Integration of refugees with mental disorders
Model project for the integration of refugees with mental disorders into the local regular health care system
Worldwide, approximately 80 million people are on the run - the highest number since the end of the Second World War. In Germany, currently about 1.1 million refugees applied for asylum [1]. The main countries of origin include Syria, Afghanistan, Iraq, Nigeria, Eritrea or Somalia. The National Academy of Sciences Leopoldina estimates that 40-50% of these individuals suffer from a trauma sequelae disorder and 25% of them need professional treatment [2] - 1,000 of circa 4,000 asylum seekers living in the district of Constance, need psychotherapeutic and/or psychiatric support.
There are clear barriers to the health insurance-financed regular care system, which go far beyond a lack of funding for language mediation. For example, in recent years, various studies by health insurance companies have found significantly lower utilization of services by psychotherapists among refugees compared to the population without a refugee background [3, 4].
A pilot project carried out in close collaboration with the non-profit non-governmental organization vivo international e.V. (www.vivo.org), a new model of care, coordinated psychotherapeutic treatment involving health sponsors (well-integrated persons from the refugees' countries of origin), has been established and tested at the community level since 2017 [5]. The project received support from the Hertie Foundation, the district of Constance, the cities of Constance, Singen and Radolfzell, and numerous other donors.
The following additional care components are implemented in the model project:
- Establishment of a municipal coordination office that manages registrations, free therapy capacities and a pool of language mediators and provides ongoing support to participating health mentors and therapists.
- The use of trained health mentors to provide outreach support for the utilization of psychotherapy in the care system.
- The development and funding of a pool of language mediators
- Regular further training and intervision offers for therapists (e.g. trauma therapy for refugees, working with language mediators, intercultural psychotherapy).
This project is co-funded by the Asylum, Migration and Integration Fund. With the help of this funding from the EU Asylum, Migration and Integration Fund (AMIF) and the district of Konstanz, the model project will be implemented on a larger scale in 2020 - 2022 and evaluated in several studies. The AMIF project "Psychotherapeutic treatment of asylum seekers: a model in regular health care system" is led by Dr. Michael Odenwald and Prof. Dr. Daniela Mier (PIs).
In a smaller sister project, run by the non-profit association vivo interational e.V. (www.vivo.org), the offer is supplemented for refugees without an AMIF funding.
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What we do? The integration project mediates and promotes the treatment of traumatized and psychologically stressed refugees in psychotherapy practices and outpatient clinics in the district of Constance and breaks down access barriers to the regular psychotherapeutic care system. A network of local partners (psychotherapy practices, outpatient clinics, ZfP Reichenau) and close cooperations with district authorities and municipalities, support the project.
Who can take advantage?
People with a refugee background of any age and gender who suffer from mental health problems. The insurance status is not relevant (AsylbLG or health card or health insurance). We clarify the specific need for help for all registered persons, provide information and arrange for suitable offers of help in the regular care system. In particular, the integration project supports and accompanies the group of refugees who can and want to take advantage of outpatient psychotherapy over a longer period of time in a variety of ways.
Procedure, registration, admission and support in the project:
A central coordination office coordinates registrations for refugees, conducts initial interviews and refers them to established therapists in the district of Constance. Trained health mentors from different countries support the patients during the waiting period and the therapy phase. They work as organizational and cultural mediators between therapists and refugees. Our health mentors receive training and regular supervision by trained psychologists.
References and publications
References
[1] United Nations High Commissioner for Refugees (2020). Global Report 2019. Geneva, Switzerland: UNHCR. Available at reporting.unhcr.org/publications
[2] Elbert T., Grüters-Kieslich A., Rösler F., et al. (2018). Traumatisierte Flüchtlinge – schnelle Hilfe ist jetzt nötig. Nationale Akademie der Wissenschaften Leopoldina, Halle (Saale).
[3] Bauhoff S. & Göpffarth D. (2018) Asylum Seekers in Germany differ from regularly insured in their morbidity, utilization and costs of care. PLOS ONE 13(5): e0197881.
[4] Schröder, H., Zok, K. & Faulbaum, F. (2018). Gesundheit von Geflüchteten in Deutschland. WIdO-Monitor 15(1): 1-20.
[5] Adorjan, K., Kluge, U., Heinz, A., Stamm, T., Odenwald, M., Dohrmann, K., Mokhtari-Nejad, R., Hasan, A., Schulze, T.G., Falkai, P. & Pogarell, O. (2017). Versorgungsmodelle für traumatisierte Flüchtlinge in Deutschland. Nervenarzt, 88(9), 989 – 994.
Publications
Bogatzki, L. (2021). Psychotherapeutische Regelversorgung für Geflüchtete. Psychotherapie Aktuell 4/21, 22 - 27.
Bogatzki, L. & Odenwald, M. (2023). Integration von Geflüchteten ins psychotherapeutische Versorgungssystem: Ein koordinierter Peer-Ansatz zur Überwindung von Zugangsbarrieren und Versorgungsdefiziten. Sozialpsychiatrische Informationen, 53(4), 37-40.
