migrants and refugees--a systematic review and meta-analysis. Soc Sci Med. 2009 Jul;69(2):246-57.

  14. Morina N, Akhtar A, Barth J, Schnyder U. Psychiatric Disorders in Refugees and Internally Displaced Persons After Forced Displacement: A Systematic Review. Front Psychiatry. 2018 Sep 21;9:433.

  15. Danuta Wasserman , Rutger van der Gaag , Jan Wisee. The term "physical distancing" is recommended rather than "social distancing" during the COVID-19 pandemic for reducing feelings of rejection among people with mental health problems. Eur Psychiatry 2020 Jun 1;63(1):e52.

  16. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020 Mar 14;395(10227):912-920.

  17. Gorwood P & Fiorillo A. The Consequences of the COVID-19 Pandemic on Mental Health and Implications for Clinical Practice. Eur Psychiatry . 2020 Apr 1;63(1):e32.

  18. Kluge HHP, Jakab Z, Bartovic J, D'Anna V, Severoni S. Refugee and migrant health in the COVID-19 response. Lancet. 2020 Apr 18;395(10232):1237-1239.

  19. The Lancet. COVID-19: protecting health-care workers. Lancet 2020 Mar 21;395(10228):922.

  20. Henssler J, Stock F, van Bohemen J, Walter H, Heinz A, Brandt L. Mental health effects of infection containment strategies: quarantine and isolation-a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2020 Oct 6:1-12.

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