Prologue:
‘’No, I cannot go to their hospital, they say I am mad, but I know I am ok. My problem is not having a job or money to take care of my family. The pain is too much and I cannot go back home now. I am afraid their medicines would make me to forget myself or complete the circle of madness.’’
Migration is as old as man and in spite of its many challenges, man has continued to move from ‘present to future dangers’. Humans are social beings and bloom in climates that are friendly to them; wherein the social environment enables them to thrive. Migration often erodes that protective mechanism offered by our local environments. Its many challenges are illustrated in the myriad of disadvantages that migrants everywhere endure; these challenges may be more than the rejection by the natives and the outsider complex. Hence, in spite of the benevolence of the natives, migrants everywhere face several problems of adjustment to the new environment.
Often the commonest challenge is the isolation occasioned by language barrier that forces the migrants to aggregate together or along urban areas where they find their likes. This is perhaps not as overwhelming as the sudden loss of worth orchestrated by forces of labour and economics that reduces the competencies of the newcomer. Beyond these socioeconomic problems, the problem of mental health is perhaps the most notable health challenge. Mental illness is a complex problem. The concept of mental illness as a disability is often keenly contested by society and persons with mental illness; even though it is recognized by the International Classification of Functioning, Disability and Health and the Convention on the rights of persons with disabilities. Migrants with mental health challenges have recognized disabilities and are sometimes unable to access needed care. Their challenges are worsened by cultural believes about mental illness that limit their utilization of available mental health care. Their rejection of care in fear and distrust of the care may have implications for their experience of mental illness.
Migrants often have higher rates of mental illness than natives. In the United Kingdom African-Carribeans were found to have higher rates of psychosis compared to the native white population and other Ethnic groups [1]. In the Netherlands, both documented and undocumented migrants face the challenges of mental illness. Although their access to healthcare differs, undocumented migrants in the Netherlands face similar social determinants such as poverty, social exclusion, unemployment and distance from health services [2]. Thrust in an environment they ran to in search of better life, they gave up the protection that their erstwhile social network offered. In addition, their access to care and social integration are limited by their social environment and the same factors that may predispose to mental illness, such as socioeconomic status and residency status. Their challenges regarding employment and social inclusion may be part and parcel of their ailment. The mental health challenges of migrants are sometimes beyond the remedies of the medicine chest and the couch. Pharmacological and psychological care are very useful but they may offer little succor if it fails to address the socioeconomic challenges faced by migrants.
It is essential that policies that seek to address migrant mental health in the Netherlands consider it as recognized disability and treat it as such. It may be helpful to explore pathways to addressing the social determinants of mental health in order to improve the health of migrants in the country. The social environment is implicated in the etiology and exacerbation of mental illness. Disability associated with mental illness may be addressed by strengthening social level factors. The socio-economic burden of migrant mental health is huge, and institutional policies that address both the health and social level problems may be relevant in reducing the associated morbidity.
Ikenna Ebuenyi is a medical doctor from Nigeria and a PhD researcher at Athena Institute, Vrije Universiteit Amsterdam. His research is focused on the identification of what works in the employment of persons with mental disabilities in East Africa.
References:
Fearon P, Kirkbride JB, Morgan C, Dazzan P, Morgan K, Lloyd T, Hutchinson G, Tarrant J, Fung WL, Holloway J, Mallett R. Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychological medicine. 2006 Nov;36(11):1541-50.
Teunissen E, Sherally J, van den Muijsenbergh M, Dowrick C, van Weel-Baumgarten E, van Weel C. Mental health problems of undocumented migrants (UMs) in the Netherlands: a qualitative exploration of help-seeking behaviour and experiences with primary care. BMJ open. 2014 Nov 1;4(11):e005738.