Similarities
Differences
Assessment is typically done by using structured interviews, ratings scales, e.g. Harvard trauma questionnaire, SCL-90, GAF, WHO-5
Access to psychiatrist
Multidisciplinary work – all provide this
Availability of physiotherapy
Individual psychotherapy is provided by all
Treatment of somatic complaints
Psychosocial counselling is provided by all
Availability of group therapy
Psychoeducation provided by all
Other kinds of therapy, e.g. music, body workshop training
In a country the size of Denmark, one may wonder why there are such differences in the treatment provided for the same population, namely, traumatised refugees, and why there are no national guidelines available.
Several reasons may be given. One reason is that the five regions have a high degree of autonomy when it comes to provision of healthcare in their region, so differences may be due to their prioritising of this treatment.
Another reason could be that the differences are a reflection of different sizes of the traumatised population and thereby different needs in the different regions.
A third reason could be that the treatment offered reflects differences in the availability of professionals, e.g. a shortage of qualified psychiatrists in some areas of the country.
A fourth reason may be historical, namely, that a new treatment facility was originally established as a contrast to another treatment model that was, for example, too medically oriented.
A fifth reason may be that, despite having a multidisciplinary approach, different centres nevertheless have a particular interest or expertise in a certain treatment (e.g. music therapy) that may not be available elsewhere.
All in all, this shows that there is still a long way to go until we have a uniform approach to treatment which is based on evidence and acceptable for all.
Concerns
When wanting to optimise treatment, a number of concerns arise, as listed below:
1.
Re: the target population
We have to be aware that the population of traumatised refugees is far from a homogeneous population, although this is often how the group is perceived by administrators. On the contrary, it includes persons with very different backgrounds in terms of education, religion, economic status, etc. as well as very different resources that need to be taken into consideration when planning services.
2.
Re: staff
There is a need to ensure that staff possess the necessary cultural competence to manage patients of different cultural and ethnic backgrounds and that there is an awareness of the important impact that trauma may have on the general psychiatric morbidity and manifestation of symptoms, also among patients suffering from other psychiatric disorders. Working more frequently with interpreters requires that staff are trained to do so.
3.
Re: services
Treatment of traumatised refugees started outside the public health services at highly specialised institutions. Over time, however, we have seen a movement of the therapeutic activities towards mainstream public services, thereby providing the possibility of inspiring the mental health services in general to have a larger focus on the impact of trauma as well as cultural matters. It is also important to be aware that working with interpreters requires extra time and resources.