scholarly journals “Better than having no evaluation done”: Conducting Remote Asylum Evaluations for Clients in a Migrant Encampment in Mexico: A Pilot Project

2021 ◽  
Author(s):  
Ranit Mishori ◽  
Kathryn Hampton ◽  
Hajar Habbach ◽  
Elsa Raker ◽  
Anjali Niyogi ◽  
...  
Keyword(s):  
Mental Health ◽  
Asylum Seekers ◽  
Pilot Project ◽  
Immigration Detention ◽  
Cross Border ◽  
Post Evaluation ◽  
Rapport Building ◽  
Hard To Reach Populations ◽  
Evaluation Survey ◽  
Better Than

Abstract Background: Asylum evaluations are highly specialized medico-legal encounters which collect physical or mental health evidence, or both, and used in immigration proceedings. Although the field of asylum medicine is growing, access to these evaluations is still inadequate, particularly for asylum seekers in immigration detention or other forms of custody, such as under the Migrant Protection Protocols or “Remain in Mexico” policy. Given advances in telemedicine in recent years and growing evidence of similar outcomes with in-person treatment, it seems prudent to examine whether remote modalities may also be effective for conducting mental health asylum evaluations in hard-to-reach populations. Methods: We analyzed the comments of 12 clinicians who conducted a total of 25 cross-border remote mental health evaluations and completed a post-evaluation survey regarding their impressions and experiences. Results: Clinicians encountered a number of challenges including technical difficulties and a decreased ability to establish rapport. Nearly uniformly, however, clinicians noted that despite difficulties, they were able achieve the goals of the evaluation, including rapport building and diagnosis. Conclusion: remote evaluations appear to be non-inferior to in-person encounters and may be useful in expanding legal options for hard-to-reach asylum seekers.

scholarly journals “Better than having no evaluation done”: a pilot project to conduct remote asylum evaluations for clients in a migrant encampment in Mexico

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ranit Mishori ◽  
Kathryn Hampton ◽  
Hajar Habbach ◽  
Elsa Raker ◽  
Anjali Niyogi ◽  
...  
Keyword(s):  
Mental Health ◽  
Pilot Project ◽  
Post Evaluation ◽  
Evaluation Time ◽  
United States Immigration ◽  
Rapport Building ◽  
States Immigration ◽  
Hard To Reach Populations ◽  
Technical Issues ◽  
Better Than

Abstract Background Asylum evaluations are highly specialized medico-legal encounters to collect physical or mental health evidence for use in immigration proceedings. Although the field of asylum medicine is growing, access to these evaluations is still inadequate, particularly for those in United States immigration detention or other forms of custody, such as under the U.S. Migrant Protection Protocols or “Remain in Mexico” policy. Given advances in telehealth in recent years and growing evidence of similar outcomes with in-person management, it seems prudent to examine whether remote modalities may also be effective for conducting mental health asylum evaluations in hard-to-reach populations. Methods We analyzed the responses of 12 U.S. clinicians who conducted 25 cross-border remote mental health evaluations with clients in Mexico prior to the COVID-19 pandemic, and completed a post-evaluation survey regarding their impressions and experiences of the remote encounter. Data were coded through a process of thematic analysis. Results The average evaluation time was 2.3 h, slightly shorter than might be expected from an in-person encounter. Five themes emerged from the coding process: rapport building, achieving overall goal, comparison of in-person vs. remote, technical issues, and coordination. Clinicians encountered a number of challenges including technical difficulties and a decreased ability to establish rapport. Nearly uniformly, however, clinicians noted that despite difficulties, they were able achieve the goals of the evaluation, including rapport building and diagnosis. Conclusion Remote evaluations appear to achieve their intended goal and may be useful in expanding legal options for hard-to-reach asylum seekers.

scholarly journals 'Protection or punishment?' The implications of detention on the mental health and well-being of migrants, a review of the literature.

