İSTANBUL’DA UYGULANAN ENTEGRE VE TOPLUM TEMELLİ BİR PSİKOSOSYAL DESTEK HİZMETİNİN GÜÇLÜ YÖNLERİ: GÖÇMEN PERSPEKTİFİNDEN NİTEL BİR KEŞİF ÇALIŞMASI

Türkiye’de çoğunluğu Orta Doğudan olmak üzere geniş bir göçmen ve sığınmacı nüfus yaşamaktadır. Türkiye'de yaşayan göçmenler; ruh sağlıklarının bozulmasına yol açan çeşitli risk faktörlerine maruz kalmalarına rağmen, ruh sağlığı hizmetlerine düşük oranlarda erişmektedirler. Bu çalışmanın amacı; İstanbul’da uygulanan entegre bir toplum temelli psikolojik danışmanlık programının özelliklerine ilişkin göçmen ve hizmet sağlayıcı bakış açılarını araştırmaktır. Programın, göçmenlerin ruh sağlığı hizmetlerine erişimlerinin önünde sık görülen engelleri azaltabileceği düşünülmektedir. Haziran ve Temmuz 2021 tarihleri arasında İstanbul'da psikolojik danışmanlık hizmeti alan 5 Suriyeli ve Afgan göçmen ve 3 hizmet sağlayıcı ile sekiz görüşme yapılmıştır. Veriler çerçeve analizi kullanılarak analiz edilmiştir. Ruh sağlığı hizmetlerine erişimin önündeki engelleri azaltabilecek hizmet özellikleri olarak dört tema belirlenmiştir: (1) İtibara dayalı güven, (2) Randevu esnekliği, (3) Çocuk dostu alanlar ve (4) Sosyal destek. Çalışmadan araştırma ve uygulama için çıkarımlar, hizmet geliştirme odaklı olarak tartışılmıştır. Göçmenlerin ruh sağlığı hizmetlerini kullanımını arttırmaya yönelik stratejiler olarak: Hasta temsilci gruplarıyla hizmet planlama, danışan merkezli yaklaşımlar ve göçmenlerin ruh sağlığı hizmetlerinin sürekli gelişimine aktif katılımı benimsenmelidir.

Anahtar Kelimeler:

Kolaylaştırıcılar, göçmenler, ruh sağlığı, toplum ruh sağlığı hizmetleri, Türkiye

IDENTIFYING STRENGTHS OF AN INTEGRATED COMMUNITY-BASED PSYCHOSOCIAL SUPPORT SERVICE IN ISTANBUL: A QUALITATIVE EXPLORATION FROM A REFUGEE PERSPECTIVE

Turkey hosts a large number of refugees and asylum seekers, mainly from the Middle East. Despite being exposed to several risk factors for developing mental health conditions, refugees have low contact rates with mental health services in Turkey. The aim of the current study was to explore refugee and service provider perspectives on the characteristics of an integrated community-based psychological counselling programme in Istanbul, which may help to mitigate the barriers to mental health services regularly experienced by refugees. Eight interviews were conducted with three service providers and five Syrian and Afghan refugees who had attended a psychological counselling service in Istanbul between June and July 2021. Data was analysed using framework analysis. Four themes were identified as potential service characteristics which could mitigate barriers to accessing mental health services: (1) reputation-based trust, (2) appointment flexibility, (3) child-friendly spaces and (4) social support. Implications for research and practice are discussed with an emphasis on service development. Patient champion networks, client-centred approaches, and active participation of refugees in the continued development of mental health services are recommended as strategies to increase refugees' engagement with mental health services.

Keywords:

