Welcome, how are you doing? – towards a systematic mental health screening and crisis management for newly arriving refugees

ABSTRACT

Background: Compared to the general German population, refugees in Germany are a high-risk group for trauma spectrum disorders. Currently, many barriers exist for the implementation of a screen-and-treat approach for mental disorders as part of the routine health care provision during the early stage of the immigration process.

Objective: The aim of the present study was to develop and test a systematic screening approach to identify individual refugees in need of mental health care during the initial immigration phase.

Method: 167 newly arrived refugees underwent a screening interview with the Refugee Health Screener (RHS) carried out by Intercultural Therapy Assistants (ITAs). The ITAs were super­vised by psychologists at a reception centre in Bielefeld, Germany. A subsample of 48 persons partici­pated in clinical validation interviews.

Results: Findings demonstrated the need for and feasibility of a systematic screening during the initial immigration phase. However, established cut-off values of the RHS had to be adapted and the screening procedure had to be adjusted due to the needs of a significant number of refugees in severe psychological crises.

Conclusion: A systematic screening that is applied shortly after arrival facilitates the early identification of refugees at risk of developing mental disorders and may be helpful to prevent chronic symptom development and an aggravation of psychological crises.

HIGHLIGHTS

• A systematic complementary screening procedure during the initial immigration phase was found to be useful for the identification of refugees in need of mental health care.

• The procedure could be implemented both safely and efficiently in conjunction with the initial medical check-up for recently arrived refugees.

• Responding to the needs of the refugees immediately following their arrival in Germany, we adjusted the cut-off of the screening instrument and suggest to explicitly include a detection procedure for severe psychological crises.

Antecedentes: En comparación con la población general alemana, los refugiados en Alemania representan un grupo de alto riesgo para los trastornos del espectro de trauma. Actualmente, existen numerosas barreras para la implementación de un enfoque de detección y tratamiento de los trastornos mentales como parte rutinaria de la prestación de atención en salud durante la etapa inicial del proceso de inmigración.

Objetivos: El objetivo del presente estudio fue desarrollar y evaluar un enfoque de detección sistemática para identificar refugiados de manera individual que requieran de atención en salud mental durante la fase inicial de inmigración.

Métodos: 167 refugiados recién llegados se sometieron a una entrevista de cribado con el instrumento “Evaluador de salud de refugiados” (RHS, por sus siglas en inglés) realizado por Asistentes de Terapia Intercultural (ITAs, por sus siglas en inglés). Los ITAs fueron supervisados por psicólogos en un centro de acogida en Bielefeid, Alemania. Una sub-muestra de 48 personas participaron en entrevistas para la validación clínica del instrumento.

Resultados: Los resultados demostraron la necesidad y viabilidad de un enfoque de evaluación sistemática durante la fase inicial de inmigración. Sin embargo, los puntos de corte establecidos del RHS tuvieron que ser adaptados y el proceso de cribado tuvo que ajustarse debido a las necesidades de un número significativo de refugiados con crisis psicológicas severas.

Conclusión: Una evaluación sistemática que se aplica poco después de la llegada de los refugiados facilita una identificación temprana de los refugiados en riesgo de desarrollar trastornos mentales y podría ser útil en la prevención del desarrollo de síntomas crónicos y el empeoramiento de las crisis psicológicas.

背景：与一般德国人群相比，德国难民是创伤谱系障碍的高危人群。目前，在移民过程的早期阶段，将精神障碍筛查和治疗方法作为常规医疗保健服务一部分的实施存在许多障碍。

目的：本研究旨在开发和检验一种系统性筛查方法，以识别在初始移民阶段需要心理健康护理的个体难民。

方法：167 名新抵达的难民接受了由跨文化治疗助理 (ITA) 执行的难民健康筛查工具 (RHS) 的筛查访谈。 ITA 由德国比勒费尔德接待中心的心理学家监督。 48 人的子样本参加了临床验证访谈。

结果：调查结果表明在初始移民阶段进行系统筛查的必要性和可行性。然而，由于大量处于严重心理危机中的难民的需求，必须调整 RHS 的既定临界值并且必须调整筛选流程。

结论：抵达后不久进行的系统性筛查有助于尽早识别有精神障碍风险的难民，并可能有助于预防慢性症状的发展和心理危机的加剧。

KEYWORDS:

• Refugee
• asylum seeker
• mental health care
• screening
• cultural mediators
• Europe
• Germany

PALABRAS CLAVE:

• Refugiado
• solicitante de asilo
• atención de la salud mental
• evaluación
• mediadores culturales
• Europa
• Alemania

关键词:

• 难民
• 寻求庇护者
• 心理保健
• 筛查
• 文化调解员
• 欧洲
• 德国

Acknowledgements

We want to thank the participants, without whom this research would not be possible. Furthermore, we would like to thank our team of Intercultural Therapy Assistants, Rezhna Mohammed, as well as all interns, students, and research assistants involved in this project. We would like to thank Justin Preston for proofreading the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s). Dr. med. Van den Heuvel declares that he is an employee of the regional government (Bezirksregierung Detmold). The statements presented in this article do not necessarily reflect the perspective of the regional government (Bezirksregierung Detmold), though.

Ethical approval and consent to participate

The Ethical Review Board of Bielefeld University granted approval for the study. Approval number: EUB 2019-162-W1. Written consent was obtained from all study participants.

Data availability statement

The data that support the findings of this study are available from the corresponding author (TS), upon reasonable request. The data are not publicly available because they contain information that could compromise the privacy of research participants.

Additional information

Funding

This work was supported by Asylum, Migration and Integration Fund of the European Union (AMIF-EU): [grant no AM17-NW3692]. The authors acknowledge support for the publication costs by the Open Access Publication Fund of Bielefeld University and the Deutsche Forschungsgemeinschaft (DFG).