Describing the objective and subjective mental health care needs of minor refugees in Germany

Abstract

Half of the estimated 70.8 million forcibly displaced people are under the age of 18. Clinical studies assessing prevalence of mental illness, commonly depict them as a particularly vulnerable group. However, screening instruments are not enough when establishing the need for mental health care. By supplementing them with subjective measures, we aim to provide insight into the mental health care needs of otherwise overlooked groups.Data were collected between February and November 2019 in German schools and refugee accommodations via tablet based self-assessment. Adolescents between 12 and 18 years of age coming from Syria, Afghanistan, and Iraq were invited to participate. The Hopkins Symptom Checklist-37 (HSCL) was used to measure internalizing and externalizing symptoms (i.e. objective need; cut-off score = 69). A single item was used to assess the subjective need for mental health care: “Do you think that you have emotional difficulties for which you need help?”A total of 259 participants completed the questionnaire. While 22.4% reported an emotional issue for which they need help (missing values=22.4%), the HSCL (α=.90) identified 10.4% of participants to be at risk for a mental health disorder (missing values=18.5%). Most participants (62.5%) reported neither objective nor subjective care need. However, 23.7% (n = 36) of those not identified as at risk said they have emotional difficulties, while 5.9% (n = 9) of those at risk stated they do not have an emotional issue.Our sample showed lower levels of mental health issues as measured by the HSCL, when compared to samples of refugee minors in Germany (33.7%) and Norway (17.2%). Especially vulnerable groups are those who report problems, but are not identified by the screening measure as at risk and those identified as at risk, but do not perceive to have mental health difficulties. Public health interventions need to develop tailored strategies to reach these groups.Screening instruments are not enough when establishing the need for mental health care of vulnerable populations.Subjective and objective need should be considered when establishing who gets mental health care.