Mental health care for irregular migrants in Europe: Barriers and how they are overcome

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Providing medical care for undocumented migrants in Denmark: what are the challenges for health professionals?

<p>Abstract</p> <p>Background</p> <p>The rights of undocumented migrants are frequently overlooked. Denmark has ratified several international conventions recognizing the right to health care for all human beings, but has very scanty legislation and no existing policies for providing health care to undocumented migrants. This study focuses on how health professionals navigate and how they experience providing treatment for undocumented migrants in the Danish health care system.</p> <p>Methods</p> <p>The study was carried out as part of an EU-project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). This presentation is based on 12 semi-structured interviews with general practitioners (9) and emergency room physicians (3) in Denmark.</p> <p>Results</p> <p>The emergency room physicians express that treatment of undocumented migrants is no different from the treatment of any other person. However, care may become more complicated due to lack of previous medical records and contact persons. Contrary to this, general practitioners explain that undocumented migrants will encounter formal barriers when trying to obtain treatment. Additional problems in the treatment of undocumented migrants include language issues, financial aspects for general practitioners, concerns about how to handle the situation including possibilities of further referrals, and an uncertainty as to whether to involve the police.</p> <p>Conclusions</p> <p>The health professionals in our study describe that undocumented migrants experience an unequal access to primary care facilities and that great uncertainties exist amongst health professionals as how to respond in such situations. The lack of official policies concerning the right to health care for undocumented migrants continue to pass on the responsibility to health professionals and, thereby, leaves it up to the individual to decide whether treatment can be obtained or not.</p

Health care for irregular migrants: pragmatism across Europe. A qualitative study

<p>Abstract</p> <p>Background</p> <p>Health services in Europe face the challenge of delivering care to a heterogeneous group of irregular migrants (IM). There is little empirical evidence on how health professionals cope with this challenge. This study explores the experiences of health professionals providing care to IM in three types of health care service across 16 European countries.</p> <p>Results</p> <p>Semi-structured interviews were conducted with health professionals in 144 primary care services, 48 mental health services, and 48 Accident & Emergency departments (total n = 240). Although legal health care entitlement for IM varies across countries, health professionals reported facing similar issues when caring for IM. These issues include access problems, limited communication, and associated legal complications. Differences in the experiences with IM across the three types of services were also explored. Respondents from Accident & Emergency departments reported less of a difference between the care for IM patients and patients in a regular situation than did respondents from primary care and mental health services. Primary care services and mental health services were more concerned with language barriers than Accident & Emergency departments. Notifying the authorities was an uncommon practice, even in countries where health professionals are required to do this.</p> <p>Conclusions</p> <p>The needs of IM patients and the values of the staff appear to be as important as the national legal framework, with staff in different European countries adopting a similar pragmatic approach to delivering health care to IM. While legislation might help to improve health care for IM, more appropriate organisation and local flexibility are equally important, especially for improving access and care pathways.</p

To frame the unframable: quantifying irregular migrants' presence

For various reasons, irregular migration has become a more frequent phenomenon during the last decades. Until recently, there was only a limited amount of scientific research on this topic. But these days, humanitarian and social problems related to this fast growing group of people give a boost to political discussion and subsequently to scientific research. Both politicians and scientists want to ‘grab’ the situation and to acquire an overview of what is happening. Major questions have predominantly a quantitative character. Estimating the number of irregular migrants in a country is in most cases the base to deal with emerging problems. For these estimations, a large number of different methods is brought into action. Unfortunately, these bring forth rather feeble results partially as a consequence of a large margin of error. Nevertheless, the latter does not seem to be an objection to base policy on these with far-reaching implications. More in particular, I will focus on a methodological question concerning estimations of irregular migrant numbers, i.e. the problematic character of conceptualizations. This problem will be treated in two different ways. First, different definitions of people without legal residence (irregular/illegal/unauthorized/undocumented migrants, refugees,…) lead to specific ways of conceptualizing the problem. The latter is problematic as both applying different concepts and using these concepts differently can influence the statistical outcomes to a large extent. This will finally lead to different conclusions and recommendations. The target group ‘irregular migrants’ is exemplary to underline the importance of conceptual demarcation; furthermore, definitions frequently have emotive connotations, they are often unclear and they are used in various ways. The insight that it is impossible to derive concepts from empirical data implies the incomparability of a lot of research data and outcomes. Secondly, there is the danger that is intrinsic to reducing (the complexity of) a large amount of data to a limited number of differences. Restricting the degrees of freedom to obtain more accurate data takes away the possibility of making distinctions that are often desirable. It unavoidably implies a tendency towards homogenization. In the case of irregular migrants, their ‘irregularity’ or illegal residence is the benchmark of categorization. How diverse the particular circumstances of these people may be, is often ignored (cf. e.g. nationality, religion, culture but as well personal experiences or reasons for taking refuge) and policy treats them as a monolithic group of people. To conclude, not only the adequateness of the adapted methods will be questioned. Moreover, we have to wonder to what extent the questions put forward by policy makers and researchers ‘make sense’ to deal with the experienced problems at stake. Why are these questions so attractive and apparently self-evident to deal with the situation we come across with