Complex migratory duels, consumption and trafficking of psychotropic drugs in unaccompanied minorssymptoms chronic anxiety, post-traumatic stress disorder, isolation… These are some of the problems faced by groups in situations of or at risk of permanent social exclusion. Among the last to get in the already very long access queue to the services of mental health in public health, migrants in an irregular situation appear. They must face a system that is saturated, explains THE NEWSPAPER OF SPAIN, from the Prensa Ibérica group, Eva Gallego, reference in this section of state programs and autonomous Doctors of the World. They don’t even know how to do it. And when they arrive at the hospitals – the ER is their only point of entry – they return to the streets without any follow-up.
The migrant condition, even without being in an irregular situation, greatly complicates access to services that, right now, in Spain, are overwhelmed. With an ever-increasing demand for care and endless waiting lists to get an appointment with a psychologist or a psychiatrist, the situation that Eva Gallego describes is that of groups that encounter more barriers than the rest of the population.
The humanitarian organization presents these days a new report on ‘Mental health and psychosocial support in vulnerable people’ to which this newspaper has had access. It is the continuity of a previous one, from 2022, whose information and technical proposals have tested new intervention strategies by promoting networking, raising awareness in psychosocial aspects and cultural of the intervention for professionals and third sector volunteers.
A collapsed system
The psychologist of Doctors of the World -entity that has been working for more than 30 years with vulnerable groups and the clear risk of health exclusion-, talks about a system that is collapsed. From a population, the Spanish population, that increasingly demands more mental attention. In this context, something that many of the irregular migrants they assist repeat is: “Who’s going to care how I feel?”
“They complain about very short appointment times, fear of stigma… There is also the language and even cultural barrier. A person from Latin America can understand how a mental health service works, because they know it, but for an African or even a person from Eastern Europe, it initially generates rejection because in their countries, it is associated with stigma,” explains Gallego, who emphasizes the importance of cultural mediation.
A risk factor
Manuel Martín Carrasco, president of the Spanish Society of Psychiatry and Mental Health (SEPSM) assures that migration “is a risk factor for the appearance of mental illnesses because it represents a very important change in people’s lives: a loss of cultural, social, religious referenceslifestyle, food, etc.”. The psychiatrist points out that, in addition, the “more painful” they are the conditions of migrationthe more impact it has on the disease and the risk increases of mental disorders appearing.
In the case of Doctors of the Worldexplains psychologist Eva Gallego, many of the migrants with whom the organization works They are living in settlements. Or in situations of homelessness. They see many women in prostitution situations. Even with their situation regularized, the delay in appointments for mental health consultations makes access impossible. Gallego describes people in a residential situation “very unstable” who, even though they are referred to hospital psychiatric emergencies in the event of a serious episode, are discharged without any follow-up. What’s more, he adds, in the case of admission, they are discharged “even stating that they have no place to be.”
“Imagine women in a situation of prostitution that they have to return to a club, or homeless people who must return to a settlement. They do not have an adequate place for their psychosocial recovery. It is difficult,” says the person in charge of the organization. What they are encountering in their interventions, in the case of people in an irregular situation, in transit areas such as the Canary Islands or Melilla, is a first impact due to the exit conditions. from the country of origin, in many cases fleeing situations of violence, and a deplorable physical conditionFor example in those who come from a boat trip.
People are in very survival mode and the option of not arriving alive exists.
“The conditions of passage on the African route, the conditions of the boats…They come with a significant impact on your mental health. In most cases, except for a very initial containment in the event that they are picked up by an NGO, not much else is done,” he adds. What do they find in these interventions? “On an emotional level, a lot of shock. Having arrived generates a situation of emotional anesthesia for everything. The fact of feeling rescued, of being treated like a person for the first time in months or years, generates a certain euphoria. People are in very survival mode and the option of not arriving alive exists,” responds the psychologist.
Go to the emergency room
The president of the SEPSM emphasizes, for his part, that there is “an overrepresentation of migrants in emergency services”, and not exactly due to poor health, but rather “because they come when the situation is already serious.” The same thing happens when it comes to mental disorders.
