Integration of Refugees Into Public Mental Health Care

Study Overview
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Brief Summary
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There are specific barriers to utilise psychotherapeutic services for refugees with mental health problems in the German public health care system. This study aims to evaluate additional organisational components that are hypothesised to improve service utilisation. In a randomised controlled trial, refugees with mental health problems are identified by peers, subsequently assessed by professional staff and referred to public psychotherapeutic health services who offer standard care. Participants are assigned to care as usual or to coordinated and peer supported mental health care; the latter includes several additional organisational assistance components, i.e. a coordination center, trained peers to support treatment utilisation, a support and training center for therapists, and a interpreter pool. Measures include service utilisation and symptom change after 6 months. Furthermore the study evaluates whether trained peers can correctly identify participants with mental health problems.

Official Title
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Integration of Refugees With Mental Disorders Into the Public Psychotherapeutic Health Care Services - a Model Project With Trained Peers

Conditions
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Psychiatric Disorders From Chapters 3 and 4 of ICD10

Intervention / Treatment
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* Other: coordinated and peer supported mental health care
* Behavioral: standard psychotherapeutic care in the public healthcare system


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Psychiatric diagnosis from Chapters 3 and 4 of ICD10 Participant applied for asylum in Germany Entry to Germany after 2012 Participants is motivated to utilise psychotherapeutic services Patient speaks one of the languages in which services are offered (i.e. German, English, French, Arabic, Kurdish, Dari, Farsi, Urdu, Pashto, Tirginya, Somali) Exclusion Criteria: Mental disorder that requires inpatient treatment

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Standard psychotherapeutic care + coordinated and peer supported mental health care<br>Participants receive standard psychotherapeutic care in the public healthcare system. For participants and therapists in this group standard care and additional organisational support is available which is labeled coordinated and peer supported mental health care. This includes several additional organisational assistance components that are currently not part of the services of the public mental health care system, i.e. a coordination center, trained peers to support treatment utilisation, a support and training center for therapists, and an interpreter pool.This is Treatment as Usual plus coordination and peer support. | Other: coordinated and peer supported mental health care<br>* Health services, coordination of services, method to support utilization<br>Behavioral: standard psychotherapeutic care in the public healthcare system<br>* Psychotherapeutic services that are financed by the public health insurance system.<br>|
| Other: Standard psychotherapeutic care<br>Participants receive standard psychotherapeutic care in the public healthcare system. For participants in this group no additional organisational support is available. This is Treatment as Usual. | Behavioral: standard psychotherapeutic care in the public healthcare system<br>* Psychotherapeutic services that are financed by the public health insurance system.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Service utilisation | Percentage of participants who utilise psychotherapeutic services | 6 months after study inclusion | 
| Psychiatric symptom change | Self-report of psychiatric symptoms by means of questionnaires | assessments 6 and 12 months after study inclusion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage correctly identified refugees with mental health problems | Comparison of peer screening and expert diagnostic assessment | two weeks |