Refugee young people in the Netherlands are at increased risk of mental health problems but make relatively little use of specialist mental healthcare. Effective, low-threshold interventions can help support young people earlier and refer them to specialist care when needed. This is shown by clinical psychologist Cansu Alözkan Sever.
‘Many young people with a refugee background have experienced highly stressful or traumatic events before, during and after migration. As a result, they are at increased risk of mental health problems such as depression, anxiety and post-traumatic stress,’ says Alözkan Sever.
‘Yet these young people make limited use of mental healthcare. Language barriers, stigma and difficulties in accessing care may all play a role. As a result, mental health problems may go unnoticed or untreated.
‘My research shows that effective psychological interventions are available for refugee children and young people. These can reduce mental health problems, even in low-income countries,’ the researcher says.
Less use of specialist mental healthcare
Alözkan Sever’s research identified an important gap in mental healthcare. ‘Young people with a migrant background make less use of specialist mental healthcare than their peers born in the Netherlands. It is also possible that they enter care more often only once their problems have become severe, through emergency routes.’
Interviews show the challenges these young people face. In addition to mental health problems, they mention language barriers, difficulties at school and the challenge of building a new life in an unfamiliar society.
‘This is why it is important not only to have effective treatments available, but also to ensure timely access to appropriate support,’ the researcher says.
Problem Management Plus adapted for young people
The study examined the potential of Problem Management Plus (PM+), a scalable psychological intervention. Based on interviews with refugee young people, professionals and other stakeholders, PM+ was subsequently adapted for use with young people.
A new module for emotional processing was also developed: PM+EP. This module focuses on the emotional processing of traumatic events.
Alözkan Sever says: ‘The initial results are positive. The adapted approach proved feasible, acceptable and safe. However, further research is needed to determine how effective the new module is and which young people benefit most from it.’
A bridge between informal support and specialist care
According to the research, interventions such as PM+ can help bridge the gap between informal support and specialist care. They provide young people with practical skills to cope with stress and problems.
‘Given the long waiting lists and increasing pressure on youth mental healthcare, such interventions could contribute to earlier support and, where necessary, timely referral to specialist care,’ says Alözkan Sever.
According to the researcher, the findings underline the importance of accessible, culturally sensitive and low-threshold support. The findings are relevant to mental healthcare professionals, policymakers, schools, municipalities and organisations working with young people with a refugee or migrant background.
A range of research methods
To map and address mental health problems among refugee young people in the Netherlands, Alözkan Sever used a range of research methods.
A systematic review and meta-analysis was conducted into the effectiveness of psychological interventions for children and adolescents in low- and middle-income countries. In addition, national register data were analysed to examine the use of specialist mental healthcare among young people with a migrant background and theır Dutch-born peers in the Netherlands.
Qualitative research was also conducted among refugee young people and other stakeholders. Their experiences and culturally relevant expressions of mental health problems were used to adapt the generic PM+ intervention and develop the new emotional processing module.
Finally, a pilot study was conducted using both qualitative and quantitative research methods. The study included a randomised controlled trial (RCT) and a qualitative process evaluation to assess the feasibility, acceptability and safety of the adapted PM+EP intervention.