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      Barriers to Accessing and Negotiating Mental Health Services in Asylum Seeking and Refugee Populations: The Application of the Candidacy Framework

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          Abstract

          This review brought together research investigating barriers asylum seekers and refugees (AS&R) face in accessing and negotiating mental health (MH) services. The candidacy framework (CF) was used as synthesizing argument to conceptualize barriers to services (Dixon-Woods et al. in BMC Med Res Methodol 6:35, 2006). Five databases were systematically searched. Twenty-three studies were included and analyzed using the CF. The seven stages of the framework were differentiated into two broader processes—access and negotiation of services. Comparatively more data was available on barriers to access than negotiation of services. The Identification of Candidacy (access) and Appearances at Services (negotiation) were the most widely discussed stages in terms of barriers to MH care. The stage that was least discussed was Adjudications (negotiation). The CF is useful to understand inter-related barriers to MH care experienced by AS&R. A holistic approach is needed to overcome these barriers together with further research investigating understudied areas of candidacy.

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          Common mental disorders in asylum seekers and refugees: umbrella review of prevalence and intervention studies

          Giulia Turrini, Marianna Purgato, Francesca Ballette … (2017)
          Background In recent years there has been a progressive rise in the number of asylum seekers and refugees displaced from their country of origin, with significant social, economic, humanitarian and public health implications. In this population, up-to-date information on the rate and characteristics of mental health conditions, and on interventions that can be implemented once mental disorders have been identified, are needed. This umbrella review aims at systematically reviewing existing evidence on the prevalence of common mental disorders and on the efficacy of psychosocial and pharmacological interventions in adult and children asylum seekers and refugees resettled in low, middle and high income countries. Methods We conducted an umbrella review of systematic reviews summarizing data on the prevalence of common mental disorders and on the efficacy of psychosocial and pharmacological interventions in asylum seekers and/or refugees. Methodological quality of the included studies was assessed with the AMSTAR checklist. Results Thirteen reviews reported data on the prevalence of common mental disorders while fourteen reviews reported data on the efficacy of psychological or pharmacological interventions. Although there was substantial variability in prevalence rates, we found that depression and anxiety were at least as frequent as post-traumatic stress disorder, accounting for up to 40% of asylum seekers and refugees. In terms of psychosocial interventions, cognitive behavioral interventions, in particular narrative exposure therapy, were the most studied interventions with positive outcomes against inactive but not active comparators. Conclusions Current epidemiological data needs to be expanded with more rigorous studies focusing not only on post-traumatic stress disorder but also on depression, anxiety and other mental health conditions. In addition, new studies are urgently needed to assess the efficacy of psychosocial interventions when compared not only with no treatment but also each other. Despite current limitations, existing epidemiological and experimental data should be used to develop specific evidence-based guidelines, possibly by international independent organizations, such as the World Health Organization or the United Nations High Commission for Refugees. Guidelines should be applicable to different organizations of mental health care, including low and middle income countries as well as high income countries. Electronic supplementary material The online version of this article (doi:10.1186/s13033-017-0156-0) contains supplementary material, which is available to authorized users.
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            Mental Health Service Use Among Immigrants in the United States: A Systematic Review.

            Amelia Seraphia Derr (2016)
            Immigrants face stressors unique to the experience of migration that may exacerbate or cause mental health problems but access care at rates far below the general population, leaving them at risk of untreated mental health conditions. This review synthesizes current findings on mental health service utilization among immigrants to inform future research efforts addressing disparities in access to care.
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              Barriers to Care: The Challenges for Canadian Refugees and their Health Care Providers

              M. McKeary, B. Newbold (2010)
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                Author and article information

                Contributors
                Catharina F. van der Boor:
                ORCID: http://orcid.org/0000-0003-2710-7601
                c.van-der-boor@liverpool.ac.uk
                Journal
                Journal ID (nlm-ta): J Immigr Minor Health
                Journal ID (iso-abbrev): J Immigr Minor Health
                Title: Journal of Immigrant and Minority Health
                Publisher: Springer US (New York )
                ISSN (Print): 1557-1912
                ISSN (Electronic): 1557-1920
                Publication date (Electronic): 23 August 2019
                Publication date PMC-release: 23 August 2019
                Publication date (Print): 2020
                Volume: 22
                Issue: 1
                Pages: 156-174
                Affiliations
                GRID grid.10025.36, ISNI 0000 0004 1936 8470, Institute of Life and Human Sciences, , University of Liverpool, ; Brownlow Hill, Liverpool, L69 3BX UK
                Author information
                http://orcid.org/0000-0003-2710-7601
                Article
                Publisher ID: 929
                DOI: 10.1007/s10903-019-00929-y
                PMC ID: 6952341
                PubMed ID: 31444614
                SO-VID: f0367343-bc93-496a-a488-04c5491c64b5
                Copyright © © The Author(s) 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Categories
                Subject: Review Paper
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media, LLC, part of Springer Nature 2020

                ScienceOpen disciplines: Health & Social care
                Keywords: asylum seekers,refugees,mental health services,candidacy framework
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: asylum seekers, refugees, mental health services, candidacy framework

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