Migrant Mental Health in Barcelona City: A Collective Challenge

[This text has been written by Stella Evangelidou, Postdoctoral Fellow at ISGlobal, and Barcelona CaixaResearch Living Lab team]

International Migrants Day, 18 December

Barcelona is the second most populated city in Spain with more than 1,600,000 inhabitants. According to the 2020 municipal register, for the first time in history the number of residents born outside the city was higher than the number of residents born in the city. Two out of every ten inhabitants of Barcelona have a foreign nationality. Since 2019, an upward trend has been observed in foreigners with non-EU nationalities (an increase of 9.6%).

The Barcelona Mental Health Plan (2016-2022) highlights that 16% of men and 19% of women residing in the city aged 18 to 64 years suffer from a mental disorder, without specifying their country of origin. The migrant population in Barcelona is not a homogeneous group and there are many elements that contribute to their well-being: individual factors (age, gender, education, income and occupation), conditions of their migratory trajectory, experience or testimony of violence, (pre-) existing health or mental health conditions, as well as perceptions of how others value and accept them in the host society.

The Barcelona Mental Health Plan highlights that 16% of men and 19% of women residing in the city suffer from a mental disorder, without specifying their country of origin

Barcelona CaixaResearch LivingLab has set out to provide a venue for co-ideation and co-creation around mental health and migration. The aim is to generate a collaborative space for expressing and addressing the mental health and psychosocial needs of migrants in the city, ​​through an intercultural perspective while applying innovative participatory methodologies. The project was developed with and not for the migrant communities of Barcelona. Collaborative synergies were created with the communities of Pakistan, Morocco, Senegal, China and Honduras. The perspectives of health and social professionals who work with migrants, as well as the viewpoints of intercultural mediators were also consulted.

Between May and October 2021, six focus group discussions were held with 42 migrants (25 women and 17 men) and four focus group discussions with 19 professionals. The migrant profile that participated in the study were migrants outside the EU, with an age range of 24-56 years, and with 2 to 20 years of stay in Barcelona (4 participants <2 years and 4 with Spanish residency). Group discussions with migrants were separated by sex. After the completion of each step of the project, group-based feedback sessions were held for the discussion of the results.

Barcelona CaixaResearch LivingLab has set out to provide a venue for co-ideation and co-creation around mental health and migration

During the exploratory phase of the project, our objective was to understand the mental health needs of migrants through a community-based lens and further, analyze the barriers (as well as the enablers) of access to mental health services in Barcelona city. During the implementation phase, a community mental health intervention proposal was co-created together with the migrants and the professionals who work with them. It is estimated that the pilot of the intervention will take place from February to May 2022.

Through an inclusive, collaborative and comprehensive way, we reached to understand migrant mental health as a multilayered and multidisciplinary challenge in the metropolitan city of Barcelona, ​​as shown in the pyramid below. This scheme reflects the breadth and multitude of needs and the corresponding levels of care.

Psychosocial and mental health support needs and interventions at multiple levels (Adaptation of the IASC model, 2007).

The satisfaction of basic needs such as nutrition, shelter and security is fundamental at the base of the pyramid of mental health and psychosocial support. At individual level, self-help/ self-care mechanisms are related to coping strategies, personal resources and resilience, as well as mental health literacy. At community level, on the one hand, informal psychosocial care provided by migrant community associations collectively addresses mental health and psychosocial support needs and, on the other hand, the integration of mental health services into the primary care of health can address such challenges as well. At the top of the pyramid, specialized psychiatric services can serve those migrants with moderate or severe clinical conditions.

In general, there is a difference between access to and use of mental health services. Although the public health system in Barcelona city offers mental health services and psychosocial support to the migrant population, migrants are less likely to initiate, continue or complete mental health treatments or adhere to recommended regimens.

Attitudinal barriers (stigma and prejudice towards mental health, perceived discrimination, self-efficacy, etc.) and structural barriers (linguistic difficulties, limited availability of attention times, etc.) influence the use of services by migrants.

Focus group discussion with Pakistani women living in Barcelona.

Migrants highly value person-centered interventions over culturally competent interventions. At times, the culture of the country of origin may be discriminatory against women, so the cultural acceptance of mental health or psychosocial interventions may not always appropriate. So the culture of origin can be a risk factor, and not a protective mechanism that promotes the psychosocial well-being of the person. The majority of migrant women, and not only those with inferior social position, is prone to sexual violence by their intimate partners, family environment and other members of the collective.

Our work shows that participatory methodologies in intercultural mental health studies may empower participants as allies to the research activities as well as decision makers of their own mental health. Thus, mental health and psychosocial support interventions´ development based on the active participation of community members can have a great social impact, ensuring their acceptability, transferability and sustainability over time.

Our work shows that participatory methodologies in intercultural mental health studies may empower participants as allies to the research activities as well as decision makers of their own mental health

Beyond the “instrumentalization” of the vulnerability of migrants, we must listen to their resilient stories. Rather than focusing on the cultural integration into the host society, migrants propose mutual intercultural exchanges that can be beneficial for all. Mental health and psychosocial support needs should be identified and addressed outside of the clinical settings and in collaboration with the migrants themselves. For mental health and psychosocial support interventions with a social impact, we propose together with the migrant communities of Barcelona city a paradigm of “task-shifting”, breaking the taboos not only those related to stigma, but also the taboos associated with the provision of care.