Abstract
Background: Most asylum seekers experiences stress, not only due to the reason of fleeing and their travel, but also due to their compulsory stay in the asylum seeker center in the Netherlands and the asylum procedure. This often leads to self-medication and addiction which causes a lower self-esteem and lower quality of life. Many professionals working with asylum seekers often have no experience with the diverse cultural background. Adverse life events, forced migration and the prolonged asylum procedures, in addition to the complexity of the acculturation process can all contribute to higher levels of psychopathology.
Objective: What are threats to well-being in terms of mental health, psychosocial and addiction problems and what are effective interventions for well-being for asylum seekers in asylum seeker centers in the Netherlands, reported in literature?
Method: Following the descriptive nature of the research question and the need for identifying knowledge gaps, we created an overview of existing knowledge by executing a scoping review on influencing factors on mental health of asylum seekers.
Results: We included 26 articles in this study. From literature we identified four major threats, two assessment instruments and five interventions.: The threats concern: 1. the influence of staying in the environment of an asylum seekers center with its tight regime, scanty living conditions, involuntary living together with other asylum seekers from multiple countries with subsequent differences in cultural backgrounds, and speaking other languages; 2. substance and drug abuse among asylum seekers; 3. health care professionals and employees who do not detect or underestimate the underlying suffering of asylum seekers leading to undertreatment; 4. frequent relocations of asylum seekers. Assessment instruments include the Rapid-Assessment-Response-method (RAR-method) and the Health-Information-Assessment-Tool-Asylum-Seeker-tool (HIATUS-tool). The five interventions comprise 1. therapy for asylum seekers diagnosed with PTSD (Post-Traumatic-Stress-Disorder); 2. art therapy; 3. education focused on prevention as intervention; 4. cultural interview; and 5. Mindspring, which is aimed at enabling professionals to reduce these threats.
Conclusions: The knowledge on identifying and reducing threats and assessment and treatment interventions for asylum seekers living in an asylum seekers center, found in literature, provides for perspectives on improving their well-being. However, the great diversity of cultural aspects and continuous changes of the number of refugees in the Dutch asylum seekers centers which for example were recently confronted with a steep increase in Afghan refugees, disrupts the continuity of care on a large scale. The absence of guidelines and required knowledge of professionals working with these asylum seekers leads to the question of what professionals need for providing effective health care to asylum seekers with mental health and addiction problems. The Netherlands is divided when it comes to the reception of asylum seekers. This is clearly visible in politics, media and society. The result is a cost reduction in care for asylum seekers, which results in fragmentation in care, lower quality and a higher burden of disease. The shortage of well-trained and intercultural expert healthcare personnel also causes loss of knowledge and the cessation of local or non-local interventions.