Sarah thinks: »Wow, this was a very full second day, I’m off for today. Oh, this is the patient we saw earlier suffering from chronic headaches for the past weeks. But the team has already ruled out any somatic cause with various diagnostic procedures. They would like to send him to a psychiatrist together with an interpreter for a consultation, but the answer from the authorities whether it will be covered is still pending... I wish I could help him! Looking forward to meeting my old colleague Gisela tonight, who is quite experienced in mental health care of refugees...«
After having watched the video, please think for yourself or discuss with your colleague or within your group whether the following statement is correct or wrong.
Take time to think about possible reasons for both options before you read the answer.
Wrong.
While the language barrier is a huge obstacle for psychological and psychiatric treatment, it is only one of many barriers. It starts with the fact that many health care workers as well as officials from the public authorities are not trained in recognizing signs of trauma. So it does happen that asylum applications are rejected because of incoherent information given by the applicant or lack of memory of certain details and so on. Often these are hints for an underlying trauma, for example in the case of torture, which is often not recognized.
Also, refugees understandably don´t tell upfront about traumatizing events or mental health problems. One example is the story of a woman who described the journey on the boat on the Mediterranean sea as a terrible storm. The official who interviewed her for her application checked the meteorological data for those days and found them to have been calm days. He therefore decided she was lying. But all she was doing was trying to find words for the several incidents she was raped during the journey.
Another important barrier in access to mental health care for refugees is the fact that the coding for diagnoses and the respective therapies in "western biomedicine" are often little compatible with disease concepts from people with different cultural backgrounds. One-to-one psychotherapy with an interpreter is often difficult for people who have a background where the healing power of an entire community is important.
So the language barrier is an important obstacle, but unfortunately not the main and only one.