NEGLECTED TRAUMA © Alessandro Penso Asylum seekers in Italy: an analysis of mental health distress and access to healthcare CONTENTS EXECUTIVE SUMMARY 1 INTRODUCTION 3 AIMS 6 METHODOLOGY 7 General purpose and qualitative research tools 7 EXECUTIVEINTRODUZIONE SUMMARY © Sara Creta Qualitative analysis 10 Epidemiological data collected in the MSF project 10 Quantitative analysis 11 RESULTS 12 he many humanitarian crises of Doctors Without Borders (MSF) from to assess the need for mental health Focus groups and in-depth interviews: mental health recent years, the persistence October 2014 to December 2015 during support among the residents of of asylum seekers and access to services 12 Tof conditions of war and the psychological support activities with the centres. The community health systematic violation of human rights asylum seekers resident in the CAS in services often lack the expertise and Quantitative data: the mental health of asylum seekers in many countries have forced millions the province of Ragusa. This provided resources needed to recognise signs according to MSF's experience 23 of people to flee, undertaking journeys a good starting point for identifying of distress among this group. Cultural Difficulties encountered 24 that are often very dangerous. the extent of the problems and the mediators, or other people who could According to data from the UN Refugee potential factors influencing them. help to establish contact and to reduce Risk factors and difficulties of post-migration life 26 Agency (UNHCR), there are now 65,3 cultural distances, are rarely present. million of people who left their home Of the 387 patients analysed in this The length of stays at the centres is DISCUSSION 28 in the world. Recent evidence shows study, 234 (or 60.5%) showed signs of protracted and is often a source of Study limitations 30 an increased risk of mental disorders mental health problems. Eighty-four further distress. among forced migrants and asylum (or 42%) of the patients had complaints CONCLUSIONS AND RECOMMENDATIONS 31 seekers. In addition to the traumatic compatible with post-traumatic stress On the one hand, the results suggest events they may have suffered before disorder (PTSD), 54 (27%) with anxiety high rates of mental illness, especially BIBLIOGRAPHY 32 and during their journeys, some of and 38 (19%) with depression. The among asylum seekers exposed to them show signs of stress and suffering average age of the patients was 23.9 traumatic events, and a negative in relation to their current situation, years. MSF provided care for 199 of impact caused by prolonged stays in ABBREVIATIONS attributable to their exile in a strange these patients, ensuring they were the CAS. On the other hand, the system land. followed up. Of the patients given care, remains unprepared, and local services ASL Azienda Sanitaria Locale - Local Health Center 87% said they suffered from difficulties are inadequate to meet the needs ASP Azienda Sanitaria Provinciale – Provincial Health Center MSF conducted an investigation from related to their current living conditions. of this population. It is necessary to CARA Centri Accoglienza Richiedenti Asilo – Asylum Seekers Reception Centres July 2015 to February 2016 to study the The main difficulties of post-migration provide an integrated response that mental health needs of asylum seekers CAS Centri Accoglienza Straordinaria – Extraordinary Reception Centres life were found to be the lack of daily involves the local health services, residing in extraordinary reception CI Confidence Interval activities, fear for the future, loneliness, mental health departments and also centres (CAS) and their access to local the world of associations, universities CIE Centri di Identificazione ed Espulsione – Identification and Expulsion Centres and concern for relatives left behind in services. The analysis – conducted their country of origin. and public authorities. As part of the CSM Centro Salute Mentale – Mental Health Centre in the provinces of Milan, Rome and response, dedicated multi-professional DSM Dipartimento Salute Mentale – Mental Health Department Trapani, which were chosen because A comparison between the asylum teams should be created that are DSM-5 Manuale Diagnostico e Statistico dei Disturbi Mentali - Diagnostic and Statistical of their large numbers of reception seekers with mental health disorders able to identify specific risk factors Manual of Mental Disorders, Fifth Edition (DSM-5) centres – benefited from a two- and those without, showed that the and provide appropriate therapeutic IQR Inter Quartile Range pronged approach using qualitative likelihood of having psychopathological approaches. and quantitative methods. The use of MSF Médecins Sans Frontières/Doctors Without Borders