PUB - Publikationen an der Universität Bielefeld

As a result of multiple traumas and stressors experienced before, during, and after migration, a significant proportion of refugees are at risk of developing mental health problems. If untreated, severe mental illness often persists for years. The detrimental impact of untreated mental health problems on affected individuals, their families, and communities underscores the importance of available and accessible mental health services for refugees. However, even in high-income countries with well-established mental health systems, there is evidence of a significant gap between the mental health needs and treatment for refugee populations. Several barriers to accessing mental health care for refugees in high-income countries have been identified in previous research and are summarized in this dissertation in an overview of systematic and scoping reviews. The studies conducted as part of this dissertation shed further light on relevant barriers and provide additional data on access to mental health care for refugees in Germany. Specifically, the studies encompassed detailed investigations of rates of mental health service use among refugees (Article 1) and relations with demand-side factors, such as the perceived need for treatment (Article 1) and explanatory models of mental illness (Article 2). In addition, the studies examined rates of mental health treatment provision to refugee patients (Article 3) and associations with supply-side barriers, including providers' perceptions of practical barriers (Article 3) and their attitudes toward refugees (Article 4). The findings demonstrate the importance of more comprehensive and contextualized assessments to provide robust information on indicators of mental health service use among refugee populations and to rigorously test prevailing assumptions about barriers to accessing mental health care. Furthermore, the current findings shift the focus from demand-side to supply-side barriers, highlighting the need to consider systemic factors and structural determinants, such as health policies and the role of mental health professionals as gatekeepers to care. In this context, our findings have important practical implications for promoting equity and efficiency in access to mental health care for refugees in high- income countries such as Germany.