CURRENT STATUS AND FUTURE PERSPECTIVES OF TRANSCULTURAL PSYCHIATRIC SERVICES IN EUROPE II

Mental Health Services among Migrants Danish Perspectives WPA Athens 2005 Marianne Kastrup, Uffe Juul Povlsen, Marianne Østerskov Centre for Transcultural Psychiatry Rigshospitalet Copenhagen Denmark Overview of presentation Introduction  Organization of mental health services  Community mental health services  Census survey  Results  Implications  Organization of Services  Mental health problems: – Primary health care: – G.P. key role in coordination interventions, diagnosis and treatment – Secondary health care: – Psychiatric clinic • Admissions • Emergency care • Community mental health care – Social psychiatric services: • E.g. workshops, shelters, fountain house Psychiatric Services for Immigrants: Present Status In some areas 20-30% of patients with other ethnic background  In forensic psychiatry 30-40% of patients with other ethnic background  No explicit mental health policy for immigrants  Assessment and treatment depend upon immigrant status  Psychiatric Services for Immigrants  Rigshospitalet Psychiatric  Approx. Clinic – Catchment area Inner Nørrebro 25% population with other ethnic background  Community mental health services with a specific transcultural multidisciplinary team  Close collaboration between inpatient, community mental health and social psychiatric services Census Survey 2004 Community Mental Health Services Information on:  Age and sex  Marital group  Migrant status  Sheltered housing  Economic situation  Children under age  Census Survey 2004 Community Mental Health Services Information on:  Diagnostic group (ICD-10) Psychosis diagnosis  Concomitant substance abuse  (none, present, previous)  Admissions none, last 2 years 1-3 adm. or < 50 days, last 2 years  4 adm. or  50 days, more than 2 years ago Clinical Global Impression (1-7)  Global Assessment of Functioning (1-100)  Assessment of GAF           1-10 persistent inability to maintain minimal personal hygiene 11-20 occasionally fail to maintain minimal personal hygiene 21-30 inability to function in almost all areas 31-40 major impairment in sevral areas 41-50 any serious impairment in functioning 51-60 moderate difficulty in functioning 61-70 some difficulty in functioning 71-80 slight impairment in functioning 81-90 good functioning in all areas 91-100 superior overall functioning Assessment of CGI not evaluated  1= normal  2= borderline mental disorder  3= mild degree of mental disorder  4= moderate degree of mental disorder  5= prominent degree of mental disorder  6= severe degree of mental disorder  7= among the most extreme mentally ill  0= Census Survey 2004 All N All Men Danes Pct N Pct Immigrants N Pct MannWhitney test 261 100% 143 55% 193 100% 102 53% 68 100% 41 60% Women Age (meanl CGI mean GAF mean BMI mean 118 45,9 5,1 47,9 26,9 45% 91 47,1 5,2 47,0 26,8 47% 27 42,4 4,8 50,3 27,1 40% P = 0,020 P = 0,001 P = 0,010 P = 0,481 Diagnostic Distribution All N = 261 Pct Danes N = 193 Pct Immigrants N = 68 Pct 2-test ns ns ns P = 0,002 DF 00-09 DF 10-19 DF 20-29 DF 30-39 3 7 210 28 1% 3% 80 % 11 % 3 6 159 14 2% 3% 82 % 7% 0 1 51 14 0% 1% 75 % 21 % DF 40-49 DF 50-59 DF 60-69 1 0 12 0% 0% 5% 0 0 11 0% 0% 6% 1 0 1 1% 0% 1% ns ns ns +psychoses -psychoses No abuse +present 235 26 143 90 % 10 % 55 % 175 18 96 91 % 9% 50 % 60 8 47 88 % 12 % 69 % ns ns P = 0,006 58 60 106 22 % 23 % 41 % 47 50 86 24 % 26 % 45 % 11 10 20 16 % 15 % 29 % ns ns P = 0,029 +previous Severely ill Housing and Children All N = 261 Sheltered housing Children under age at home Children 36 40 Pct 14 % 15 % Danes N = 193 31 10 Pct 16 % 5% Immigrants N = 68 5 30 Pct 7% 44 % 2-test ns P < 0,001 97 14 83 *P < 0,001 Mean childr. No adm. 1-3 adm or < 50 d < 2 yrs ≥ 4 adm or > 50 d < 2 yrs 2,4 35 19 81 1,4 13 % 7% 31 % 2,8 7% 6% 34 % 13 11 66 22 8 15 32 % 12 % 22 % P < 0,001 Adm>2yrs ago 125 49 % 102 53 % 23 34 % P = 0,007 Statistik: * = Mann-Whitney Test Economic Situation All N = 261 Disability 167 Pct 64 % Danes N = 193 132 Pct 68 % Immigrants N = 68 35 Pct 51 % 2-test P = 0,012 Agepension Preretired Welfare 18 1 46 7% 0% 18 % 17 0 19 9% 0% 10 % 1 1 27 1% 1% 40 % ns ns P < 0,001 Sickleave Unempl Training Work 4 5 6 13 2% 2% 2% 5% 3 5 5 11 2% 3% 3% 6% 1 0 1 2 1% 0% 1% 3% ns ns ns ns Flexjob Cohabit Single 1 55 193 0% 21 % 74 % 1 22 163 1% 11 % 84 % 0 33 30 0% 49 % 44 % ns P < 0,001 P < 0,001 Sngl+child 13 5% 8 4% 5 7% ns Age, Sex, CGI, GAF, BMI All N All Men Rest Pct N Pct Transcult. N Pct Statistik MannWhitney test 261 100% 143 55% 210 100% 112 53% 51 100% 31 61% Women Age mean CGI mean GAF mean BMI mean 118 45,9 5,1 47,9 26,9 45% 98 46,8 5,2 47,2 26,6 47% 20 41,9 4,7 50,6 27,8 39% P = 0,026 P = 0,002 P = 0,033 P = 0,166 Diagnostic Group and Abuse All N = 261 Pct Other N = 210 Pct Transcult N = 51 Pct 2-test ns ns P = 0,018 DF 00-09 DF 10-19 DF 20-29 3 7 210 1% 3% 80 % 3 6 175 1% 3% 83 % 0 1 35 0% 2% 69 % DF 30-39 DF 40-49 DF 50-59 DF 60-69 28 1 0 12 11 % 0% 0% 5% 15 0 0 11 7% 0% 0% 5% 13 1 0 1 25 % 2% 0% 2% P < 0,001 ns ns ns +Psychoses -Psychoses -Abuse 235 26 143 90 % 10 % 55 % 191 19 102 91 % 9% 49 % 44 7 41 86 % 14 % 80 % ns ns P < 0,001 Abuse now Abuse prev Sev illness 58 60 106 22 % 23 % 41 % 54 54 94 26 % 26 % 45 % 4 6 12 8% 12 % 24 % P = 0,006 P = 0,034 P = 0,006 Housing and Children All N = 261 Sheltered living Children under age Children 36 40 Pct 14 % 15 % Other N = 210 34 12 Pct 16 % 6% Transcult N = 51 2 28 Pct 4% 55 % 2-test P = 0,023 P < 0,001 97 17 80 *P < 0,001 Mean no No admiss 1-3 adm. or < 50 ds < 2 yrs ≥ 4 adm or > 50 ds < 2 yrs 2,4 35 19 81 1,4 13 % 7% 31 % 2,9 7% 6% 34 % 15 12 72 21 7 9 41 % 14 % 18 % P < 0,001 P = 0,048 P = 0,021 Adm >2 yrs 125 49 % 111 53 % 14 27 % P = 0,001 Statistik: * = Mann-Whitney Test Economic Situation All N = 261 Disability 167 Pct 64 % Other N = 210 145 Pct 69 % Transc N = 51 22 Pct 43 % 2-test P = 0,001 Agepension Preretired Welfare 18 1 46 7% 0% 18 % 18 1 21 9% 0% 10 % 0 0 25 0% 0% 49 % P = 0,030 ns P < 0,001 Sickleave Unemploy Training Work 4 5 6 13 2% 2% 2% 5% 3 5 5 11 1% 2% 2% 5% 1 0 1 2 2% 0% 2% 4% ns ns ns ns Flexjob Cohabit Single 1 55 193 0% 21 % 74 % 1 25 177 0% 12 % 84 % 0 30 16 0% 59 % 31 % ns P < 0,001 P < 0,001 Sngl+child 13 5% 8 4% 5 10 % ns Antipsychotics Antipsychotics FGA SGA FGA + SGA FGA or SGA All N 261 59 202 193 N 80 9 71 63 Pct 31 % 15 % 35 % 33 % N 159 43 116 118 Pct 61 % 73 % 57 % 61 % N 26 7 19 21 Pct 10 % 12 % 9% 11 % N 213 45 168 160 Pct 82 % 76 % 83 % 83 % All < 36 yrs All > 35 yrs Danes DK < 36 yrs DK > 35 yrs Immigrants 43 150 68 5 58 17 12 % 39 % 25 % 30 88 41 70 % 59 % 60 % 4 17 5 9% 11 % 7% 31 129 53 72 % 86 % 78 % Imm < 36 yrs Imm > 35 yrs Transc. 16 52 51 4 13 12 25 % 25 % 24 % 13 28 31 81 % 54 % 61 % 3 2 4 19 % 4% 8% 14 39 39 88 % 75 % 76 % Tran< 36 yrs Tran > 35yrs 11 40 4 8 36 % 20 % 8 23 73 % 58 % 3 1 27 % 3% 9 30 82 % 75 % N = 261 hereof 90 % psychosesdiagnoses