Inter-professional and inter-cultural competence training as a preventative strategy to promote collaboration in encountering new-coming refugees in the reception programme: A case study

Every encounter with a patient/client in the mental health and social services constitutes a
challenge for the responsible staff or organisation. Meeting a patient/client from a culture
other than the one to which the caretaker/case manager belongs accentuates this challenge.
The challenge will be even greater in the future because the number of refugees at mental
health facilities is steadily increasing around the world. One of many aspects of the
challenge is the language barrier. This may be a problem even when an interpreter makes
the work of communication function smoothly (Farooq & Fear, 2003). A qualitative study by
O’Donell et al. (2007) researched various aspects of health care for immigrants in the UK.
Overall the participants were satisfied with the help they got from interpreters, but lacked
help from them at key moments during their treatment. The participants also felt that the
interpreters did not tell the GP what the patient had actually said and were not familiar with
medical terminology, which impeded information sharing. This undermined trust. The
participants stressed the importance of mental health services and the lack of care they
received.
When the patient facing a clinician is a refugee from another culture (in some cases he/she
could be a refugee from the clinician’s own country of origin) the assessment or treatment
will be even more complicated. Having access to the care to which the patient has a right is
essential for refugees’ mental health. Silove (2002) reports some of the consequences which
the new Australian policy with detention centres had for refugees: an increase in self-harm
behaviours, hunger strikes and riots at detention camps for refugees in Australia.
Regardless of the refugee’s grounds for deciding to move from his/her country of origin to a
reception country, the goal is to avoid death, secure a better future, avoid persecution and
discrimination or leave a war zone to avoid being killed. The decision to move will have
consequences for the refugee’s entire life as well as for his/her family and will affect their
health, economy and general welfare.
The migration process can be divided into two stages: pre- and post-migration. The pre-
migration stage covers the time up to the decision to leave the place of residence as well as
the journey to a new place in which to live; its duration will vary with the circumstances.
Lindencrona, Ekblad and Hauff (2008) identified four dimensions of resettlement stress
among recently resettled refugees from the Middle East in Sweden: social and economic
strain, alienation, discrimination and loss of status, and violence and threats in Sweden. To
remain where they came from would have exposed them to psychological and physical
abuse.
The goal of this chapter is to prepare mental health and social service staff to cope with the
challenges posed by the above at every level of the organization. An important part of this is
to get tools to be able to assess and understand the inherent potential that refugees carry
within the clinical and social service space. At the same time it is of significance to pay
attention to resilience factors (Antonovsky, 1988); why some cope better than others, to bear
in mind the strengths which these people possess. The chapter aims to provide an
introduction to refugees’ mental health and the challenges and gaps which health and social
care staff meet in encounters with this target group. The topic is highly relevant as the world
becomes increasingly globalised. Refugees’ health, especially mental health, is thus a world
problem. The competence training is presented as a Case from Sweden but it can be
generalized to other countries in similar situations