Responding to mental health needs of Syrian refugees in Turkey: mhGAP training impact assessment

Karaoğlan Kahiloğulları et al. Int J Ment Health Syst (2020) 14:84 https://doi.org/10.1186/s13033-020-00416-0 International Journal of Mental Health Systems Open Access RESEARCH Responding to mental health needs of Syrian refugees in Turkey: mhGAP training impact assessment Akfer Karaoğlan Kahiloğulları1* , Esra Alataş2, Fatmagül Ertuğrul2 and Altin Malaj1 Abstract Background: About 1468 Syrian and Turkish doctors, serving in primary health care, have received the mhGAP training during 2016–2019. As additional training needs were identified, MoH and WHO wanted to understand the usefulness of the training and its impact in responding to the mental health needs of Syrian refugees in Turkey. Methods: A five component assessment was done in 2019, consisting of feedback of trainees, assessment of increase in knowledge; utilization of service; compliance to treatment guidelines and service user satisfaction. The purpose was to understand the perception of participants on the training; estimate the knowledge gained—attributable to the training; estimate the increase in mental health cases identified and treated; compliance with treatment guidelines; as well as perception of the services received by end-beneficiaries. Results: Results indicate that most of the respondents were happy with the training, but preferred additional mhGAP training as a refresher course in the future. There was knowledge gained due to the training, 9% for the Syrian and 5% for Turkish doctors. The knowledge gained has helped the practicing doctors to be more attentive and increase the numbers of cases diagnosed after the training for almost all groups of diagnoses. Most doctors, observed during practice, comply with the guidelines shared during the training, but improvement is still needed when it comes to prescription and treatment of certain conditions. The average number of mental health cases identified increased by 38 (%27) cases in the year following the training. We observed over 70% compliance with guidelines for 9 out of 12 criteria in question. The results of the patient exit interviews indicate a high level of satisfaction with the MHPSS services provided. About 95% of beneficiaries were happy with the quality of the service, and 92% having their needs met. Conclusions: The mhGAP training was found useful. More training should be conducted to fill in the gap in service provision and meet the mental needs of Syrian refugees in Turkey. Keywords: Refugee mental health, mhGAP, Turkey Background Numerous studies have highlighted the role that war, armed conflict, torture, hunger, forced migration, and post-migration assimilation to host population have in mental health illness [1, 2]. Being a refugee/migrant, *Correspondence: 1 WHO Country Office Turkey, Ankara, Turkey Full list of author information is available at the end of the article suffering or witnessing violence, daily stressors, living conditions, low socioeconomic status, being a female and of young age, increases the likelihood of feeling hopeless, afraid and worried. Ultimately, the mental health disorders (post-traumatic stress disorder; depression and anxiety) will take a toll, but especially women, children and adolescents will be more affected. Women that have suffered violence, rape, intimate partner violence are more prone to PTSD, as are © The Author(s) 2020. 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The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/ zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Karaoğlan Kahiloğulları et al. Int J Ment Health Syst (2020) 14:84 children and adolescents, especially in temporary shelters [3, 4]. Literature on the prevalence of mental disorders showed higher prevalence rates for the refugee population, but the prevalence rates are heterogenous in different studies [5–8]. The burden of mental health illness is made worse by numerous barriers to service provision, linked to stigma, language, financial, legal status, social and cultural beliefs, and information sharing reasons [9, 10]. The situation is often exacerbated by restrictive migration policies, health system challenges (human and financial resources), as well as service providers barriers [11]. In addition to dealing with the disorders themselves, one need to also address the other issues related to poverty and social exclusion. Turkey is hosting 3.6 million Syrians under temporary protection [12]. This is the largest number of refugees hosted in one country since World War II. Most of the Syrians reside in the south-eastern provinces, close to the border. Less than 2% of them are in 7 temporary shelters. Turkey has maintained an open-door policy and has offered shelter, food, education and health services, for free, to millions of Syrian refugees and others, and the United Nations Regional Refugee and Resilience Plan actors have complemented this support. Operational data from the MoH and assessments done by WHO, since 2016, indicate that Syrians have the same burden of disease and risk factors as the host population in Turkey, for most non-communicable diseases, excluding mental health [13]. The mental health disorders of refugees fleeing from war and destruction became a priority for the Ministry of Health and WHO in Turkey. The treatment gap for mental disorders is more than 50% in general and may reach to 90% in low resource countries [14]. Traumatic events such as war and forced migration are expected to increase the treatment gap. The resulting treatment gap has been described as 89% for PTSD, 90% for anxiety, and 88% for depression [10]. The early identification and treatment remain crucial for easing the burden of mental health disorders. Turkey has the lowest number of psychiatrists in the WHO European Region. The number of other mental health professionals and inpatient beds allocated to psychiatric care is also limited, compared with other European countries [15, 16]. Considering the limited resources in the area of mental health, integration of mental health services to primary care services is crucial for decreasing t (...truncated)