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Global Mental Health and Services for Migrants in Primary Care Settings in High-Income Countries: A Scoping Review.

ABSTRACT: Migrants are at a higher risk for common mental health problems than the general population but are less likely to seek care. To improve access, the World Health Organization (WHO) recommends the integration of mental health services into primary care. This scoping review aims to provide an overview of the types and characteristics of mental health services provided to migrants in primary care following resettlement in high-income countries. We systematically searched MEDLINE, EMBASE, PsycInfo, Global Health, and other databases from 1 January 2000 to 15 April 2020. The inclusion criteria consisted of all studies published in English, reporting mental health services and practices for refugee, asylum seeker, or undocumented migrant populations, and were conducted in primary care following resettlement in high-income countries. The search identified 1627 citations and we included 19 studies. The majority of the included studies were conducted in North America. Two randomized controlled trials (RCTs) assessed technology-assisted mental health screening, and one assessed integrating intensive psychotherapy and case management in primary care. There was a paucity of studies considering gender, children, seniors, and in European settings. More equity-focused research is required to improve primary mental health care in the context of global mental health.

SUBMITTER: Lu J

PROVIDER: S-EPMC7699722 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Global Mental Health and Services for Migrants in Primary Care Settings in High-Income Countries: A Scoping Review.

Lu Jia J Jamani Shabana S Benjamen Joseph J Agbata Eric E Magwood Olivia O Pottie Kevin K

International journal of environmental research and public health 20201120 22

Migrants are at a higher risk for common mental health problems than the general population but are less likely to seek care. To improve access, the World Health Organization (WHO) recommends the integration of mental health services into primary care. This scoping review aims to provide an overview of the types and characteristics of mental health services provided to migrants in primary care following resettlement in high-income countries. We systematically searched MEDLINE, EMBASE, PsycInfo, ...[more]

PMID: 33233666

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Project description:AimsThis systematic review compiled evidence on interventions to reduce mental health-related stigma in primary health care (PHC) in low- and middle-income countries (LMICs). Studies targeting PHC staff (including non-professionals) were included. Primary outcomes were stigmatising attitudes and discriminatory behaviours.MethodsData collection included two strategies. First, previous systematic reviews were searched for studies that met the inclusion criteria of the current review. Second, a new search was done, covering the time since the previous reviews, i.e. January 2013 to May 2017. Five search concepts were combined in order to capture relevant literature: stigma, mental health, intervention, PHC staff and LMICs. A qualitative analysis of all included full-texts was done with software MAXQDA. Full-texts were analysed with regards to the content of interventions, didactic methods, mental disorders, cultural adaptation, type of outcome measure and primary outcomes. Furthermore, a risk of bias assessment was undertaken.ResultsA total of 18 studies were included. Risk of bias was rated as high in most included studies. Only six studies had tested their intervention against a control condition, two of which had used random allocation. Most frequently used interventions were lectures providing theoretical information. Many studies also used interactive methods (N = 9), discussed case studies (N = 8) or used role plays (N = 5). Three studies reported that they had used clinical practice and supervision. Results of these studies were mixed. No or little effects were found for brief training interventions (e.g. 1 h to 1 day). Longer training interventions with more sophisticated didactic methods produced statistically significant changes in validated stigma questionnaires. These results have to be interpreted with caution due to risk of bias. Methods for cultural adaptation of interventions were rarely documented.ConclusionsMore rigorous trials are needed in LMICs to test interventions that target discriminatory behaviours in relationship with patients. Cultural adaptation of stigma interventions and structural/institutional factors should be more explicitly addressed in such trials.