2020 ◽  
Author(s):  
Edward Stagg
Keyword(s):  
Mental Health ◽  
Health Outcomes ◽  
Asylum Seekers ◽  
Poor Mental Health ◽  
Mental Health Outcomes ◽  
Narrative Synthesis ◽  
Immigration Detention ◽  
The World ◽  
The Uk ◽  
The Impact

Background: The number of individuals forced to leave their home and seek asylum in other countries has risen alongside political instability, conflict and persecution in many parts of the world. These individuals are therefore extremely vulnerable. Many asylum-seekers have witnessed and experienced traumatic events that have contributed to mental illness. Detention is often used to incarcerate asylum-seekers who are waiting for asylum decisions to be made, however many are held in inadequate conditions for long periods of time. With governments using immigration detention increasingly more often, there are serious questions surrounding the impact this has on the mental health of detainees.Methods: A systematic review was undertaken using a comprehensive search strategy across six databases. Both qualitative and quantitative studies were included in the review providing that the mental health implications of immigration detention were explored or measured. Grey literature was also searched. The quality of the included studies were appraised and a narrative synthesis conducted in order to establish the main findings of the review. The results of the narrative synthesis were included in a conceptual model that explains how detention works to influence mental health. Results: 22 studies were included in the review. Six themes were identified from analysis of study findings from around the world. Five of those themes also occurred within studies conducted within the UK. In both the UK and globally: detention was associated with poor and deteriorating mental health outcomes; specific conditions inside detention centres were found to contribute to poor mental health; longer durations spent in detention were associated with poorer mental health outcomes; several negative behavioural and emotional responses to the detention experience were observed – particularly in children; the trauma of detention and mental health difficulties developed while in detention remained with individuals after release. In addition to these five themes, a higher number of relocations between detention centres contributed to greater mental distress among detainees outside the UK.Conclusions: This review provides evidence to suggest that an association exists between immigration detention and poor mental health outcomes and that many of the mediators of this relationship are universal. The findings of this paper have several implications for further research and policy. The UK must end indefinite detention and move towards alternative solutions for dealing with asylum-seekers. Detention should only be used as a last resort. Vulnerable individuals, such as children and individuals with existing mental health issues should never be detained. Finally, greater care should be taken to ensure that families with young children are not separated from one-another. Due to the implications of the findings included in this review, it is vital that scientific research of this type is allowed to continue. Future research must evaluate the feasibility and suitability of alternative policies to detention.

scholarly journals Moral Injury Related to Immigration Detention on Nauru: A Qualitative Study

2021 ◽  
Author(s):  
Sandra Passardi ◽  
Debbie Hocking ◽  
Naser Morina ◽  
Suresh Sundram ◽  
Eva Alisic
Keyword(s):  
Mental Health ◽  
Health Outcomes ◽  
Asylum Seekers ◽  
Health Impact ◽  
Moral Injury ◽  
Mental Health Outcomes ◽  
Immigration Detention ◽  
Policy Makers ◽  
Moral Frameworks ◽  
Refugees And Asylum Seekers

Background: Immigration detention is associated with detrimental mental health outcomes but little is known about the underlying psychological processes. Moral injury, the experience of transgression of moral beliefs, may play an important role. Objective: Our aim was to explore refugees’ and asylum seekers’ moral injury appraisals and associated mental health outcomes related to immigration detention on Nauru.Methods: We conducted in-depth interviews with 13 refugees and asylum seekers who had an experience of immigration detention on Nauru and lived in Australia after medical transfer. We used reflexive thematic analysis to develop themes from the data.Results: The participant statement “In my country they torture your body but in Australia they kill your mind.” conveyed key themes in our analysis. We describe 1) how participants’ home country experience and the expectation to get protection led them to seek safety in Australia; 2) how they experienced deprivation, trauma and dehumanisation after arrival, with the Australian government seen as the driving force behind these experiences; and 3) how these experiences led to feeling irreparably damaged.Conclusion: Our findings suggest that moral injury may be one of the mechanisms by which mandatory immigration detention can cause harm. Hence, refugees returned to Australia from offshore detention may benefit from interventions that specifically target moral injury. Our results highlight the potentially deleterious mental health impact of experiencing multiple subtle and substantial transgressions of one’s moral frameworks. Policy makers should incorporate moral injury considerations to prevent damaging refugee mental health.

