[10 years of public mental health services for asylum seekers persons in Geneva What balance? Which new horizons?] / Dix ans de soins psychiatriques communautaires auprès des personnes requérantes d'asile à Genève - Bilan et perspectives.

Transcultural psychiatry in the public sector is specifically linked to current political events. The recent ukrainian crisis is an illustration of how massive displacement of refugees can occur. Recently, the COVID-19 pandemic had consistently and in many ways weakened the vulnerable population of asylum seekers. These two major events remind us how flexible and reactive our care settings have to be, how much we need to collaborate with our partners in order to maintain creativity and quality in our interventions.

La pratique de la psychiatrie transculturelle en institution se caractérise par un lien constant entre l'actualité mondiale et nos dispositifs de soins. La toute récente crise ukrainienne illustre la rapidité avec laquelle d'importants flux migratoires peuvent soudain être déclenchés. Auparavant, la pandémie de Covid-19 avait déjà fragilisé, par différents aspects, la population vulnérable des personnes requérantes d'asile. Ces deux événements majeurs nous rappellent à quel point nos dispositifs de soins se doivent d'être souples et réactifs et capables de s'articuler avec d'autres partenaires afin de maintenir une créativité et une qualité dans nos soins.

Determinants of Suicidality and of Treatment Modalities in a Community Psychiatry Sample of Asylum Seekers.

A high prevalence of mental illness has been reported in asylum seekers. The present cross-sectional study examined suicidal thoughts, treatment modalities (outpatient crisis intervention, inpatient care), and their determinants in asylum seekers (n = 119) and permanent residents (n = 120) attending the same outpatient clinic in Geneva, Switzerland. The most frequent diagnoses were depressive disorders (64.7%) and posttraumatic stress disorder (34.5%) in asylum seekers and psychotic (55.0%) and depressive disorders (33.3%) in permanent residents. The frequency of suicidal thoughts was similar in both groups (>30%). Asylum seekers benefited from outpatient crisis intervention more frequently than residents did (26.9% vs. 5.8%), whereas inpatient care was less frequent (25.2% vs. 44.2%). In asylum seekers, acute suicidal thoughts were associated with increased frequency of outpatient crisis interventions, and, suicidal thoughts, psychosis, or personality disorders were associated with higher rates of hospitalization. Documenting clinical characteristics and service utilization of asylum seekers is a prerequisite to organizing targeted interventions.

[Evolution in Geneva of institutional psychiatric services for asylum seekers persons]. / Evolution à Genève des soins psychiatriques institutionnels pour les personnes requérantes d'asile.

Recent conflicts in the Middle East and Africa generated the displacement of millions of refugees seeking a safe haven. It led to a transformation in the population of asylum seekers attending our community psychiatry clinic serving refugees and asylum seekers in Geneva. That patient population doubled in a couple of years, comprising a higher number of young men, migrating alone, mostly from the Middle East and Afghanistan. Higher demand on our system and specific mental health needs brought us to transform our setting. We have set up a new evaluation step, we developed outreach interventions, we work more closely with people in the patients' networks and we have dedicated meetings to discuss cases within the team and with supervisors with expertise in working in transcultural settings.

Les récents conflits internationaux survenus au Proche-Orient et en Afrique ont conduit à l'exode massif de millions de réfugiés en quête d'abri. Cela a conduit à une profonde transformation de la population des requérants d'asile soignés au CAPPI Servette. Cette population a doublé en l'espace de quelques années. Les jeunes hommes migrants seuls, provenant majoritairement du Moyen-Orient et d'Afghanistan sont ainsi bien plus fortement représentés. L'augmentation et la modification des besoins en termes de santé mentale de cette population nous ont amené à transformer notre dispositif d'accueil et d'évaluation, à développer des interventions mobiles tout en intensifiant le travail de réseau et en déployant des espaces de supervisions plus spécifiques aux interventions transculturelles.

What are the barriers to access to mental healthcare and the primary needs of asylum seekers? A survey of mental health caregivers and primary care workers.

BACKGROUND: We aimed to assess the opinion of primary care workers, social workers, translators and mental health caregivers who work with asylum seekers about the latter's unmet needs and barriers to access to mental healthcare. METHODS: We used a Likert scale to assess the opinion of 135 primary care workers (general practitioners, nurses, social workers and translators) and mental health caregivers about the proportion of asylum seekers with psychiatric disorders, their priority needs and their main barriers to mental health services. RESULTS: Insufficient access to adequate financial resources, poor housing and security conditions, access to employment, professional training and legal aid were considered as priority needs, as were access to dental and mental healthcare. The main barriers to access to mental healthcare for asylum seekers included a negative representation of psychiatry, fear of being stigmatized by their own community and poor information about existing psychiatric services. CONCLUSIONS: We found a good correlation between the needs reported by healthcare providers and those expressed by the asylum-seeking population in different studies. We discuss the need for greater mobility and accessibility to psychiatric services among this population.

Personality Factors and Attachment Styles as Predictors of the Therapeutic Efficacy of a Short-Term Ambulatory Intervention for Depression.

BACKGROUND: Several studies have shown a significant positive impact of intensive short-term ambulatory psychiatric interventions for depression. However, data on outcomes related to factors that are predictive of the efficacy of these interventions in terms of remission or response to treatment remain scarce. The goal of this naturalistic prospective study was to identify factors, including Big Five Inventory personality traits and attachment style, that are predictive of the efficacy of crisis interventions (CIns) in major depressive disorder. METHODS: The study included 234 adult outpatients with major depressive disorder who completed all assessments in a study of a short-term intensive ambulatory CIn. In this study, we evaluated sociodemographic factors, and scores on the Global Assessment of Functioning Scale, the Big Five Inventory personality assessment, the Montgomery-Åsberg Depression Rating Scale, and the Adult Attachment Scale. RESULTS: Mean scores on the Montgomery-Åsberg Depression Rating Scale decreased significantly from 26.3 (SD=9.0) at admission to 10.6 (SD=8.1) at the end of the CIn (t=23.9; P<0.001); 99 patients (42%) experienced remission, 151 patients (65%) were considered treatment responders, and 98 patients (42%) both responded to treatment and experienced remission. Results of multivariate regression analysis showed that education level and family intervention were associated with response to treatment. Neuroticism traits were related to a lower rate of response to treatment. The dependency dimension attachment style had a positive impact on response to treatment. CONCLUSIONS: Neuroticism traits can predict clinical outcomes after a short-term intensive psychiatric intervention for depression. Results of family interviews, education level, and Global Assessment of Functioning scores should also be taken into account in predicting clinical outcomes.