Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Avenida Las Condes 12461, Las Condes, Región Metropolitana, Chile.
Department of Psychiatry, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, P.O.Box 22, 00014, Helsinki, Finland.
Int J Equity Health. 2020 Nov 4;19(1):197. doi: 10.1186/s12939-020-01312-2.
Mental health in a context of international migration is a particularly pressing issue, as migration is recognised as a social determinant of physical and mental health. As Chile is increasingly becoming a receiving country of South-South migration, immigrants face mental health inequities, with regards to outcomes and access to care.In order to identify and synthetize mental healthcare inequities faced by international migrants with regards to locals in Chile, a narrative review of the literature on national mental healthcare policies in Chile and a narrative review of the literature on migrants' mental healthcare in Chile were conducted, with a focus on describing mental health outcomes, policy environment and persisting gaps and barriers for both topics. The existing literature on mental healthcare in Chile, both for the general population and for international migrants, following the social determinant of health framework and categorised in terms of i) Inequities in mental health outcomes; ii) Description of the mental health policy environment and iii) Identification of the main barriers to access mental healthcare.Despite incremental policy efforts to improve the reach of mental healthcare in Chile, persisting inequities are identified for both locals and international migrants: lack of funding and low prioritisation, exacerbation of social vulnerability in the context of a mixed health insurance system, and inadequacy of mental healthcare services. International migrants may experience specific layers of vulnerability linked to migration as a social determinant of health, nested in a system that exacerbates social vulnerability.Based on the findings, the article discusses how mental health is a privilege for migrant populations as well as locals experiencing layers of social vulnerability in the Chilean context. International migrants' access to comprehensive and culturally relevant mental healthcare in Chile and other countries is an urgent need in order to contribute to reducing social vulnerability and fostering mechanisms of social inclusion.International migration, social determinants of mental health, mental health inequities, social vulnerability, review.
心理健康在国际移民背景下是一个特别紧迫的问题，因为移民被认为是身心健康的社会决定因素。随着智利越来越成为南南移民的接收国，移民在心理健康方面面临着不平等，无论是在结果还是在获得护理方面。为了确定并综合分析国际移民在智利面临的心理健康方面的不平等，对智利国家精神卫生保健政策的文献进行了叙述性审查，并对智利移民精神卫生保健的文献进行了叙述性审查，重点描述了心理健康结果、政策环境以及这两个主题的持续差距和障碍。智利的精神卫生保健现有文献，无论是针对一般人群还是针对国际移民，都遵循健康的社会决定因素框架，并根据以下三个方面进行分类：i）心理健康结果的不平等；ii）心理健康政策环境的描述；iii）获得精神卫生保健的主要障碍的确定。尽管智利在改善精神卫生保健覆盖面方面做出了渐进式的政策努力，但无论是当地人还是国际移民，都存在着持续的不平等：缺乏资金和低优先级、在混合医疗保险制度背景下加剧社会脆弱性、以及精神卫生保健服务的不足。国际移民可能会因为移民作为健康的社会决定因素而经历特定的脆弱性层次，这些脆弱性嵌套在一个加剧社会脆弱性的系统中。基于这些发现，本文讨论了在智利背景下，心理健康对于移民群体以及经历多层次社会脆弱性的当地人来说是一种特权。为了减少社会脆弱性并促进社会包容机制，智利和其他国家迫切需要为国际移民提供全面和文化相关的精神卫生保健。国际移民、心理健康的社会决定因素、心理健康不平等、社会脆弱性、综述。
