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Bridging Barriers to mental health support for newly arrived minors (TINA)

This research project is conducted at the EPiCSS group and aimed at examining mental health care utilisation among newly arrived migrants, investigating the causes of differences in mental health care utilisation, and transforming this knowledge into practical improvements in early intervention mental health services.

The overarching aim of a more inclusive access to health care will bring benefits not only to migrants, but also to other marginalised groups. The main aims of the project are:

  • To develop and evaluate new methods to understand symptoms in their cultural context
  • To enhance treatment at the First-line mental health care
  • To find methods to overcome the barriers and increase equity in care

This project is funded by the Swedish Research Council.

About the project

Early interventions within mental health care can speed up recovery and prevent problems from becoming worse. With this in mind, first-line mental health care services for children and adolescents have been commissioned to provide early interventions for this group.

Diagram showing Percentage of individuals (%) in the Stockholm region in psychiatric care or with psychiatric diagnosis (2011), by country of origin and length of stay in Sweden.
Percentage of individuals (%) in the Stockholm region in psychiatric care or with psychiatric diagnosis (2011), by country of origin and length of stay in Sweden. Data from our register linkage Psychiatry Sweden, processed by the Unit for Mental Health, CES. Image: Susanne Wicks.

We know that migrant minors - despite high prevalence of mental ill-health - have lower mental health care utilisation overall compared to Swedish-born children, and evidence suggests that this is particularly true for first-line mental health care.

The aim of this project is to facilitate care-seeking of first-line mental health services for newly arrived children and youth. In addition, we intend to develop and evaluate new methodologies which aim to enhance the support available by culturally adapting “treatment as usual” and improving the tools available to practitioners who work with children and young people from diverse backgrounds. Through these methodologies, we aim to promote first-line mental health care on equal terms.

The TINA-project will take place in Haninge municipality; chosen as 30% of children living in this municipality have two parents born outside of Sweden. Furthermore, the municipality has prior experience in large-scale projects directed towards this group. 

The project consists of two main parts:

  • A community-based intervention
  • An individual intervention

First part of the project: A community intervention

The aim of the first part of the project is to perform interventions to increase both help seeking behaviour and referrals to first-line mental health services. We have gathered data on Haninge’s demographics to tailor interventions geographically according to need.

In order to explore possible barriers to care, interviews with migrant parents in contact with psychiatric services for their children are being or were conducted. The focus of the interviews is to elicit parents’ experiences of help-seeking and to understand factors that can facilitate or hinder this process.

close-up of open book.
Photo: Pixabay

We will provide:

Health communication to stakeholders

  • Stakeholders and professionals in the immediate community, such as: NGOs, Student health, Social services, BUP and primary care 
  • One-day training offered, several opportunities within six months
  • Training focuses on how to identify children in need of health care; on migration and trauma
     

Health communication to the target group

  • Target group: migrant parents and unaccompanied minors who have been in Sweden less than 10 years
  • Delivered by health communicators from Transkulturellt Centrum
  • Delivered in groups, multiple sessions

Second part of the project: Individual intervention

seated girl with her legs stretched out in front of her, turning her back to the photographer.
Photo: Pixabay

At the participating site(s), the project aims to:

Improve structures by:

  • Creating a more patient/target group friendly entry point
  • De-briefing interpreters prior to the treatment session 

Strengthen the assessment by:

  • Providing training in migration and trauma 
  • Using the tool The Cultural Formulation Interview (CFI) to understand symptoms in a cultural context
  • Strengthen the interpretation, by educating the interpreters.

The individual intervention will take place at Rudans Vårdcentral in Haninge.

Involved in the project 

Co-applicants, expertise

  • Sofie Bäärnhielm, director of The Knowledge Centre For Transcultural Psychiatry, Region Stockholm. Role: project leader of the qualitative studies. 
  • Cécile Rousseau, professor in child- and adolescent psychiatry at McGill University, Canada. Role: Over all expert and experienced in using the cultural formulation interview in clinical practice.
  • Aina Vaage, the Centre for Transcultural Psychiatry, Stavanger University Hospital. Role: planning and evaluations of the focus groups interviews, adaption of treatment as usual, training of the staff at site, and over all expertise in building up health care structures targeting migrants.
  • Rosaria Galanti, (EPHIR) Department of Global Public Health, KI. Role: project leader of the evaluation part of the project.
  • Henna Hasson, (Procome) LIME, KI. Role: project leader of the implementation.

The core working group

  • Christina Dalman, PI, consultant, professor in psychiatric epidemiology, EPiCSS Research Group
  • Anna-Clara Hollander, PhD, psychologist, researcher, EPiCSS Research Group
  • Emma Wikell, Head of  First Line Mental Health, Rudans Vårdcentral, Haninge
  • Karima Assel, consultant, child and adolescent psychiatrists, The Knowledge Centre For Transcultural Psychiatry, Region Stockholm
  • Johan Åhlén, PhD, psychologist, The Unit for Mental Health, Region Stockholm
  • Ester Gubi, MD, doctoral student in the project, EPiCSS Research Group
  • Hanna Johans, project coordinator, EPiCSS Research Group