A qualitative evidence synthesis of refugee patients' and professionals' perspectives on mental health support

To generate a more comprehensive understanding of mental health support for refugees, a qualitative evidence synthesis of studies examining professionals' and patients' perspectives was conducted. The aim was to identify what refugees and psycho-social professionals working with refugees perceived as positive/helpful and negative/hindering in the therapeutic process.Six electronic databases were searched, followed by citation tracking. Of the 711 studies found, 10 studies were selected for a thematic synthesis based on inclusion criteria such as being qualitative research reports published after 1998. From these studies, referring to 145 insider perspectives, descriptive themes were developed and subsequently synthesised into 13 analytical clusters. The results highlight the importance of a trusting therapeutic relationship, of the adaptation of therapeutic approaches to patients' needs and situation and of psycho-social support, and of cultural sensitivity and external support structures for professionals. Negative or hindering aspects were identified as a lack of mental health care structures, the impact of the post-migrational situation of patients' well-being, cultural and language differences, and a context of mistrust and negative experiences. Finally, ambivalences were formulated regarding verbal therapies, trauma exposure, the use of mental health care, and the impacts of this work on professionals. Results are discussed in relation to flexible therapeutic boundaries. Suggestions are made for practice, such as using integrative approaches that focus on psychoeducation and transparency, and for future research, such as investigating psychotherapy with refugees in non-Western countries.