Serious shortcomings in assessment and treatment of asylum seekers' mental health needs

• Published in: PloS one 2020-10, Vol.15 (10), p.e0239211-e0239211
• Main Authors: Führer, Amand, Niedermaier, Andreas, Kalfa, Vivian, Mikolajczyk, Rafael, Wienke, Andreas
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Antidepressive Agents - therapeutic use; Anxiety; Anxiety disorders; Anxiety Disorders - diagnosis; Anxiety Disorders - drug therapy; Biology and Life Sciences; Biometrics; Care and treatment; Civil society; Codes; Cross-Sectional Studies; Data analysis; Depression - diagnosis; Depression - drug therapy; Diagnosis; Epidemiology; Female; Health aspects; Health care; Health care access; Health insurance; Health risks; Humans; Informatics; Male; Medicine and Health Sciences; Mental depression; Mental disorders; Mental Health; Middle Aged; Patients; People and Places; Physicians; Political asylum; Populations; Post traumatic stress disorder; Posttraumatic stress disorder; Psychological aspects; Psychological stress; Psychotherapy; Questionnaires; Refugees; Refugees - psychology; Signs and symptoms; Social Sciences; Social Welfare; Statistical analysis; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - drug therapy; Surveys and Questionnaires; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0239211

The prevalence of psychological complaints is known to be very high in populations of asylum seekers. Despite this, data on the health care system's ability to adequately meet these high-risk populations' mental health needs are scarce. This article investigates how well the German outpatient health care system is able to detect and adequately treat them. To this end, we combined data from a cross-sectional survey with billing data from the local social welfare office from the year 2015. Using descriptive statistics, the data of the cross-sectional study are used to quantify the psychological health care needs of asylum seekers while the secondary data analysis indicates the actual access to and extent of psychological treatment. In the cross-sectional study, 54% of patients were screened positive for symptoms of depression, 41% for symptoms of anxiety disorder and 18% for symptoms of Posttraumatic Stress Disorder. In total, 59% were screened positive for at least one of these three disorders. However, when contrasting these screening-based prevalences with the prevalences based on data from the health care system, a mismatch becomes apparent: According to the social welfare office's billing data, only 2.6% of asylum seekers received the diagnosis of depression, 1.4% were diagnosed with anxiety disorder and 2.9% with Posttraumatic Stress Disorder (PTSD). In combination, 4.9% were diagnosed with at least one of these three disorders. Overall, less than one tenth of asylum seekers with symptoms of depression, anxiety or PTSD received the corresponding diagnosis by the health care system. Among those who were diagnosed, about 45% received no treatment at all, while 38% were treated with drugs alone. Only 1% of all patients received psychotherapy. Psychological complaints are very common among asylum seekers, yet only a small proportion of this population receives the corresponding diagnoses and treatment. While various factors can contribute to these shortcomings, there is an urgent need to systematically address this deficit and introduce measures to improve mental health care for this high-risk population.