Faculty of Political, Administrative and Communication Sciences, Center for Health Innovation, Babeș-Bolyai University, Cluj-Napoca, Romania.
Department of Community Medicine, Discipline of Public Health and Management, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
BMC Public Health. 2024 Jun 14;24(1):1593. doi: 10.1186/s12889-024-19046-z.
Forced displacement is a significant issue globally, and it affected 112 million people in 2022. Many of these people have found refuge in low- and middle-income countries. Migrants and refugees face complex and specialized health challenges, particularly in the area of mental health. This study aims to provide an in-depth qualitative assessment of the multi-level barriers that migrants face in accessing mental health services in Germany, Macao (Special Administrative Region of China), the Netherlands, Romania, and South Africa. The ultimate objective is to inform tailored health policy and management practices for this vulnerable population.
Adhering to a qualitative research paradigm, the study centers on stakeholders' perspectives spanning microsystems, mesosystems, and macrosystems of healthcare. Utilizing a purposive sampling methodology, key informants from the aforementioned geographical locations were engaged in semi-structured interviews. Data underwent thematic content analysis guided by a deductive-inductive approach.
The study unveiled three pivotal thematic barriers: language and communication obstacles, cultural impediments, and systemic constraints. The unavailability of professional interpreters universally exacerbated language barriers across all countries. Cultural barriers, stigmatization, and discrimination, specifically within the mental health sector, were found to limit access to healthcare further. Systemic barriers encompassed bureaucratic intricacies and a conspicuous lack of resources, including a failure to recognize the urgency of mental healthcare needs for migrants.
This research elucidates the multifaceted, systemic challenges hindering equitable mental healthcare provision for migrants. It posits that sweeping policy reforms are imperative, advocating for the implementation of strategies, such as increasing the availability of language services, enhancing healthcare providers' capacity, and legal framework and policy change to be more inclusive. The findings substantially contribute to scholarly discourse by providing an interdisciplinary and international lens on the barriers to mental healthcare access for displaced populations.
被迫流离失所是一个全球性的重大问题，2022 年全球有 1.12 亿人受到影响。其中许多人在中低收入国家寻求庇护。移民和难民面临着复杂和专业的健康挑战，特别是在心理健康领域。本研究旨在深入评估移民在德国、中国澳门特别行政区、荷兰、罗马尼亚和南非获得心理健康服务时所面临的多层次障碍。最终目标是为这一弱势群体提供量身定制的卫生政策和管理实践。
本研究遵循定性研究范式，重点关注跨越医疗保健微观系统、中观系统和宏观系统的利益相关者的观点。采用目的抽样方法，从上述地理位置邀请关键信息提供者参与半结构化访谈。数据采用主题内容分析法进行分析，采用演绎归纳法指导。
该研究揭示了三个关键的主题障碍：语言和沟通障碍、文化障碍和制度障碍。普遍缺乏专业口译员加剧了所有国家的语言障碍。发现文化障碍、污名化和歧视，特别是在精神卫生部门，进一步限制了获得医疗保健的机会。制度障碍包括复杂的官僚程序和明显缺乏资源，包括未能认识到移民对精神保健需求的紧迫性。
本研究阐明了阻碍为移民提供公平的精神保健服务的多方面、系统性挑战。它认为，必须进行全面的政策改革，倡导实施增加语言服务的提供、提高医疗服务提供者的能力以及法律框架和政策改革以提高包容性等战略。这些发现通过提供一个跨学科和国际视角来看待流离失所人口获得精神保健服务的障碍，为学术讨论做出了重大贡献。