Facilitators, refugees, mental health, community mental health services, Turkey,

PDF

___

1. Erdogan MM. Urban Refugees From “Detachment” to “Harmonization”. Syrian Refugees and Process Management of Municipalities: The Case of Istanbul, Marmara Municipalities Union (MBB) [Internet]. Istanbul: Gafa Media; 2017 Jan. [cited 2022 Nov 11]. Available from: https://mmuraterdogan.files.wordpress.com/2016/06/mmuurban-refugees-report-2017_en.pdf
2. Acarturk C, McGrath M, Roberts B, Ilkkursun Z, Cuijpers P, Sijbrandij M, et al. Prevalence and predictors of common mental disorders among Syrian refugees in Istanbul, Turkey: a cross-sectional study. Social Psychiatry and Psychiatric Epidemiology [Internet]. 2021;56(3):475–84. doi:10.1007/s00127-020-01941-6.
3. Operational Data Portal Refugee Situations [Internet]. Geneva: UNHCR; c2022. Registered Syrian Refugees; [Updated 2022 Nov 3; Cited 2022 Nov 11]; [about 1 p.]. Available from: https://data2.unhcr.org/en/situations/syria/location/113
4. UNHCR: Refugee Data Finder [Internet]. Geneva: UNHCR; 2022 [cited 2022 Nov 11]. Available from: https://www.unhcr.org/refugee-statistics/download/?url=7SR7ch
5. Bhugra D, Jones P. Migration and mental illness. Advances in psychiatric treatment: the Royal College of Psychiatrists' journal of continuing professional development [Internet]. 2001;7(3):216–22. doi:10.1192/apt.7.3.216.
6. Kuschminder K. Afghan Refugee Journeys: Onwards Migration Decision-Making in Greece and Turkey. Journal of refugee studies [Internet]. 2018;31(4):566–87. doi:10.1093/jrs/fex043.
7. Jones D. Turkey Faces Dilemma as Afghan Refugees Start Arriving. Voice of America News [Internet]. 2021 July 29. [cited 2023 May 29]. [about 2 p.]. Available from: https://www.voanews.com/a/europe_turkey-faces-dilemma-afghan-refugees-start-arriving/6208900.html
8. Kirmayer LJ, Narasiah L, Munoz M, Rashid M, Ryder AG, Guzder J, et al. Common mental health problems in immigrants and refugees: general approach in primary care. Canadian Medical Association journal (CMAJ) [Internet]. 2011;183(12):E959–E967. doi:10.1503/cmaj.090292.
9. Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC international health and human rights [Internet]. 2015;15(1):29–29. doi:10.33417/tsh.977939
10. Dattani S, Ritchie H, Roser M. Mental Health [Internet]. Our World in Data; 2018 Apr. [updated 2021 Aug]. [cited 2022 Nov 11]. Available from:https://ourworldindata.org/mental-health#citation
11. Ministry of Health. National mental Health Action Plan (2011-2023) [Internet]. Ankara: Ministry of Health; 2011. Report No.: 847. [cited 2022 Nov 11]. Available from:http://ahmetsaltik.net/arsiv/2014/07/ULUSAL_RUH_SAGLIGI_EYLEM_PLANI_2011-2023.pdf
12. Fuhr DC, Acarturk C, McGrath M, Ilkkursun Z, Sondorp E, Sijbrandij M, et al. Treatment gap and mental health service use among Syrian refugees in Sultanbeyli, Istanbul: a cross-sectional survey. Epidemiology and Psychiatric sciences [Internet]. 2019;29:e70–e70. doi:10.1017/S2045796019000660.
13. Kilic C, Kaya E, Karadag O, Uner S. Barriers to accessing mental health services among Syrian Refugees in Ankara. BMC Health Services Research [Internet]. Forthcoming. [cited 2022 Nov 11]. Available from:https://www.researchsquare.com/article/rs-461860/v2
14. Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bulletin of the World Health Organization [Internet]. 2004;82(11):858–66. doi:10.1590/S0042-96862004001100011.
15. Bilir Uslu M.K. Mental Healthcare Policy Reform in Turkey: A Qualitative Study on the Perspectives of User Groups. Toplum ve Sosyal Hizmet [Internet] 2022;33(1):113-32. doi: 10.33417/tsh.977939
16. Eurostat. Mental health and related issues statistics. Number of psychiatrists, 2020 [Internet]. Eurostat; 2022 Sept [cited 2022 Nov 11]. Available from: https://ec.europa.eu/eurostat/statisticsexplained/index.php?title=Mental_health_and_related_issues_statistics
17. Karaoğlan Kahiloğulları A, Alataş E, Ertuğrul F, Malaj A. Responding to mental health needs of Syrian refugees in Turkey: mhGAP training impact assessment. International Journal of Mental Health Systems [Internet]. 2020;14(1):84–84. doi:10.1186/s13033-020-00416-0.
18. Weissbecker I, Hanna F, El Shazly M, Gao J, Ventevogel P. Integrative Mental Health and Psychosocial Support Interventions for Refugees in Humanitarian Crisis Settings. In: Wenzel T, Drožđek B. editors. An Uncertain Safety. Cham: Springer; 2019. pp.117-153.
