Mental health and undocumented migrants in Portugal

Abstract

Purpose While awaiting resolution of their legal process, undocumented migrants (UM) face several challenges, including limited access to public health care. The purpose of this paper is to survey UM attending a detention centre in Oporto (Portugal) to estimate the prevalence of mental health disorders in this population. Design/methodology/approach A retrospective chart review was performed with the relevant sociodemographic and clinical data of all UM in the process of coercive removal from Portuguese territory, observed by Doctors of the World, during three years (2014–2016). The Tenth Version of International Classification of Mental and Behavioural Disorders was used for nosological classification. Findings In total, 393 detainees were eligible for the study. Most detainees were male (84 per cent) and 76 months was the mean length of stay in Portugal before detention. In total, 29 per cent of detainees were diagnosed with a mental and behavioural disorder. The most prevalent diagnosis was neurotic, stress-related and somatoform disorders (47 per cent). UM with dual diagnosis (28 per cent) led to the articulation with the integrated centres of drug addiction, which provided and monitored opioid substitution therapy. Female UM were more prone to develop any mental and behavioural disorder when compared to men (χ2=7,017; p<0.05). Research limitations/implications In total, 9 per cent of the detainees were excluded from this study due to incomplete data on their medical charts. Some detainees presented oppositional behaviour, hostility towards others and refused to be assessed by the medical team. Both situations could have biased the prevalence of mental disorders. Finally, the appropriateness of the western model of mental health disorders (ICD-10) in the study population is controversial, considering the culture-bound phenomenology and syndromes. Originality/value This paper identified the most prevalent mental health disorders in UM detained in Portugal. The most prevalent mental health disorders were either stress-related (associated with the detention itself) or related to previous patterns of substance abuse. Given the study outcomes, it is highly recommended to mobilise human and technical resources to provide specialized mental health care to UM at least while detention policies could not be changed.

Contemporary Migrant Health Experience and Unique Health Care Needs in European Prisons and Immigration Detention Settings

“…The majority of the literature referred to the UK (n=7) (Arshad et al, 2018;Dexter & Katona, 2018;Hollis, 2019;Sen et al, 2018;Sen et al, 2014;Smith, 2017;Till et al, 2019). Of the eight remaining: three were based in Sweden (Puthoopparambil, Ahlberg, et al, 2015a, 2015bPuthoopparambil, Bjerneld, et al, 2015) one in Spain (Ruiz-García & Castillo-Algarra, 2014); one in Portugal (Santos et al, 2018); one at a Greek-Turkish border (Eonomopoulou et al, 2017); one in the Benelux countries Belgium, the Netherlands and Luxembourg (Puthoopparambil & Bjerneld, 2016) and one referred to the EU as a whole (Mulgrew, 2016). There were five qualitative studies using interviews (Arshad et al, 2018;Hollis, 2019;Puthoopparambil, Ahlberg, et al, 2015a, 2015bRuiz-García & Castillo-Algarra, 2014); three review articles (Mulgrew, 2016;Sen et al, 2014;Till et al, 2019); two case studies (Puthoopparambil & Bjerneld, 2016;Santos et al, 2018); one feasibility study (Sen et al, 2018); one prospective study (Eonomopoulou et al, 2017); one correspondence (Smith, 2017); one cross-sectional study using a questionnaire (Puthoopparambil, Bjerneld, et al, 2015) and one editorial (Dexter & Katona, 2018).…”

“…Included records represented different populations with either direct experience as a detained migrant or as staff: foreign female prisoners (Ruiz-García & Castillo-Algarra, 2014); detainees in immigration removal centres (IRC) (Dexter & Katona, 2018;Hollis, 2019;Sen et al, 2018;Smith, 2017); pregnant migrant women in detention centres (Arshad et al, 2018); detention staff (Puthoopparambil, Ahlberg, et al, 2015a); FNPs (Mulgrew, 2016;Sen et al, 2014;Till et al, 2019); undocumented migrants in detention centre (Santos et al, 2018); newly arrived migrants in holding centres (Eonomopoulou et al, 2017); immigrant detainees, mostly refused asylum seekers, in immigration detention centres (Puthoopparambil, Ahlberg, et al, 2015b;Puthoopparambil & Bjerneld, 2016;Puthoopparambil, Bjerneld, et al, 2015) and staff and immigrant detainees in detention centre (Puthoopparambil & Bjerneld, 2016). Records were also diverse in terms of combinations of perspectives and focus; with four addressing experiences, conditions and health care access (Arshad et al, 2018;Hollis, 2019;Puthoopparambil, Ahlberg, et al, 2015b;Ruiz-García & Castillo-Algarra, 2014); five focusing on conditions and health care access (Dexter & Katona, 2018;Eonomopoulou et al, 2017;Santos et al, 2018;Sen et al, 2014;Till et al, 2019); five focusing solely on health care access (Mulgrew, 2016;Puthoopparambil & Bjerneld, 2016;Puthoopparambil, Bjerneld, et al, 2015;Sen et al, 2018;Smith, 2017); and one solely on experiences (Puthoopparambil, Ahlberg, et al, 2015a). The diversity of included records and subsequent findings illustrate how the vas...…”

“…were described in some publications as particularly sub-standard and potentially breaching the human rights of migrants (Dexter & Katona, 2018;Hollis, 2019;Mulgrew, 2016;Smith, 2017;Till et al, 2019). Immigration detention centres in Sweden, Portugal, Greek/Turkish border, and in the UK were described as overcrowded, unsanitary, unsafe and lacking in adequate nutrition, safe drinking water, privacy and access to health supports (Eonomopoulou et al, 2017;Puthoopparambil, Ahlberg, et al, 2015b;Santos et al, 2018;Till et al, 2019). The presence of mental health problems appeared to be particularly and adversely impacted by such detention conditions (Arshad et al, 2018;Hollis, 2019;Sen et al, 2018;Sen et al, 2014;Till et al, 2019).…”

“…They couldn't give you food in the room" (Hollis, 2019, p. 80) Theme Two: Communication challenges, isolation and poor mental health Communication difficulties were closely interlinked with poor mental health and the worsening of underlying mental health issues of migrants in prisons and immigration detention settings. High levels of mental health problems experienced amongst migrants were reported in thirteen studies (Arshad et al, 2018;Dexter & Katona, 2018;Eonomopoulou et al, 2017;Hollis, 2019;Mulgrew, 2016;Puthoopparambil, Ahlberg, et al, 2015a;Puthoopparambil, Bjerneld, et al, 2015;Ruiz-García & Castillo-Algarra, 2014;Santos et al, 2018;Sen et al, 2018;Sen et al, 2014;Smith, 2017;Till et al, 2019). Ten clearly acknowledged the severity of mental health needs of migrants, which were often undiagnosed prior to intake/committal, and unmet thereafter (Dexter & Katona, 2018;Eonomopoulou et al, 2017;Mulgrew, 2016;Puthoopparambil & Bjerneld, 2016;Puthoopparambil, Bjerneld, et al, 2015;Santos et al, 2018;Sen et al, 2018;Sen et al, 2014;Smith, 2017;Till et al, 2019).…”

Gender, Vulnerability and Everyday Resistance in Immigration Detention: Women’s Experiences of Confinement in a Portuguese Detention Facility

“…As far as Portugal is concerned, information about immigration detention is particularly scant. Not only has very little research been produced on migrant detention (for exceptions see Sacramento and Ribeiro 2011;Santos et al 2018), but also public debate on this topic is almost non-existent (for exceptions see Gorjão Henriques 2018a, 2018b). 2 Unsurprisingly, nobody has (yet) explicitly addressed gender issues.…”