Psychological Needs, Service Utilization and Provision of Care in a Specialist Mental Health Clinic for Young Refugees: A Comparative Study

• Published in: Clinical child psychology and psychiatry 2009-04, Vol.14 (2), p.273-296
• Main Authors: Michelson, Daniel, Sclare, Irene
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Caregiver burden; Caregivers; Carers; Child; Child, Preschool; Children; Cognitive therapy; Combined Modality Therapy; Community Mental Health Centers - utilization; Comparative analysis; Comparative studies; Delivery of Health Care - utilization; England; Female; Health needs; Health services; Humans; Infant; Interdisciplinary Communication; Male; Medical sciences; Medicine; Mental health; Mental health care; Mental health services; Migration; Minors - psychology; Minors - statistics & numerical data; Miscellaneous; Morbidity; Needs Assessment - utilization; Organization of mental health. Health systems; Parent training; Parenthood education; Patient Care Team - utilization; Peers; Political asylum; Post traumatic stress disorder; Psychiatric morbidity; Psychological distress; Psychological needs; Psychological trauma; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy; Referral and Consultation - utilization; Referrals; Refugees; Refugees - psychology; Refugees - statistics & numerical data; Relocation; Service provision; Social psychiatry. Ethnopsychiatry; Social services; Social services utilization; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Trauma; Traumatic life events; Treatments; Unaccompanied; Utilization Review - statistics & numerical data
• ISSN: 1359-1045; 1461-7021
• DOI: 10.1177/1359104508100889

This study addressed psychological needs, patterns of service utilization and provision of care in a specialist mental health service for young refugees and asylum seekers in London. Comparisons were made between two groups with different levels of postulated mental health need: unaccompanied minors (UAMs; n = 49) and children accompanied to the UK by one or more primary caregivers (n = 29). Significant differences were observed in referral pathways, with UAMs more likely to be referred by social services and less likely to be referred from medical agencies. UAMs also attended fewer sessions during treatment, and missed a greater proportion of scheduled appointments. Contrary to prediction, group comparisons revealed similar levels of post-migration stress and overall psychological morbidity. However, UAMs experienced significantly more traumatic events prior to resettlement, and were more likely to exhibit symptoms of post-traumatic stress disorder (PTSD) than their accompanied peers. Despite their elevated risk of PTSD, UAMs were less likely than accompanied children to have received trauma-focused interventions. UAMs were also significantly less likely to have been treated using cognitive therapy, anxiety management and parent/carer training, as well as receiving fewer types of practical assistance with basic social needs. The clinical and service implications of these findings are discussed.