Equitable substance use treatment for migrants and ethnic minorities: the entwinement of micro and meso barriers and facilitators

Abstract

In Europe, the prerequisites of equitable substance use treatment (SUT) for migrants and ethnic minorities (MEM) remain understudied. This qualitative study maps barriers and facilitators identified by 14 professionals in Flanders, Belgium. The analysis identified micro and meso level barriers and how they intersect. Whereas barriers to treatment are often attributed to the client (vulnerabilities, language, trust, knowledge) our results demonstrate that they are also rooted in services (lack of expertise, issues with interpreters, diversity policies, waiting list and referral bias). These results emphasize the responsibility of meso and macro policymaking in resolving treatment mismatch problems.

Keywords:

• Substance use treatment (SUT)
• migrants and ethnic minorities (MEM)
• equitable substance use treatment
• ecosocial theory
• intersecting barriers

Disclosure statement

None.

Notes

1 The combined terminology ‘migrants and ethnic minorities’ is used by the European Regional Office of the World Health Organization (WHO EU, 2010). It is also used in the ETHEALTH report for equal health and health care (Derluyn et al., 2017), and by the European Public Health Association in its statement on migration, ethnicity, and health (2018). This combined terminology allows researchers to consider 1) the individual history of migration, 2) the feeling of belonging to an ethnic group, and 3) societal denomination, categorization, and its consequences (De Kock et al., 2017). These three aspects are especially important in studying problem substance use and treatment in these populations, because they allow for a layered understanding of the aetiology of problem use and help-seeking behavior. The combined terminology encompasses residence statuses, generations, nationalities, gender, socio-economic status, etc., while allowing researchers to distinguish between these factors.

2 At least two respondents were located in each of the following provinces: Limburg (n = 2), East-Flanders (n = 3), West-Flanders (n = 3).

3 In Flanders, people with a migration background were, for a long time, prevented from establishing non-governmental organizations (NGOs). In the 1980s these restrictions were annulled. Ever since, NGOs set up by individuals with a migration background and aimed at these populations have been denominated ‘self-organizations’ in policy documents. It remains unclear why they are called ‘self-organizations’ and other types of NGOs are not.

4 Respondent quotes are referred to anonymously in the results section (respondent numbers 1 to 14). The respondents’ characteristics are listed in Table 1.

Additional information

Funding

This work was supported by Ghent University under grant number [BOF24Y2017002301].