Distal determinants of mental health conditions (MHC) for asylum-seeking children in Greece: A health system enhancement study |
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| Affiliation: | 1. Harvard T.H. Chan School of Public Health, Global Health & Population, Boston, MA, USA;2. Save the Children, Athens, Greece;1. School of Pharmacy, Gyeongsang National University, Jinju, South Korea;2. Institute of Pharmacy, Gyeongsang National University, Jinju, South Korea;3. Health Insurance Research Institute, National Health Insurance Service, Wonju, South Korea;4. Graduate School of Public Health, Seoul National University, Seoul, South Korea;5. College of Pharmacy, Ewha Women’s University, Seoul, South Korea;1. New York University Wagner Graduate School of Public Service, USA;2. University of Illinois at Chicago School of Public Health, Division of Health Policy & Administration, USA;1. Health Economics Research Centre, University of Oxford, 0X37LF Oxford, UK;2. Leeds Institute of Health Sciences, University of Leeds, LS29JT Leeds UK;3. Centre for Health Economics, University of York, YO105DD Heslington UK;1. Drexel University, Kline School of Law and Dornsife School of Public Health, 3320 Market Street, Philadelphia, PA, 19104, USA;2. Ecole des Hautes Etudes en Sante Publique, Department of Human and Social Sciences, 15 avenue du Professeur Leon-Bernard, CS 74312, 35043, Rennes cedex, France;3. Ecole des Hautes Etudes en Sante Publique, Institute of Management, 15 avenue du Professeur Leon-Bernard, CS 74312, 35043, Rennes cedex, France;1. Department of Psychiatry & Neuropsychology, Alzheimer Center Limburg, Maastricht University, the Netherlands;2. School for Mental Health and Neuroscience (MHeNs), Maastricht University, the Netherlands;3. Care and Public Health Research Institute (CAPHRI), Maastricht University, the Netherlands;4. Burgerkracht Limburg, Sittard, the Netherlands;5. Department of Health Services Research, Maastricht University, the Netherlands;6. Stichting euPrevent|EMR, Heerlen, the Netherlands;1. Health Economics Research Unit (HERU), University of Aberdeen, UK;2. Department of Economics, University of Bergen, Norway;3. Division of Population Health, Health Services Research & Primary Care, University of Manchester, UK;4. Institute of Applied Health Sciences, University of Aberdeen, UK |
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| Abstract: | Mental health conditions (MHC) of asylum-seeking children in Greece are dire, but still recovering from the financial crisis, Greece cannot afford the cost of mental health treatments. We were motivated to understand the root causes of these mental health problems to explore the possibilities for prevention. We developed our inferences in four ways: (1) secondary analyses of thirty-nine semi-structured informational interviews conducted with national and international aid organizations and healthcare providers; (2) secondary analyses of nine interviews with asylum seekers; (3) direct observation during six refugee camp visits from June 1 to July 28, 2017; and (4) a literature review to develop a diagnostic tree of causal outcomes.Results revealed eight proximal causes: chronic stress, trauma, at-risk population without protection and assistance, the large number of vulnerable groups, feeling of insecurity, feeling of lacking control, a lack of autonomy, and feeling helpless and hopeless. We identified sixty-nine distal determinants of adverse MHC beneath the proximal causes. Too numerous and too diverse to treat effecvively with limited resources, these root causes of MHC were thematically grouped into: laws and regulations, capacity and resources, accountability and standards, prioritization, bias and stigma, and displacement. Using a common health systems framework, we developed strategic policy approaches to target the root causes, which could prevent ill-health while saving time and resources. |
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| Keywords: | Determinants of health Refugees Health system reform Greece Mental health |
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