19. Home Office. Country Policy and Information Note. Turkey: Medical and healthcare provision [Internet]. Version 1.0. London: Home office; 2021 Apr [cited 2022 Nov 11]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/979377/CPIN_-_Turkey_-_Medical_and_healthcare._FINAL._APRIL_2021.pdf
20. Doğan N, Dikeç G, Uygun E. Syrian refugees’ experiences with mental health services in Turkey: “I felt lonely because I wasn’t able to speak to anyone” Perspectives in psychiatric care [Internet]. 2019;55(4):673–80. doi:10.1111/ppc.12400.
21. International Organization for Migration. Baseline Assessment in Istanbul Province. Analysis Report [Internet]. Ankara: International Organization for Migration; 2019. [cited 14 July 2021]. Available from: https://displacement.iom.int/system/tdf/reports/IST_Baseline_Assessment_Phase5_ENG_29012020.pdf?file=1&type=node&id=7733
22. UNHCR. Convention and Protocol Relating to the Status of Refugees. 189 U.N.T.S. 137, opened for signature 28 July 1951, entered into force 22 April 1954 [Internet]. Geneva: UNHCR; 1967. [cited 2022 Nov 11]. Available from: https://www.unhcr.org/3b66c2aa10.html
23. Ritchie J, Lewis J, Elam G. Designing and selecting samples. In: Ritchie J, Lewis J. editors. Qualitative research practice: a guide for social science students and researchers. London: SAGE Publications Ltd; 2003. pp.77–108.
24. Corbin JM, Strauss AL. Basics of qualitative research : techniques and procedures for developing grounded theory. 3rd ed. Thousand Oaks, CA : London: SAGE Publications; 2008.
25. Wallin AM, Ahlström G. Cross-cultural interview studies using interpreters: systematic literature review. Journal of Advanced Nursing [Internet]. 2006;55(6):723–35. doi:10.1111/j.1365-2648.2006.03963.x.
26. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A and Burgess RG. editors. Analyzing qualitative data. London: Routledge; 1994. p.173-194.
27. Parkinson S, Eatough V, Holmes J, Stapley E, Midgley N. Framework analysis: a worked example of a study exploring young people's experiences of depression. Qualitative Research in Psychology [Internet]. 2016;13(2):109–29. doi:10.1080/14780887.2015.1119228.
28. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology [Internet]. 2013;13(1):117. doi:10.1186/1471-2288-13-117.
29. Byrow Y, Pajak R, Specker P, Nickerson A. Perceptions of mental health and perceived barriers to mental health help-seeking amongst refugees: A systematic review. Clinical Psychology Review [Internet]. 2020;75:101812. doi:10.1016/j.cpr.2019.101812.
30. Gruner D, Magwood O, Bair L, Duff L, Adel S, Pottie K. Understanding Supporting and Hindering Factors in Community-Based Psychotherapy for Refugees: A Realist-Informed Systematic Review. International Journal of Environmental Research and Public Health [Internet]. 2020;17(13):4618. doi:10.3390/ijerph17134618.
31. Lloyd A. Building Information Resilience: How do Resettling Refugees Connect with Health Information in Regional Landscapes - Implications for Health Literacy. Australian Academic and Research Libraries [Internet]. 2014;45(1):48–66. doi:10.1080/00048623.2014.884916.
32. Joshi C, Russell G, Cheng IH, Kay M, Pottie K, Alston M, et al. A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination. International Journal for Equity in Health [Internet]. 2013;12(1):88. doi:10.1186/1475-9276-12-88.
33. Kung WW. Cultural and practical barriers to seeking mental health treatment for Chinese Americans. Journal of Community Psychology [Internet]. 2004;32(1):27–43. doi:10.1002/jcop. 10077.
34. Clark N. Exploring community capacity: Karen refugee women’s mental health. International Journal of Human Rights in Healthcare [Internet]. 2018;11(4):244–56. doi:10.1108/IJHRH-02-2018-0025.
35. Hassan G, Kirmayer LJ, Mekki-Berrada A, Quosh C, el Chammay R, Deville-Stoetzel JB, et al. Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians: A Review for Mental Health and Psychosocial Support staff working with Syrians Affected by Armed Conflict [Internet]. Geneva: UNHCR; 2015. [cited 2022 Nov 11]. Available from: https://www.unhcr.org/55f6b90f9.pdf
36. Bradley EH, Curry LA, Ramanadhan S, Rowe L, Nembhard IM, Krumholz HM. Research in action: using positive deviance to improve quality of health care. Implementation Science: IS [Internet]. 2009;4(1):25–25. doi:10.1186/1748-5908-4-25.
37. Suurmond J, Woudstra A, Essink-Bot ML. The interpreter as co-interviewer. Journal of Health Services Research and Policy [Internet]. 2016;21(3):172–7. doi:10.1177/1355819616632020.