Mental health and undocumented migrants in Portugal

Pages200-209
Date17 December 2018
Published date17 December 2018
DOIhttps://doi.org/10.1108/JPMH-11-2017-0039
AuthorGustavo Santos,Célia Soares,Raquel Rebelo,Paula Ferreira
Subject MatterHealth & social care,Mental health,Public mental health
Mental health and undocumented
migrants in Portugal
Gustavo Santos, Célia Soares, Raquel Rebelo and Paula Ferreira
Abstract
Purpose While awaiting resolution of their legal process, undocumented migrants (UM) face several
challenges,including limitedaccess to public health care.The purpose of this paperis to survey UM attending a
detention centrein Oporto (Portugal) to estimate the prevalenceof mental health disorders in this population.
Design/methodology/approach A retrospective chart review was performed with the relevant
sociodemographic and clinical data of all UM in the process of coercive removal from Portuguese territory,
observed by Doctors of the World, during three years (20142016). The Tenth Version of International
Classification of Mental and Behavioural Disorders was used for nosological classification.
Findings In total, 393 detainees were eligible for the study. Most detainees were male (84 per cent) and
76 months was the mean length of stay in Portugal before detention. In total, 29 per cent of detainees were
diagnosed with a mental and behavioural disorder. The most prevalent diagnosis was neurotic, stress-related and
somatoform disorders (47 per cent). UM with dual diagnosis (28 per cent) led to the articulation with the integrated
centres of drug addiction, which provided and monitored opioid substitution therapy. Female UM were more
prone to develop any mental and behavioural disorder when compared to men ( χ
2
¼7,017; po0.05).
Research limitations/implications In total,9 per cent of the detainees were excludedfrom this study due
to incompletedata on their medicalcharts. Some detaineespresented oppositionalbehaviour, hostilitytowards
others and refusedto be assessed by the medical team. Both situationscould have biased the prevalence of
mental disorders.Finally, the appropriateness of thewestern model of mental health disorders(ICD-10) in the
study population i s controversial , considering the cul ture-bound phen omenology and syndro mes.
Originality/value This paper identified the most prevalent mental health disorders in UM detained in
Portugal. The most prevalent mental health disorders were either stress-related (associated with the
detention itself) or related to previous patterns of substance abuse. Given the study outcomes, it is highly
recommended to mobilise human and technical resourcesto provide specialized mental health care to UM at
least while detention policies could not be changed.
Keywords Europe, Health inequalities, Asylum seekers, Mental health disorders, Public mental health,
Undocumented migrants
Paper type Case study
Introduction
As people are migrating across the world in an unparalleled way, undocumented migrants (UM)
present one of the greatest challenges to western society. The International Organization for
Migration defines undocumented or irregular migrant as a person who, owing to unauthorised
entry, breach of a condition of entry, or the expiry of his or her visa or work permit, lacks legal
status in a transit or host country (Pe rruchoud and Redpath-Cross, 2011 ). The migrants who
have failed asylum seeker applic ations and have no t left the country ar e also included in th is
group. Different t erms could be found in the liter ature to describe t his heterogeneou s group
including clande stine,unauthorisedand illegal. There is some evide nce that this
population group faces higher rates of mental health difficulties than the general population
(Woodward et al., 2014; Lindert et al., 2016). This has been attributed both to traumatic
experiences befo re and during thei r flight, and to the un derlying vulner ability conditio ns they
face in the host country regarding uncertainty and fear of deportation (Robjant et al., 2009;
Myhrvold and Småstuen, 2017).
Received 19 November 2017
Revised 3 September 2018
Accepted 15 September 2018
This work has been informed by
the input of a wide range of health
professionals from across medical
and social sciences. The authors
wish to acknowledge all the
volunteers of the DW team, who
put much personal effort and
scientific skills on this project. It
was thanks to their commitment
that this work was possible. Dr
Jeffrey Patterson, who was also an
undocumented migrant in the past,
and Miss Eve Bayram deserve a
special mention, for the English
revision of the manuscript.
Gustavo Santos is based at the
North Delegation, Doctors of
the World, Porto, Portugal and
Psychiatry Department,
Hospital de Magalhaes Lemos
EPE, Porto, Portugal.
Célia Soares is based at the
North Delegation, Doctors of
the World, Porto, Portugal and
Psychiatry Department,
Hospital de Braga, Braga,
Portugal.
Raquel Rebelo is based at the
North Delegation, Doctors of
the World, Porto, Portugal.
Paula Ferreira is based at the
Jesuit Refugee Service
Portugal, Porto, Portugal.
PAGE200
j
JOURNAL OF PUBLIC MENTAL HEALTH
j
VOL. 17 NO. 4 2018, pp. 200-209, © Emerald Publishing Limited, ISSN 1746-5729 DOI 10.1108/JPMH-11-2017-0039

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