issues was 3.7 times higher among focus groups and in-depth interviews individuals who had suffered traumatic We know that the data presented here NIRAST Network Italiano per i Richiedenti Asilo sopravvissuti a Tortura – Italian Network with asylum seekers, healthcare events than those who had not suffered refers to a complex situation, and for Asylum Seekers who Survived Torture workers and CAS operators made it any. that the work done by MSF is small in OR Odds Ratio possible to decipher the needs of the comparison to the scale of the needs. PTSD Post Traumatic Stress Disorder residents of the reception centres, the The qualitative study provides a picture However, we hope that this report SPDC Servizio Psichiatrico Diagnosi e Cura – Psychiatric Diagnosis and Treatment Service clinical paths taken where necessary of a system that responds to this can serve as an additional prompt for SPRAR Sistema di Protezione per Richiedenti Asilo e Rifugiati – Protection System for and the response of local health particularly distressed population as reflection for other organisations and Asylum Seekers and Refugees services. The quantitative research if dealing with an emergency, without institutions so that structural solutions was conducted based on the data adequate preparation. In many cases, can be developed in relation to the SSN Sistema Sanitario Nazionale – National Health System collected by Medecins Sans Frontieres/ there is no active screening available mental health of asylum seekers. TSO Trattamento Sanitario Obbligatorio – Compulsory Health Treatment UNHCR United Nations High Comissioner for Refugees, United Nations Refugee Agency Morire di parto Quando partorire diventa un'emergenza 3 Introduzione INTRODUCTION © Sami Al-Subaihi he increase in migration towards These additional shelters are known 1. According to the Ministry of Interior, the Europe as a result of wars, as CAS (Extraordinary Reception number of refugees who reached Italian shores in 2015 (as of 23.02.2016) was Tpolitical persecution, endemic Centres), and provide an emergency around 153,842. http://www.interno.gov.it/ poverty and the hope of a better life system for asylum seekers, regulated it/sala-stampa/dati-e-statistiche/trend- has called for Western countries to by temporary agreements with public arrivi-dei-migranti-sulle-coste-italiane provide a civil and political response facilities, private-social organisations According to Eurostat data, the largest 7 groups of asylum seekers who have sought to a problem that has now taken and private entrepreneurs . These protection in Italy come from Nigeria (17,780, on global dimensions. Indeed, facilities are of a varied nature 21%), Pakistan (10,285 12%), Gambia (8,015, although not a recent phenomenon, (hotels, B&Bs, private homes, 10%), Senegal (6370, 8%) and Bangladesh (6,015, 7%). Full report at: international migration is now apartments rented ad hoc, holiday http://ec.europa.eu/eurostat/statistics- centre-stage in world events. Italy, in villages, schools, gyms, former explained/index.php/Asylum_statistics particular, has faced this phenomenon orphanages and public buildings that have fallen into disuse). The operator, 2. UNHCR, Global Trends, Forced Displacement for more than 20 years, since the early 2015. Full report: : https://s3.amazonaws. 1990s, and has received an increasing who has an agreement with the local com/unhcrsharedmedia/2016/2016-06- number of requests for international Prefecture, is committed to providing 20-globaltrends/2016-06-14-Global- Trends-2015.pdf protection in recent years, in parallel a shelter service in return for a fee with the increase in the number of of 30/35 euro per day (or sometimes 3. Circular no. 104. Flow of foreign citizens resident foreign nationals1. The annual even less) for each asylum seeker. requesting international protection. UNHCR report speaks of 65.3 million The management body ensures Identification of reception centres. managerial and administrative forced migrants recorded globally 4. Circular no. 2.204. Reception centres at the end of 20152, an increase of services, general support services following further landings on the Italian 9.7% from 2014, which is the highest for individuals, cleaning and coast. environmental hygiene services, increase ever recorded in a single provision of meals, provision of goods 5. This plan provides for the subdivision of year. 2,390 shelter places between around 60 (clothes, personal hygiene products, provincial capitals. In the above-mentioned The growth in the number of new mattresses, a daily sum of so-called circular, the Ministry also refers to another pocket money equalling 2.50 euros 883 places, as well as to 5,500 places arrivals has seen a gradual saturation already assigned in 115 temporary