Bogatzki, L., Miredin, J., Millet, S., Lipinski, L., Molle, M., Rockstroh, B., Mier, D. & Odenwald, M. (2023). Konstanzer Modellprojekt für psychisch belastete Geflüchtete: Koordinierte Psychotherapeutische Behandlung unter Einbezug von Gesundheitspat*innen (KOBEG). Der Nervenarzt, published online: 11 August 2023. doi: 10.1007/s00115-023-01524-1
Conference contributions:
Odenwald, M. & Bogatzki, L. (2023). Ein diskriminierungsfreier Zugang zum Menschenrecht auf Gesundheit: Psychotherapie für Geflüchtete und andere benachteiligte Patient:innen. Symposium. 2. Deutscher Psychotherapie-Kongress, 10. – 13.05.2023, Berlin. https://deutscher-psychotherapie-kongress.de
Bogatzki, L. & Odenwald, M. (2023). Psychotherapie für Geflüchtete: Praktische Erfahrungen und Impulse bei der Integration einer besonders vulnerablen Patient:innengruppe in die Regelversorgung. 32. DGVT-Kongress für Klinische Psychologie, Psychotherapie und Beratung, Man-made Distasters. 15.-19.03.2023, Berlin.Odenwald, M., Bogatzki, L., Mier, D. & Rockstroh, B. (2023). Regel-Psychotherapie für Geflüchtete Patient:innen – Pilotstudie des Konstanzer Modellprojekts mit Koordinierter Behandlung unter Einbezug von Gesundheitspat:innen (KOBEG). Symposiums-Vortrag. 2. Deutscher Psychotherapie-Kongress, 10. – 13.05.2023, Berlin. https://deutscher-psychotherapie-kongress.de
Bogatzki, L., Trauner, L., Mier, D., Rockstroh, B. & Odenwald, M. (2023). „Weil ich weiß, dass ich der Person helfen kann. Und das ist für mich unbezahlbar“ – Die Bedeutung von Peers in der Gesundheitsversorgung von Geflüchteten. Symposiums-Vortrag. 2. Deutscher Psychotherapie-Kongress, 10. – 13.05.2023, Berlin. https://deutscher-psychotherapie-kongress.de
Lipinski, L., Bogatzki, L., Mier, D., Rockstroh, B. & Odenwald, M. (2023). Eine randomisiert-kontrollierte Studie zur Evaluation des Versorgungsmodells Koordinierte Behandlung unter Einbezug von Gesundheitspat:innen (KOBEG) für Geflüchtete mit psychischen Störungen. Poster. 2. Deutscher Psychotherapie-Kongress, 10. – 13.05.2023, Berlin. https://deutscher-psychotherapie-kongress.de
Bogatzki, L., Mier, D., Rockstroh, B. & Odenwald, M. (2023). Psychotherapeutische Regelversorgung für Geflüchtete – das Konstanzer Modellprojekt mit Koordinierter Behandlung unter Einsatz von Gesundheitspat:innen (KOBEG). Vortrag. 32. DGVT-Kongress für Klinische Psychologie, Psychotherapie und Beratung, Man-made Distasters. 15.-19.03.2023, Berlin.
Bogatzki, L., Mole, M., Braztzke, A., Rockstroh, B., Mier, D. & Odenwald, M. (2022). Integration von Geflüchteten in die psychotherapeutische Regelversorgung: Eine Pilotstudie zur Koordinierten Behandlung unter Einsatz von Gesundheitdpat:innen (KOBEG). Poster. 1. Deutscher Psychotherapiekongress 2022, 07.-11.06.2022, Berlin.
Lipinski, L., Bogatzki, L., Mier, D., Rockstroh, B. & Odenwald, M. (2024). Eine randomisiert-kontrollierte Studie im Landkreis Konstanz zur Evaluation einer Koordinierten Behandlung unter Einbezug von Gesundheitspat:innen (KOBEG). Symposium. 3. Deutscher Psychotherapie–Kongress, 11. – 15.06.2024, Berlin. https://deutscher-psychotherapie-kongress.de
Lipinski, L., Bogatzki, L., Rockstroh, B., Mier, D. & Odenwald, M. (2023). A randomised controlled trial to evaluate the care model Coordinated Treatment with the Involvement of Health Mentors (KOBEG) for refugees with mental disorders. Poster. WIN-Konferenz zum Thema “Interdisciplinary conference on the study of mental health: Bridging psychological practice and scientific research” der Heidelberger Akademie der Wissenschaften, 10. – 12.07.2023, Heidelberg. https://www.hadw-bw.de/news/events/interdisciplinary-conference-study-mental-health
Further projects and therapeutic offers
Project Fearless
Psychotherapeutic support for refugees between the ages of 14 and 21.
Contact:
furchtlos.projekt@uni-konstanz.de
Project Yourtreat
Narrative exposure therapy for traumatised refugee and asylum-seeking children and young people aged 10-18.
Contact:
sabrina-barbara.mueller@uni-konstanz.de