Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
BMC Health Serv Res. 2023 Jun 27;23(1):699. doi: 10.1186/s12913-023-09682-3.
Persistent disparities in access to mental health care for refugee and immigrant children and their families pose unique challenges to policy and practice. This study examined service provider perspectives on the barriers and opportunities for improving mental health supports for newcomer children and families in Canada.
Semi-structured individual and group interviews were conducted with 33 leadership and frontline staff from 14 organizations in the health, education, settlement, and social service sectors in Hamilton, Ontario. Interview data were analyzed using the framework method.
Participants described barriers at the systems, provider, and individual and family levels that prevented newcomer families from accessing and benefiting from mental health supports. Structural barriers included inadequate services and funding, complexity of systems, cultural tensions, and, lack of prevention and early identification. Provider-level barriers included lack of representation, mental health knowledge and cultural competency, and staff shortages and burnout. Individual and family-level barriers included lack of mental health literacy, primacy of settlement needs, stigma, fear, and the high threshold for help-seeking. Participants' recommendations for "reimagining care" related to newcomer engagement, person- and family-centered care, cultural responsiveness, mental health promotion and prevention, workforce diversity and development, collaborative and integrated care, and knowledge generation and uptake.
The intersection of structural, provider, and individual/family-level barriers reduce newcomer families' access to and effectiveness of mental health supports. Reducing disparities in mental health and access to care will require a paradigm shift in the way that mental health care is conceptualized and delivered to newcomer children and families.
难民和移民儿童及其家庭获得心理健康服务方面持续存在的差距，这给政策和实践带来了独特的挑战。本研究考察了服务提供者对改善加拿大新移民儿童和家庭心理健康支持的障碍和机会的看法。
在安大略省汉密尔顿的 14 个卫生、教育、移民和社会服务部门的组织中，对 33 名领导和一线工作人员进行了半结构式的个人和小组访谈。使用框架方法对访谈数据进行了分析。
参与者描述了系统、提供者以及个人和家庭层面的障碍，这些障碍阻止了新移民家庭获得和受益于心理健康支持。结构性障碍包括服务和资金不足、系统复杂性、文化紧张、预防和早期识别不足。提供者层面的障碍包括代表性不足、心理健康知识和文化能力、人员短缺和倦怠。个人和家庭层面的障碍包括心理健康知识不足、安置需求优先、耻辱感、恐惧、以及寻求帮助的门槛高。参与者对“重新构想护理”的建议涉及新移民的参与、以人为本和以家庭为中心的护理、文化响应能力、心理健康促进和预防、劳动力多样性和发展、协作和综合护理以及知识的产生和应用。
结构性、提供者和个人/家庭层面障碍的交叉，减少了新移民家庭获得和有效利用心理健康支持的机会。减少心理健康和获得护理方面的差距，需要在为新移民儿童和家庭提供心理健康护理的方式上进行观念转变。
