Tortelli Andrea, Perquier Florence, Melchior Maria, Lair François, Encatassamy Fabien, Masson Chloé, K'ourio Hélène, Gourevitch Raphaël, Mercuel Alain
Pôle Psychiatrie Précarité, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, 75014 Paris, France.
Pierre Louis Institute for Epidemiology and Public Health (IPLESP/INSERM UMR_S 1136), 75012 Paris, France.
Int J Environ Res Public Health. 2020 Dec 15;17(24):9397. doi: 10.3390/ijerph17249397.
Migrants, and particularly asylum seekers, are at increased risk of psychiatric disorders in comparison with natives. At the same time, inequalities in access to mental health care are observed.
In order to evaluate whether the Parisian public psychiatric system is optimally structured to meet the needs of this population, we examined data on mental health and service use considering three different levels: the global system treatment level, a psychiatric reception center, and mobile teams specializing in access to psychiatric care for asylum seekers.
We found higher treatment rates among migrants than among natives ( < 0.001) but inequalities in pathways to care: more mandatory admissions (OR = 1.36, 95% CI: 1.02-1.80) and fewer specialized consultations (OR = 0.56, 95% CI: 0.38-0.81). We observed a mismatch between increased need and provision of care among migrants without stable housing or seeking asylum.
Inequalities in the provision of care for migrants are observed in the Parisian public psychiatric system, particularly for those experiencing poor social and economic conditions. There is a need to facilitate access to mental health care and develop more tailored interventions to reduce discontinuity of care.
与本地人相比，移民，尤其是寻求庇护者患精神疾病的风险更高。与此同时，人们观察到在获得精神卫生保健方面存在不平等现象。
为了评估巴黎公共精神科系统的结构是否优化以满足这一人群的需求，我们从三个不同层面考察了心理健康和服务使用数据：全球系统治疗层面、一个精神科接待中心以及专门为寻求庇护者提供精神科护理的流动团队。
我们发现移民的治疗率高于本地人（<0.001），但在就医途径方面存在不平等：强制入院更多（比值比=1.36，95%置信区间：1.02-1.80），专科会诊更少（比值比=0.56，95%置信区间：0.38-0.81）。我们观察到在没有稳定住房或寻求庇护的移民中，需求增加与护理提供之间存在不匹配。
在巴黎公共精神科系统中，为移民提供护理存在不平等现象，特别是对于那些社会和经济条件较差的人。需要便利获得精神卫生保健，并制定更具针对性的干预措施以减少护理的间断性。
