IN & OUT: Integrated transcultural intervention for psychiatric care

Practice Aim

To establish an ethno-psychiatric day centre dedicated to immigration issues with the activation of a Mobile Unit and development of a network of services to facilitate health care, as well as establish inter-institutional networking in the immigration field.

Target Groups

Young migrants, drug users or high-risk behaviour.

“IN & OUT, intervento integrato transculturale per l’assistenza psichiatrica”. Progetto camper [Integrated transcultural intervention for psychiatric care]. Mental Health Department, Sicily Region. ASP Palermo
progettoineout@asppalermo.org

Summary

“Take care of yourself” is the Mobile Unit of the Mental Health Department – Pathological Dependencies Operating Unit of Palermo ASP. It reaches the main public squares and other important social gathering places of the city in order to promote health and wellbeing with interventions aimed at raising awareness of behaviours at risk, prevent the main sexually transmitted infections (HIV), diagnose early mental illness and provide direct territorial services.
In&Out allows young migrant drug users to get closer to health services and involves institutions such as ASP, the Municipality, health emergency services and CSOs operating in the territory. The mobile health unit visits public squares of the city of Palermo to reach young people who are addicted to drugs and alcohol who, for various reasons, do not turn to health services. Doctors, nurses, psychologists, social workers, street educators and cultural mediators work in a dedicated motorhome to meet youngsters who gather in the streets in the evening at weekends. Doctors and nurses offer HIV testing and provide information on drug-related diseases, but above all they listen to and try to understand the needs of young people.

Target VG and type of host community

Young migrants, drug users or with high-risk behaviour

Application setting: context

Forced migrants demand complex interventions due to their harsh and precarious living conditions. Although many of them regard as temporary their stay in Sicily, the ethical and clinical responsibility of the ASP, and the Department of Mental Health, and the public institutions is to provide care for psychological and psychiatric disorders. It is essential to promote a joint action of the agencies involved in order to offer competent intervention by taking into consideration the complexity of the migration phenomena. For instance, the growing number of unaccompanied minors and the issues of second generation migrants require wholesome initiatives promoted by various agencies, including Child Neuropsychiatry services also for preventive purposes.

Objectives

To establish an ethno-psychiatric day care centre specialising in migration issues along with a Mobile Unit and a network of services to facilitate healthcare, as well as create an inter-institutional network in the migration field.
To develop psychiatric care and psychosocial support procedures, with the establishment of an inter-institutional group responsible for integration activities aimed at improving psychosocial well-being
To monitor access to services, request for psychiatric care and epidemiological study of the migrant population living in the area.
To bring users closer to health services

Activities

Mobile Unit (Human resources needed: doctor, nurse, street operator, driver) with socio-medical characteristics who works in the area with a high concentration of migrant population to carry out outreach activities, possibility to activate on-site screening activities, social and health care services, counselling and orientation towards the material assistance, activities aimed at preventing risky behaviours. This intervention must be activated in both the metropolitan areas the metropolitan areas, in spontaneous gathering places (public squares) and structured ones (community centres, low-threshold centres, etc. ) and in territories where there is a greater presence of immigrant population.

Results

prevented HIV infection, hepatitis and other infectious and sexually transmitted diseases;
early detection of HIV, hepatitis and other infectious and sexually transmitted diseases;
prevent overdose deaths;
provide preventive health devices;
delivered orientation services and referral to territorial services;
promoted awareness of risky behaviour;

Difficulties or constrains for its implementation

Forecasting Human Resource needs (Recruitment of missing professionals) Staff training, training/self-training meetings to align procedures, specialist and operational knowledge for both the Day Care Centre and the Mobile Unit teams.

Strengths

Intercultural training of the operators
Awareness of the authorities and their involvement in facing the psychological issues of migrants
Change migrants’ perceptions of health care system by creating f friendly operators to them in order to reduce mistrust
Outreach strategy: Bus reaches vulnerable city areas with high concentration of people in need
Integration between structures sharing complementary tasks so that they can put in place transversal modes of intervention
The presence of operators on board of a ‘nice’ and attractive vehicle, can bring users closer to the services

Weaknesses

Limited funding opportunities

Year and length (duration)

Since 2012

CRITERIA actors or stakeholder are using to assess them as a “good practice”

Service aimed at the whole population and the so-called “hidden populations” (young people and adults who live on the street addicted to substances who do not make use of health services).
Number of visits
Number of foreign persons accessing the service
Increase of number of health services related to drug addiction and alcoholism among migrants
Number of persons helped in day hospitals
Reduction of repeated accesses in emergency areas by same persons
Number of activities integrated with territorial agencies working on migration issues