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

Children and adolescents with migrant backgrounds are less likely to access mental health care, despite often having substantial mental health problems. The TINA project (Tidiga Insatser NyAnlända) explored how barriers to care can be reduced through interventions in healthcare, municipalities, and civil society.

Based in Haninge, Stockholm, the project combined community interventions, and changes within primary care mental health services (“First-line services”) to improve access to care.

The evaluation included quantitative and qualitative methods; Questionnaires and interviews, focusing on both process and effect measures, and finally, we explored whether the number of first-time contacts had increased during a follow-up period of three years, taking advantage of full coverage administrative health care registers.

Preliminary findings suggest that several components of the intervention were feasible and well accepted by participants and collaborating organisations. Increased knowledge of mental health services and referral pathways was observed among both professionals and parents, and the project identified practical measures that appeared to facilitate access to care, including simplified contact routes to primary care mental health services.

The analysis of register data showed a significant increase in first-time contacts among individuals without migrant backgrounds during the first year of the follow-up period, compared to matched controls (IRR 1.3 (95% CI 1.1-1.5). An increase of similar magnitude was found during the same period for individuals with migrant backgrounds, although not statistically significant (IRR 1.3 (95 % CI 0.9-1.8)). No increase in first-time contacts was observed during the last two years of the follow-up period, neither among individuals with or without migrant backgrounds.

The project highlights important challenges related to sustainability. Effects on care-seeking appeared during the initial phase of the intervention, suggesting that continued collaboration through stable organisational structures, and ongoing local engagement may be necessary to maintain impact over time.

Publications

Publications from the project

The first thesis within the project

Ester Gubi: "Mental health service use among refugee children, other migrant children, and children born in Sweden - what are the differences and why does it differ?"

An interview with Ester Gubi (in swedish)

Project contact person

Christina Dalman

Professor, Senior

Email: christina.dalman@ki.se

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
Johan Åhlén, PhD, psychologist, The Unit for Mental Health, Region Stockholm
Karima Assel, child and adolescent psychiatrists, PhD student, EPiCSS Research Group
Ana Hagström, Phd student, PROCOME Research Group
Hanna Johans, project coordinator, EPiCSS Research Group
Ester Gubi, MD, PhD, EPiCSS Research Group