10/12/2018 Undocumented Migrants and Mental Health in the Context of the S.P.R.A.R. (Protection Service for Refugees and Asylum seekers) of Bologna (Italy) Vincenzo Spigonardo, MD Coordinator Ethnopsychiatry and Cultural Consultation Service Hospital Villa Ai Colli - Bologna (Italy) v.spigonardo@aicolli.com 1
10/12/2018 S.P.R.A.R. (Protection Service Refugees and Asylum seekers) run by the local Municipalities 27.731 Migrants 70% Relocated First line of intervention in Italy Hotspots Second line of intervention Relocation by Ministry of Italy Sea C.A.S. Arrivals Internal Affairs (Center for Extraordinary Reception) run by the Ministry of Internal Affairs 132.286 Migrants 30% Relocated in Europe Source: Ministry of Internal Affairs, 31 July 2018 2
10/12/2018 Distribution of Migrants housed at regional level (percentage ‐ %) Source: Ministry of Internal Affairs , 31 July 2018 Migrants hosted in Bologna 31 July 2018 Adult Unaccompained Minors • • Hub: 80 people Hub (Hotspot): • 400 people • stay/average 37 days • 50 days stay/average • 80 Male vs 0 female • 25.555 people arrived from 2014 • SPRAR: • CAS: 1.159 people • 208 people • • mostly male ‐ 2% female SPRAR: • 865 people • Stay/average 3 months • 70% Male • No CAS available for Source: Ministry of Internal Affairs, 30 June 2018 Unaccompained Minors Ethnopsychiatry and Cultural Consultation Service (S.E.C.C.) Liason Activities Prefecture (Department of Internal Affairs) S.E.C.C. + Hospital Villa Colli Local Private Health Unit Social + Services Municipality of Bologna 3
10/12/2018 No Referral and No Referral and Follow-Up (3 Follow-Up (3 clinical interviews) clinical interviews) Referral Referral S.E.C.C. Patients-Nationality To GP and Follow- To GP and Follow- Up (3 clinical Up (3 clinical Cultural Consultation: Cultural Consultation: 14 interviews) interviews) Psychopathological Psychopathological 12 Assessment Assessment 10 8 Referral Referral 6 To Department of To Department of 4 Ethnopsychiatric & Ethnopsychiatric & Mental Health Mental Health 2 Cultural Cultural 0 Consultation Consultation Admission to the Admission to the Service Service Hospital Villa Hospital Villa Colli Colli Discharge and Discharge and Referral Referral Ethnopsychiatry: Ethnopsychiatry: To GP To GP Admission to the Admission to the Hospital and clinical Hospital and clinical Discharge and Discharge and evaluation (30-40 days) evaluation (30-40 days) Referral To Referral To From January 2015 to July 2018: 97 patients (95 Adults + 2 AC) 81 Male + 16 Female Department of Department of Mental Health Mental Health Types of Clinical Resources Used Legal Status 100 70 90 60 80 70 50 60 40 No documents 50 86.21 93.1 Immigrant Resident 30 40 Asylum Seeker 75.86 30 20 Refugee 20 10 10 0 0 No documents Immigrant Farmacological 3.45 Resident Asylum Seeker Clinical Interview Refugee Liason Support Legal documentation Diagnosis Reasons for Consultation 50 45 40 100 35 90 80 70 30 60 50 25 40 30 20 20 10 0 15 10 5 0 Psychosis Schizophrenia Personality Disorders PTSD Drug Addiction (*comorbility) Male Female 4
10/12/2018 Use of Cultural Broker Institutional Sources of Cultural Evaluation Request 40 35 30 25 Social Services 20 Min. Internal Affairs 15 Emergency-General Hospital 10 Department of Mental Health 5 0 Cultural Broker vehicular language Use of Cultural Broker Working with Culture: Clinical Implications Critical Issues • Usually they provide linguistic support rather Ethnopsychiatry Cultural Consultation • Have in charge the patient than cultural insight • Consultation • The patient is the expert • We are the “experts” as • They tend to have a low educational • Use the “objects” of the liaison service & legal background and an history of traumatic patient impact • Cultural levers & migration • Define Cultural and Social Countertransference frame of the patient • They can be seen as threat by the patient • Trauma, Brief Psychotic • Barriers to care and equality (stigma/ethnicity) Episode, Depression, and • Misdiagnosis, use of cultural somatization • Costs brokers, transfer knowledge • Risk of ghettoization T HANK Y OU Vincenzo Spigonardo, MD Coordinator Ethnopsychiatry and Cultural Consultation Service Hospital Villa Ai Colli - Bologna (Italy) S.P.R.A.R. – Municipality of Bologna v.spigonardo@aicolli.com V.Spigonardo, MD 5
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