The number of people seeking protection in Germany from war, persecution, violence and hunger has increased considerably. Many of the newcomers are under great mental stress. Despite their distress they encounter considerable barriers to entering the psychosocial care system. The same is true for people with a migration background who have been living in Germany for a long time.
The influx of refugees poses major problems for health care systems – especially psychiatry and psychotherapy – because experiences in crisis areas and when fleeing are often not without consequences for mental health. The rate of post-traumatic stress disorder, for example, is up to ten times that in the general population. The psychiatric-psychotherapeutic care system in Germany is inadequately prepared for this situation. For example, primary contact people in reception centres need to be taught about psychiatric symptoms, screenings for mental illness need to be routinely performed and qualified language and cultural mediators need to be involved in diagnostics and treatment. In case of an acute need for treatment, specialists for psychiatry and psychotherapy have to be consulted.
People with a migration background who reached Germany under other circumstances or who have lived in Germany for a long time also face language, cultural and administrative barriers in the psychiatric-psychotherapeutic care system. Migration can be accompanied by different stress and risk factors that affect mental health. These include, for example, separation from relatives, poorer education, poor socioeconomic status, homelessness, discrimination and xenophobic attacks. Furthermore, perceptions of health and disease and treatment expectations vary greatly depending on the cultural background, traditional values, personal experiences and social environment. Consequently, mentally ill people with a migration background can receive too little, too much or the wrong care, which in turn increases costs for treatment and care.
Care that considers the special needs of people with a migration background therefore needs clearly structured basic conditions, for example ensuring that language and cultural mediators are paid for and tiered care offerings are available. Improvements are also needed in the training of health care professionals in culturally sensitive diagnosis and treatment.