Access to mental healthcare for refugees, asylum seekers and migrants: an umbrella review of barriers

Abstract

Objective: To identify the factors that prevent or hinder access to mental healthcare services for refugees, asylum seekers and migrants.

Design: An umbrella review was conducted on scoping reviews, systematic reviews, meta-analyses and meta-syntheses published between January 2013 and December 2023.

Data sources: The databases searched (on 11 December 2023) included PubMed (via NCBI, including MEDLINE), Embase (via Embase.com), Web of Science Core Collection, Scopus and the Cochrane Database of Systematic Reviews (via Cochrane Library). Search strings were categorised as concepts, wherein concept one was population (refugees, asylum seekers and migrants), concept two was mental health services and concept three was the type of review (systematic review, meta-analysis, scoping review or literature review).

Eligibility criteria for selecting studies: Reviews were included if study participants were refugees, asylum seekers and migrants. Additionally, mental health-providing services or organisations and mental health providers were included. Excluded study participants were people with a migration background and second- or third-generation migrants.

Data extraction and synthesis: Two independent reviewers screened the identified articles on title and abstract. The 48 full-text articles were assessed in detail against inclusion and exclusion criteria by the two researchers and one person from the Belgian Superior Health Council.

Results: 18 reviews were included. The extensive literature review identified various factors that prevent and restrict access to mental healthcare services for individuals with a recent migration background. Among the eight concepts of barriers, the most frequently mentioned were stigma and stigmatisation, language and communication challenges, financial obstacles, cultural barriers (including religious beliefs and faith) and issues with service delivery. Additionally, differences in culture, education and gender were recognised as factors limiting access to mental health services. Recommendations for policy and practice included implementing a multidisciplinary and multi-agency approach to facilitate access for newly arriving migrants and refugees, increasing financial allocations for translation and interpretation services, enabling policies to promote mental health utilisation and introducing educational programmes at the grassroot level among migrants and refugees.

Conclusion: Policy implementation should address the identified barriers and be routinely assessed for efficacy in service delivery and uptake. Future research should focus on enabling the utilisation of mental healthcare services among migrants, asylum seekers, and refugees.

Keywords: Health Services Accessibility; MENTAL HEALTH; PSYCHIATRY; PUBLIC HEALTH; Refugees.

Figure 1. PRISMA flowchart. Umbrella review selection process. This figure is a flowchart of the selection process of the articles included in the umbrella review. We systematically searched five databases, which resulted in a total of 3886 records. After the duplicates were removed (n=1835), we had 2033 articles left to be screened on title and abstract. This screening was carried out by two independent researchers and resulted in 1985 articles that were removed. The remaining 48 articles were assessed full text for eligibility. We excluded 30 more articles. The remaining 18 articles were assessed for eligibility by critical appraisal. No articles were excluded in this process. No articles were added from the reference lists either. 18 articles were included in the umbrella review.