Perceived barriers to care for migrant children and young people with mental health problems and/or neurodevelopmental differences in high-income countries: a meta-ethnography

Abstract

ObjectivesTo develop conceptual understanding of perceived barriers to seeking care for migrant children and young people (aged 0–25 years) with mental health problems and/or neurodevelopmental differences in high-income countries.DesignQualitative evidence synthesis using meta-ethnography methodology. We searched four electronic databases (Medline, PsycINFO, Global Health and Web of Science) from inception to July 2019 for qualitative studies exploring barriers to care (as perceived by migrant communities and service providers) for migrant children and young people in high-income countries with neurodevelopmental differences and/or mental health problems. The quality of included studies was explored systematically using a quality assessment tool.ResultsWe screened 753 unique citations and 101 full texts, and 30 studies met our inclusion criteria. We developed 16 themes representing perceived barriers to care on the supply and demand side of the care-seeking process. Barriers included: stigma; fear and mistrust of services; lack of information on mental health and service providers lacking cultural responsiveness. Themes were incorporated into Levesque et al’s conceptual framework of patient-centred access to healthcare, creating a version of the framework specific to migrant children and young people’s mental health and neurodevelopmental differences.ConclusionsThis is the first qualitative evidence synthesis on barriers to care for mental health problems and/or neurodevelopmental differences in migrant children and young people in high-income countries. We present an adapted conceptual framework that will help professionals and policy-makers to visualise the complex nature of barriers to care, and assist in improving practice and designing interventions to overcome them. Similar barriers were identified across study participants and migrant populations. While many barriers were also similar to those for children and young people in general populations, migrant families faced further, specific barriers to care. Interventions targeting multiple barriers may be required to ensure migrant families reach care.

Predisposing, need and enabling factors for service utilization amongst newly arrived youth in Sweden

“…A large limitation of the study was the lack of additional relevant variables for assessing health-care utilization. Research has pointed out the complexities of needs and utilization of care, and the circular process of care-seeking rather than a linear relationship between need and utilization (Place et al , 2021). This corresponds to both supply-side factors, such as approachability, acceptability, availability and appropriateness, as well as demand-side factors such as ability to seek, reach and engage.…”

Are all children treated equally? Psychiatric care and treatment receipt among migrant, descendant and majority Swedish children: a register-based study

“…The discrepancies in terms of treatment receipt were larger between migrant and Swedish majority children, than between descendent and Swedish majority children, which is consistent with findings that psychiatric care use is higher among descendent refugee children compared to newly arrived refugee children (Berg et al ., 2020). Given that research has shown that migrant children may face multiple barriers to psychiatric care, including communication and cultural barriers, as well as limited knowledge of the mental health care system among parents (Place et al ., 2021), it is conceivable that families with children who are born in Sweden may be better able to navigate the mental health care system and to overcome barriers, compared to more recently arrived migrant families. Lack of knowledge of the Swedish language should not formally restrict the receipt of certain types of treatments, such as psychotherapy, which should be offered with the help of interpreters, but such obstacles may of course nonetheless exist.…”

“…Immigrant parents may be less likely to accept psychotropic drug treatments compared to the majority parents (Guzder et al ., 2013), while psychotherapy adapted to transcultural encounters may better meet the needs of migrant children (Grau et al ., 2020). Most studies, however, have focused on barriers to accessing care, and therefore, we do not know how saliently reported barriers such as stigma, language obstacles, lack of knowledge of services, perceived lack of cultural sensitivity among providers, etc., (Place et al ., 2021) relate to the provision and/or acceptance of treatments for those who overcome barriers to accessing care.…”

Developing a Collaborative Approach to Support Access and Acceptability of Mental Health Care for Refugee Youth: An Exploratory Case Study with Young Afghan Refugees

“…In spite of this elevated morbidity risk, studies consistently document how young refugees have fewer contacts with mental health services than host country youth [ 17 , 18 , 19 , 20 ]. This underutilization is explained by the complex interplay of barriers to access and engagement in mental health services for refugee communities [ 21 , 22 , 23 ].…”