Mental health problems of undocumented migrants (UMs) in the Netherlands: a qualitative exploration of help-seeking behaviour and experiences with primary care

Abstract

ObjectiveTo explore health-seeking behaviour and experiences of undocumented migrants (UMs) in general practice in relation to mental health problems.DesignQualitative study using semistructured interviews and thematic analysis.Participants15 UMs in the Netherlands, varying in age, gender, country of origin and education; inclusion until theoretical saturation was reached.Setting4 cities in the Netherlands.ResultsUMs consider mental health problems to be directly related to their precarious living conditions. For support, they refer to friends and religion first, the general practitioner (GP) is their last resort. Barriers for seeking help include taboo on mental health problems, lack of knowledge of and trust in GPs competencies regarding mental health and general barriers in accessing healthcare as an UM (lack of knowledge of the right to access healthcare, fear of prosecution, financial constraints and practical difficulties). Once access has been gained, satisfaction with care is high. This is primarily due to the attitude of the GPs and the effectiveness of the treatment. Reasons for dissatisfaction with GP care are an experienced lack of time, lack of personal attention and absence of physical examination. Expectations of the GP vary, medication for mental health problems is not necessarily seen as a good practice.ConclusionsUMs often see their precarious living conditions as an important determinant of their mental health; they do not easily seek help for mental health problems and various barriers hamper access to healthcare for them. Rather than for medication, UMs are looking for encouragement and support from their GP. We recommend that barriers experienced in seeking professional care are tackled at an institutional level as well as at the level of GP.

Reporting mental health problems of undocumented migrants in Greece: A qualitative exploration

“…It indicates that many barriers were unrelated to the healthcare system. [3,5,23,24] The role of the employer, the obligatory consultation fee and the profound impact of austerity measures on the accessibility and quality of primary care are more specific for the Greek context. [19] As has also been reported in the Netherlands, Cretan GPs mentioned societal resistance to work with UMs and governmental measures to criminalize UMs.…”

“…[3] In particular, their psychological well-being is low: many feel lonely, lack emotional support, and suffer from anxiety, depression and stress. [3][4][5] Mental health is the most frequently reported health need but their access to professional care for mental health problems varies widely between the EU-member states, owing to differences in the healthcare system and legislation. [6][7][8] In Greece, UMs are entitled to receive only emergency care in case of life-threatening conditions; they are not entitled to have health insurance.…”

“…[3] Mental health problems in UMs are reported in the international (primary healthcare) literature, but little is known about the problems Greek GPs encounter in UMs. [3,5,[15][16][17] The aim of the study was to gain insight in how Greek GPs cope with UMs with mental health problems, the barriers and levers encountered and solutions applied. We anticipate that the results of this study will be useful for the policy makers when the primary healthcare reform is under development.…”

The mental healthcare needs of undocumented migrants: an exploratory analysis of psychological distress and living conditions among undocumented migrants in Norway

“…, Teunissen et al . ). Language barriers and cultural constraints are also shown to have significant impact on mental health of refugees in Norway (Tingvold et al .…”

“…, Teunissen et al . ), and may have an impact on undocumented migrants’ ability to apply for assistance as well as the health professionals’ ability to access their need for health care (Holmes ).…”