Mental health of irregular
migrants in Sweden
Alexis Gainza Solenzal
Licensed psychologist
Group leader of the Rosengrenska Psychiatric team
[email protected]
www.rosengrenska.org
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
Background:
The Rosengrenska foundation
• From 1998 - 2004/2005: telephonecoordinated 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.
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.
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
Background: Mental health
among Rosengrenska’s 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”.
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.
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
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
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.
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.
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.
Results of sent referrals:
Mental health care providers
Results of sent referrals:
Psychiatric symptoms
Results of sent referrals:
Initial obstacles
Results of sent referrals:
Established health care
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
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.
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-education and
access to preschools for the
younger children.
Mental health of irregular
migrants in Sweden
Alexis Gainza Solenzal
Licensed psychologist
Group leader of the Rosengrenska Psychiatric team
[email protected]
www.rosengrenska.org