Project description:IntroductionRegional, rural, and remote people represent nearly half the world's population yet experience disproportionally higher disease, mortality, and disability rates, coupled with limited healthcare access. Occupational therapy has committed to occupational justice, yet no descriptive framework of services provided by occupational therapists in non-urban locations exists. Understanding current non-urban service practices will provide a basis for non-urban service development and research to reduce this inequity.MethodsFour databases were systematically searched for publications describing non-urban occupational therapy services, from any country, written in English, French, Portuguese, or Spanish, from 2010 to 2020. Publications were screened against criteria for inclusion, and data were identified using an extraction tool and presented in a frequency table, on a map, and in a searchable supporting information Table S1.ResultsOnly 117 publications were included discussing services provided to populations across 19 countries. They were mostly published in English (98%) and about populations from English-speaking countries (70%). Included publications discussed individualist services (65%), for defined age groups (74%), and for people with specific medical diagnoses (58%). Services were commonly provided in the client's community (56%), originating from urban locations (45%) where the provider travelled (26%) or contacted clients using telehealth (19%). Individual 1:1 enabling strategies were most described (59%), including remediation (34%), compensation (9%), or education (7%). Community enablement strategies were infrequently described (14%), focused primarily on transformation to improve existing service delivery (9%), with some redistributive justice (3%), and one community development strategy (1%). Exploratory research services accounted for the remaining studies (27%). Differences were noted between Global North and South approaches.ConclusionGlobally, occupational therapy has limited focus on non-urban services and favours individualist rehabilitative strategies provided by therapists remote from the client's context. Further research is required on the effectiveness and appropriateness of occupational therapy strategies to improve rural/urban inequity and health outcomes.

Project description:IntroductionImproving reproductive, maternal, newborn, and child health (RMNCH) care services is imperative for reducing maternal and child mortality. Many low- and middle-income countries (LMICs) are striving to achieve RMNCH-related Sustainable Development Goals (SDGs). We monitored progress, made projections, and calculated the average annual rate of change needed to achieve universal (100%) access of RMNCH service indicators by 2030.MethodsWe extracted Demographic and Health Survey (DHS) data of 75 LMICs to estimate the coverage of RMNCH indicators and composite coverage index (CCI) to measure health system strengths. Bayesian linear regression models were fitted to predict the coverage of indicators and the probability of achieving targets.ResultsThe projection analysis included 64 countries with available information for at least 2 DHS rounds. No countries are projected to reach universal CCI by 2030; only Brazil, Cambodia, Colombia, Honduras, Morocco, and Sierra Leone will have more than 90% CCI. None of the LMICs will achieve universal coverage of all RMNCH indicators by 2030, although some may achieve universal coverage for specific services. To meet targets for universal service access by 2030, most LMICs must attain a 2-fold increase in the coverage of indicators from 2019 to 2030. Coverage of RMNCH indicators, the probability of target attainments, and the required rate of increase vary significantly across the spectrum of sociodemographic disadvantages. Most countries with poor historical and current trends for RMNCH coverage are likely to experience a similar scenario in 2030. Countries with lower coverage had higher disparities across the subgroups of wealth, place of residence, and women's/mother's education and age; these disparities are projected to persist in 2030.ConclusionNone of the LMICs will meet the SDG RMNCH 2030 targets without scaling up essential RMNCH interventions, reducing gaps in coverage, and reaching marginalized and disadvantaged populations.

Project description:OBJECTIVES:To identify a generic set of face valid quality indicators for primary care mental health services which reflect a multi-stakeholder perspective and can be used for facilitating quality improvement. DESIGN:Modified two-round postal Delphi questionnaire. SETTING:Geographical spread across Great Britain. PARTICIPANTS:One hundred and fifteen panellists representing 11 different stakeholder groups within primary care mental health services (clinical psychologist, health and social care commissioner, community psychiatric nurse, counsellor, general practitioner, practice nurse/district nurse/health visitor, psychiatrist, social worker, carer, patient and voluntary organisations). MAIN OUTCOME MEASURES:Face validity (median rating of 8 or 9 on a nine point scale with agreement by all panels) for assessing quality of care. RESULTS:A maximum of 334 indicators were rated by panels in the second round; 26% were rated valid by all panels. These indicators were categorised into 21 aspects of care, 11 relating to general practices and 10 relating to health authorities or primary care groups/trusts. There was variation in the total number of indicators rated valid across the different panels. Overall, GPs rated the lowest number of indicators as valid (41%, n=138) and carers rated the highest number valid (91%, n=304). CONCLUSIONS:The quality indicators represent consensus among key stakeholder groups in defining quality of care within primary care mental health services. These indicators could provide a guide for primary care organisations embarking on quality improvement initiatives in mental health care when addressing national targets and standards relating to primary care set out in the National Service Framework for Mental Health for England. Although many of the indicators relate to parochial issues in UK service delivery, the methodology used in the development of the indicators could be applied in other settings to produce locally relevant indicators.

Dataset Information

Global Mental Health and Services for Migrants in Primary Care Settings in High-Income Countries: A Scoping Review.

Publications

Global Mental Health and Services for Migrants in Primary Care Settings in High-Income Countries: A Scoping Review.

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