The role of psychotherapists' perceived barriers in providing psychotherapy to refugee patients

Psychotherapists' readiness to treat PTSD: the influence of refugees' country of origin

Background: Previous research suggests that psychotherapists' readiness to treat traumatized patients varies according to patient and therapist characteristics, including the patient's refugee background.Objective: This study aims to examine the relationship between psychotherapists' readiness to treat patients with symptoms of post-traumatic stress disorder and various patient and therapist characteristics, including refugee background and country of origin.Method: In our vignette study with a nationwide online survey in Germany (N = 871), we assessed the readiness of licensed psychotherapists (LPTs) and therapists in training (PiTs) to treat patients with PTSD. Vignettes described patients with PTSD who differed in gender, refugee background, and country of origin (Syria vs. Ukraine). Participants rated treatment readiness and expected treatment success based on the vignette they received.Results: Treatment readiness and expected success were significantly lower for refugee patients. There was no difference in treatment readiness between refugees from Syria and Ukraine, but therapists expected less therapeutic success for Syrian patients compared to Ukrainian patients. Gender did not influence the results.Conclusions: The study shows that refugee background and country of origin influence psychotherapists' readiness to treat PTSD and their expectations of treatment success. These findings highlight potential reasons for the undertreatment of refugees and suggest opportunities for intervention and training, such as informing therapists about effective treatments for refugee patients.

Psychotherapists' Readiness to Treat Refugee Patients and the Influence of Professional Quality of Life: A Cross-Sectional Vignette Study

BACKGROUND

Previous research has shown that psychotherapists' characteristics influence their readiness to treat refugee patients. The impact of therapists' professional quality of life (ProQOL) regarding their treatment readiness for refugee patients is unknown.

OBJECTIVE

This study aims to evaluate the ProQOL among psychotherapists in Germany. It examines how these factors and previous experience working with refugees affect psychotherapists' treatment readiness for refugee patients with symptoms of post-traumatic stress disorder (PTSD).

METHOD

In our study, we assessed the treatment readiness of licensed psychotherapists (LPTs) and psychotherapists in training (PiTs) using randomized refugee verus nonrefugee vignettes. Participants (N = 821) rated their treatment readiness for the presented case, reported their professional quality of life on the ProQOL questionnaire as well as prior experience with psychotherapy for refugees.

RESULTS

The ProQOL differed significantly between therapists with and without experience treating refugees: Compassion satisfaction was higher, and burnout lowers for those who had already treated refugees. Overall, treatment readiness was lower for refugee than for nonrefugee patients. Therapists with prior experience of working with refugees reported a significantly higher treatment readiness for the refugee vignette. Treatment readiness was not affected by the reported ProQOL.

CONCLUSIONS

Treatment experience with refugees did not negatively impact therapists' ProQOL but fostered their further treatment readiness for this specific patient group. Psychotherapists should be encouraged to gain initial treatment experience with refugees to improve long-term health care for refugees. Encouragement could be achieved by providing supervision or specialist training.

Barriers to accessing mental health care for refugees and asylum seekers in high-income countries: A scoping review of reviews mapping demand and supply-side factors onto a conceptual framework

This study undertakes a scoping review of reviews on barriers to accessing mental health care for refugees and asylum seekers in high-income countries. By assessing mental health care access using the Levesque's conceptual framework, we identify barriers along the patient care pathway and highlight research gaps. Following PRISMA-ScR guidelines, 10 relevant systematic and scoping reviews were identified and analyzed. Seven common barriers were identified, that could be located across different stages of the conceptual framework. Demand-side barriers included: (1) refugees' understanding of mental illness, (2) fear of stigma, (3) lack of awareness of services, (4) attitudes towards formal treatment; while supply-side barriers comprised: (5) language barriers, (6) practical and structural issues, and (7) providers' attitudes and competence. There was a focus on demand-side barriers as key determinants for low service use. We observed a paucity of quantitative studies linking barriers and indicators of access to care. In the context of well-established mental health care systems, previous research has largely explained low access through peculiarities of refugees and asylum seekers, thereby neglecting the role of supply-side factors (including system structures and attitudes of service providers). We discuss how future research can critically question prevailing assumptions and contribute to rigorous evidence.

Low access and inadequate treatment in mental health care for asylum seekers and refugees in Germany-A prospective follow-up study over 12 months and a nationwide cross-sectional study

Refugees experience elevated rates of mental health problems, but little is known about mental health service utilization and quality among asylum seekers and refugees in Europe. In a 12-month follow-up study of newly arrived refugees (N = 166, Mage = 32.38 years, 30.7% female) and a nationwide cross-sectional study (N = 579, Mage = 33.89 years, 36.2% female) of refugees who had been living in Germany for an average of 6 years, we examined objective need for mental health treatment, perceived need, access to treatment services, and adequacy of treatment. We defined minimally adequate mental health treatment according to the WHO World Mental Health Survey as ≥8 sessions of psychotherapy (minimally adequate psychotherapy) or pharmacotherapy plus ≥4 medical visits (minimally adequate pharmacotherapy). In both studies, two in three individuals screened for mental health symptoms and additionally perceived a need for professional treatment. Of those, less than half had contact to any service provider, with only 1 in 14 receiving minimally adequate psychotherapy. Overall, no more than one in seven of refugees in need received minimally adequate treatment. Despite a comprehensive mental health-care system, refugees' access to mental health care and the treatment provided are inadequate. Health policies are urgently needed to provide equitable mental health care for all.