Telepsychiatry - When Resources are Short

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
D. Mucic
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Asylum Seekers ◽  
Video Conferencing ◽  
Pilot Project ◽  
Prefer Treatment ◽  
Rural And Remote Areas ◽  
Audio Video ◽  
Resource Shortage

“Telepsychiatry” refers to video conferencing (interactive audio-video link in real-time where patient and doctor can both see and hear each other at the same time). Limited access to clinicians that have similar cultural and ethnic background decrease speed and accuracy of diagnosis and treatment (especially psychotherapeutic intervention). One solution to this problem is to give refugees, migrants and asylum seekers access to ethnic specialists by using Telepsychiatry.4 stations have been established in Denmark during pilot project in periode 2005-2007. The equipment has been installed in two hospitals, one asylum seekers centre and one social rehabilitation institution.Participants were mentally ill refugees, migrants and asylum seekers. 61 participants were involved in the assessment and/or treatment through 318 telepsychiatry provided remote consultations. They received mental health care by video-conferencing from providers who spoke participants ‘own language, i.e. without the assistance of interpreters.All participants were asked to fulfil 10-items satisfaction questionnaire after the end of Telepsychiatry contact. The most of participants would prefer treatment via Telepsychiatry than via interpreter.Aside from cross cultural patient population, Telepsychiatry can be used in order to provide mental health care towards domestic population in rural and remote areas with resource shortage.

Overcoming the deficiency of refugee mental health research

2019 ◽  
Author(s):  
Kristina Kalfic ◽  
Glenn Mitchell ◽  
Lezanne Ooi ◽  
Sibylle Schwab ◽  
Natalie Matosin
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health Research ◽  
Asylum Seekers ◽  
Scientific Discovery ◽  
Mental Health Research ◽  
Psychiatric Research ◽  
Risk And Resilience ◽  
Refugee Mental Health ◽  
Refugees And Asylum Seekers

The growing number of refugees and asylum seekers are one of the most significant global challenges of this generation. We are currently witnessing the highest level of displacement in history, with over 65 million displaced people in the world. Refugees and asylum seekers are at higher risk to develop mental illness due to their trauma and chronic stress exposures, and particularly post-migration stressors. Yet global and Australian psychiatric research in this area is greatly lacking, particularly with respect to our understanding of the molecular underpinnings of risk and resilience to mental illness in traumatised populations. In this Viewpoint, we explore the reasons behind the lack of refugee mental health research and use this context to propose new ways forward. We believe that scientific discovery performed with a multidisciplinary approach will provide the broad evidence-base required to improve refugee mental health. This will also allow us to work towards the removal of damaging policies that prolong and potentiate mental health deterioration among refugees and asylum seekers, which impacts not only on the individuals but also host countries’ social, economic and healthcare systems.

scholarly journals Mental health and resilience among Eritrean refugees at arrival and one-year post-registration in Switzerland: a cohort study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Afona Chernet ◽  
Nicole Probst-Hensch ◽  
Véronique Sydow ◽  
Daniel H. Paris ◽  
Niklaus D. Labhardt
Keyword(s):  
Mental Health ◽  
Asylum Seekers ◽  
Assessment Tools ◽  
Migration Route ◽  
Post Traumatic Stress ◽  
Hazardous Alcohol Use ◽  
Hazardous Alcohol ◽  
One Year ◽  
The One

Abstract Objective Eritrea is the most frequent country of origin among asylum seekers in Switzerland. On their journey through the desert and across the Mediterranean Sea, Eritrea refugees are often exposed to traumatizing experiences. The aim of this study is to assess the mental health status and resilience of Eritrean migrants in Switzerland upon arrival and one-year post-arrival, using standardized mental health screening and resilience assessment tools. Results At baseline, 107 refugees (11.2% female, median age 25) were interviewed: 52 (48.6%) screened positive for Post-Traumatic Stress Disorder (score ≥ 30), 10.3% for anxiety (≥ 10) and 15.0% for depression (≥ 10); 17.8% scored as risk/hazardous drinkers (≥ 8). The majority (94.4%) had a high resilience score (≥ 65). For one-year follow-up, 48 asylum seekers could be reached. In interviews 18 (38%) of these reported imprisonment in a transit country and 28 (58%) that they had witnessed the death of a close person along the migration route. At the one year assessment, rates of risky/hazardous alcohol use remained unchanged, rates of positive PTSD screening tended to be lower (50.0% (24/48) at baseline vs 25.0% (12/48) at follow-up), as were rates of positive screening for anxiety (8.3% vs 4.2%) and depression (14.6 vs 6.3%).

