By Patrick Nyikavaranda, Doctoral Candidate (Brighton and Sussex Medical School) and NIHR Applied Research Collaboration Kent, Surrey and Sussex, Primary and Community Health Services theme.

This World Mental Health Day (10 October), it is important to put our focus on marginalised communities and individuals who are often denied their rights and sometimes are not aware of their rights.

In 2020, more than half (52%) of international migrants to Europe were female and, in recent years, there have been record levels of migration to Europe of individuals born outside Europe, as people leave their homeland to look for work, reunite with family or to seek protection.

According to The UN Refugee Agency, USA for UNHCR, the 'Refugee Crisis' saw 40% of people arriving in Europe identifying as women and children. In the UK, female migrants face challenges with one in five females seeking asylum having experienced gender-based abuse. Disclosure of violence, victimisation and mental health concerns in this group remains a challenge due to factors such as lack of awareness, threats, shame, guilt, fears of being deported, as well as unsafe housing and overall instability in their socio-economic lives.

Evidence suggests that females in newcomer populations are at higher risk of diagnosable mental health-related illnesses due to trauma, social isolation, discrimination, and financial hardship, including Post Traumatic Stress Disorder (PTSD) and perinatal depression.  Yet, migration research and the mainstream media largely focus on men and have led to services being designed with male migrants in mind, with little input from and consideration for female migrant populations. 

And, while male migrants use mental health services less than the general population, female migrants use these services even less. This is because the male narrative-dominated review of perceptions and experiences of access does not reflect female migrant views.  Inequalities are found among class, race, sexuality, gender, and power. Within these different inequalities, the group traditionally labelled as 'female' has faced even more inequalities, within inequalities.

Through a feminism lens, the Barriers and facilitators to seeking and accessing mental health support in primary care and the community among female migrants in Europe: a 'feminisms' systematic review identifies the barriers and facilitators, faced by women and girls, from newcomer populations, when looking for and accessing mental health services and, from this, addresses the important gaps.

It highlights how, as part of our research, it was important to set up a co-production group of female migrants and professionals who support them to discuss the issues they faced. The group co-produced a framework for research on female migrant mental health that continues to contribute to subsequent research on this topic, as well as a commentary on the review.

The themes identified as barriers to accessing mental health included: lack of access to the right information, cultural barriers, and stigma. GP services were seen as facilitators, to access support, as many female migrants had expressed a willingness to use these services, further potential facilitators were also identified including, culturally appropriate serviced gender-specific support and religious leaders.

Access to information was highlighted as an issue for female migrants, in particular, as one 34-year-old female from Eritrea expressed frustration as not knowing who to talk to about her mental well-being, due to a lack of awareness about which services are appropriate to access mental health support.

To summarise, the findings show how mental health research, services, policies, and commissioning of support all need to do more to meet the needs of female migrants.  With record levels of migration to Europe, mental health services must listen to the needs of female migrants and be more culturally aware and gender sensitive. Services need to be designed in a way that will remove the barriers currently faced by female migrants and support them in their mental health journey.

Let us take time to genuinely listen to female migrants and work with them to improve their social and health situations. In so doing, we are improving the lives of some of those who are close to us.

Read the full Review

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