背景:强迫位移是全球范围内的重要问题,它在2022年影响了1.12亿人。其中许多人在低收入和中等收入国家找到了避难所。移民和难民面临复杂和特殊的健康挑战,特别是在心理健康方面。这项研究旨在对移民在德国获得精神卫生服务时面临的多层次障碍进行深入的定性评估,澳门(中国特别行政区),荷兰,罗马尼亚,和南非。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。
方法:坚持定性研究范式,这项研究以利益相关者的观点为中心,跨越微系统,介观系统,和医疗保健的宏观系统。利用有目的的抽样方法,来自上述地理位置的主要线人进行了半结构化访谈。数据在演绎归纳方法的指导下进行了主题内容分析。
结果:该研究揭示了三个关键的主题障碍:语言和交流障碍,文化障碍,和系统约束。缺乏专业口译员普遍加剧了所有国家的语言障碍。文化障碍,污名化,歧视,特别是在精神卫生部门,被发现进一步限制了获得医疗保健的机会。系统性障碍包括官僚错综复杂和明显缺乏资源,包括未能认识到移民精神保健需求的紧迫性。
结论:这项研究阐明了多方面的,系统性挑战阻碍了为移民提供公平的精神医疗服务。它认为全面的政策改革势在必行,倡导实施战略,例如增加语言服务的可用性,提高医疗保健提供者的能力,以及法律框架和政策变化,以更具包容性。这些发现通过提供跨学科和国际视角来探讨流离失所者获得精神保健的障碍,从而为学术话语做出了重大贡献。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.