scholarly journals Learning to Detain Asylum Seekers and the Growth of Mass Immigration Detention in the United States

2021 ◽  
pp. 1-29
Author(s):  
Smita Ghosh ◽  
Mary Hoopes
Keyword(s):  
United States ◽  
Infectious Diseases ◽  
Cognitive Dissonance ◽  
Media Coverage ◽  
Asylum Seekers ◽  
Ad Hoc ◽  
The United States ◽  
Critical Component ◽  
Immigration Detention ◽  
Important Shift

Drawing upon an analysis of congressional records and media coverage from 1981 to 1996, this article examines the growth of mass immigration detention. It traces an important shift during this period: while detention began as an ad hoc executive initiative that was received with skepticism by the legislature, Congress was ultimately responsible for entrenching the system over objections from the agency. As we reveal, a critical component of this evolution was a transformation in Congress’s perception of asylum seekers. While lawmakers initially decried their detention, they later branded them as dangerous. Lawmakers began describing asylum seekers as criminals or agents of infectious diseases in order to justify their detention, which then cleared the way for the mass detention of arriving migrants more broadly. Our analysis suggests that they may have emphasized the dangerousness of asylum seekers to resolve the dissonance between their theoretical commitments to asylum and their hesitance to welcome newcomers. In addition to this distinctive form of cognitive dissonance, we discuss a number of other implications of our research, including the ways in which the new penology framework figured into the changing discourse about detaining asylum seekers.

scholarly journals Deterioration of housing environment and mental health of asylum seekers – a multi-level analysis

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Mohsenpour ◽  
L Biddle ◽  
K Bozorgmehr
Keyword(s):  
Mental Health ◽  
Internal Consistency ◽  
Odds Ratio ◽  
Asylum Seekers ◽  
Rapid Assessment ◽  
Living Environment ◽  
Generalized Anxiety ◽  
Rater Reliability ◽  
General Anxiety ◽  
Housing Environment

Abstract Background Asylum seekers arriving in Germany are assigned to a local district and an accommodation centre wherein. We developed and validated a six-item questionnaire for rapid assessment of housing deterioration and investigated its association with inhabitant mental health. Methods Using cross-sectional data from a state-wide survey in Germany, we applied a random-effects modelling approach to estimate the exposure effect of housing deterioration on depression and general anxiety among a random sample of asylum seekers, using validated instruments (GAD2/PHQ2) for outcome variables. Housing deterioration was assessed on six items (windows/glass, walls/roof, garbage, graffiti, outside spaces, overall living environment) resulting in a deterioration score as exposure of interest. Additionally, we assessed the instrument’s intra- and inter-rater reliability and internal consistency. Results Of the 412 asylum seekers living in 58 accommodation centres, 45.7% reported symptoms of depression and 45.0% suffered general anxiety. Most centres (76.7%) were based in urban municipalities and 45.7% of inhabitants were living in an accommodation centre hosting ≥51 inhabitants. Preliminary adjusted odds ratio for accommodation centres with highest deterioration (Q 4) was 2.07 (0.67-6.40) for generalized anxiety, compared to 1.17 (0.45-3.08) for centres with lowest deterioration (Q 1). For depression, preliminary odds ratio was 1.92 (0.87-4.27) compared to 1.26 (0.63-2.50). The validation study confirmed inter-/intra-rater reliability (Brennan-Prediger coefficient: 0.81 and 0.92, respectively) and internal consistency (Crohnbach’s α: 0.80). Conclusions There are higher odds ratios for generalized anxiety disorder and depression among asylum seekers based on higher deterioration of housing environment. A questionnaire for rapid deterioration assessment and identification of accommodations needing further evaluation has been developed and successfully validated. Key messages Deterioration of small-scale housing environment is associated with poorer mental health for asylum seekers living in accommodation centres. A highly reliable new tool has been developed for rapid assessment of deterioration status of accommodation centres and identification of those needing further evaluation.

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