Lack of language knowledge and the functioning of the system, sometimes combined with the fear of identifying themselves in case they are deported, mean that migrants take longer to go to this type of services and that the first contact with health services is, precisely, through the Emergencies, explains Martín Carrasco. Added to this are the obstacles that doctors encounter when it comes to maintaining contact. with these patients and to be able to follow them up later.
If they came by boat and had to be rescued or experienced situations where their companions died, that adds a traumatic circumstance.
One of the variables that influences the mental health status of this population is the reason for their migration. “If they came by boat and had to be rescued or experienced situations where their companions died, that adds a traumatic circumstance,” says Manuel Martín. The economic motivation, the political problems, the persecutionscircumstances such as having been prisoners, having suffered abuse or having witnessed a war, are factors that can generate greater risks to the health of migrants.
From there, organizations encounter with all types of traumatic symptoms. “Post-traumatic stress disorder, very dissociated people in whom you see a total disconnection from your emotions, of denial, of I’m fine, of not connecting emotionally with anything. When they are left outside the official reception resources and appear through assistance resources such as Doctors of the World, they have a lot of anxious depressive symptoms“, says Eva Gallego.
The psychologist points to another “surprising” fact. A “incredible black market for psychotropic drugs; We have seen them, above all, in young kids in Melilla. In the case of minors, it is easier to refer them to the public system, which they do is to sell the pills loose; This is used both on the route and at the arrival, without any type of guideline. Are psychotropic drugs that are sometimes mixed with hashish or alcohol with which the action systems or the nervous system are terrible,” warns the professional.
There is one aspect that stands out: the resilience of people who had been in a survival context for a long time.
In his latest reports, the organization also describes the status of people who have been on a longer journey. There they find “a lot of impact of violence, especially on women. And above all, when have been through trafficking or prostitution. Lots of traumatic symptoms. In men, there are more substance abuse problems as a coping strategy. But there is one aspect that stands out, explains the Technical Reference for Mental Health of Doctors of the World, the resilience of people who had been in a survival context for a long time. His ability to get up again and again.
There is an incredible black market for psychotropic drugs, especially we have seen it in Melilla and in young kids.
In his new job -state-wide, compiling information from the different locations of the regional headquarters of Médicos del Mundo: Tenerife, Vigo, Melilla, Mallorca, Valencia, Zaragoza, Barcelona and Almería– Vulnerability factors for mental health are detailed, such as the migration process itself – which affects two thirds of the sample -; followed by self-perceived poverty, which affects more than half of the sample and homelessness, which affects more than half of the participating people.
Among the conclusionsthat the majority of people in different situations of vulnerability who make up the sample recognize frequent difficulties related with sleep disorders, constant nervousness, or tendency to isolate or social withdrawal.
Without previous physical health problemsagree in a high percentage in pointing out frequent symptoms of physiological activation, chronic musculoskeletal discomfort, and feeling of fatigue and tiredness on a regular basis. At the beginning of the intervention, the majority, at a cognitive level, report recurring concerns and a habitual feeling of failure and helplessness.
Good health at its origin
Dr. Martín Carrasco emphasizes: people who emigrate They have good health at birth because “it is very difficult for those who suffer from serious mental disorders to face the challenge of immigration in such hazardous conditions.” At this point, it highlights the phenomenon of ‘healthy immigrant’: “In the first years, it is appreciated that they are people who are in good health and, it is not until after several years of stay in the host country, when the levels of health or illness begin to equate to those of the host population.
During the journey to your final destination, migrants suffer what is known as ‘migratory grief’, a term that encompasses all the losses they face in the migration process, explains Manuel Martín Carrasco. “All the references that have been lost both spatial, where it lives, the landscape, the climate, as well as social, family and friend, and cultural and religious. The person has to integrate all these losses,” says the psychiatrist.
The dream of a job
In these cases, Employment becomes one of the most relevant factors to achieve stability in the destination country. “Work is a fundamental element of socialization and personal autonomy, therefore, if you don’t have it, everything is much more difficult,” reflects the president of SEPSM.
From the Spanish Society of Psychiatry and Mental Health They advocate carrying out greater pedagogical work: “The person who emigrates comes from a very different cultural and social reality, and for this reason, education is important to promote integration,” says Dr. Martín Carrasco.