Ayesha Bano, BSc student, Bachelor of Healthcare, Nursing, Novia UAS
Supervisor: Anita Wikberg, RN. RM. PhD, Senior Lecturer, Novia UAS

Abstract

Mental health is a highly debated phenomenon of today’s fast paced technological world. It is widely discussed and addressed by the health authorities and international institutions like WHO. Immigrants often face more mental health challenges in a foreign country like Finland. The underlying causes and related factors are discussed in this article. Additionally, it is discussed how the Covid pandemic has played its role in mental health issues along with the strategies and treatment plans. Immigrants in Finland also face increased mental health challenges due to certain factors like language issues, poor understanding of the information about health services and social stigma. The understanding of an immigrant’s background can help health professionals to better assess and treat the mental health issues. The authorities need to initiate the plans where immigrants are understood and encouraged to use mental health services when needed. Discrimination, poor trust and being away from the family can cause increased mental health problems among immigrants.

1. Introduction

World Health Organization (2004) defines mental health as “a state of well-being in which every individual realises their own potential and can cope with the normal stresses of life, can work productively, and is able to contribute to their community.” (WHO, 2004).

Immigration and adjusting to a new country are acknowledged as stressful and difficult. Among many other issues, immigrants may face a psychological downfall. This concept is known as acculturative stress (Sam & Berry, 2010). Psychological problems like depression or anxiety can be caused by acculturative stress (Berry et al, 2006). Several factors can make immigrants exposed to these disorders, like possible traumatic incidents in their own country before migration or factors after immigration such as discrimination or low social mobility (George et al, 2015). Moreover, stress seems to be associated with the differences between their own culture and the culture they moved in. If both cultures are very different, it is harder to adjust into the new culture (Ward, 2001).

Immigrants usually tend to have bad mental health as compared to native people of a certain country like Finland. It has already been established that refugees have increased risk of poor mental health (Close et al, 2016). According to international standards of immigrants, the proportion of immigrants remains lower in Finland as compared to other Nordic countries (OECD, 2016). However, during the past 10 years, the number of immigrants in Finland have doubled. As stated by the Statistics Finland (2017), 7.5% of children under the age of 18 were from immigrant families in Finland.

The occurrence rate of mental health issues among immigrants is different across various studies. However, according to Lindert et al. (2009), occurrence rate of mental health problems is two times greater in refugees than in other immigrants who migrate for other reasons for instance for work or study. According to Markkula et al. (2017), in Finland the rate of having mental disorders in immigrants may vary between different setting and immigrant groups. Despite higher or even equal occurrence rate of mental disorders as compared to native population, immigrants use less mental healthcare services (Abebe et al, 2017). Kieseppä et al. (2019) stated that in Finland immigrants use less and lower intensity specialized mental health services as compared to native Finns. However, the barriers with the use of specialized mental healthcare services may include language issues along with poor understanding of the information about health services and social stigma (Derr, 2016).

In Finland, mental health services are provided under ministry of health and social affairs and Finnish mental healthcare act (1116/1990). This act aims to provide mental health services in order to improve mental wellbeing, psychological and personal development of a person.

2. Mental health factors and immigrants

Mental health services system includes those who access the system for treatment of mental issues. It is an ongoing process of a person’s life that could be managed through sufficient maintenance and prevention methods. Keyes (2014) mentioned three factors of mental health: (i) psychological well-being, (ii) emotional well-being and (iii) social well- being. According to Keyes (2014), psychological well-being means that the person likes what he or she actually is, manages the responsibilities of daily life and has good relations with others around. Emotional well-being indicates happiness, interest and satisfaction in life. Lastly, social well-being is having positive contribution to the society, being a part of it as social integration, consider society as a good place for everyone and being satisfied with the way society works.

It may not be easy to identify the psychiatric issues and symptoms in immigrants from different backgrounds or due to difficult situations that lead them to move to Finland. A study conducted by Finnish institute of health and welfare (THL) noted that mental health, trust, seeking help and social inclusion can be different among research participants (THL, 2015). The reasons of this variation could be country of origin, duration and age of being in Finland and the reasons of migration to Finland. The understanding of patient’s background can help professionals in assessing the patients and in providing the services more effectively (Ellis Abdi & Winer, 2020).

According to several studies, psychotic disorders, post-traumatic stress disorder and mood disorders have been more common in immigrants in many countries as compared to native population (Bhugra & Jones, 2001, Bourque et al., 2011, Mindlis & Boffetta,2017). However, Finnish register studies showed that psychiatric disorder was lower in immigrants than native Finns (Markkula et al., 2017) and suicide or death rate because of alcohol use was also less in immigrants as compared to native population (Lehti et al., 2017). Post-traumatic stress disorder however, is one of the most common mental issues among immigrants as compared to native population (Kieseppä et al, 2021)

According to Finnish Institute of Health and Welfare (THL, 2021) discrimination, lower trust level on authorities in new country and being away from the family are also causing mental health problems among immigrants. Racism, hate speech and discrimination causes mental health issues and affect the quality of life for those experiencing it. Discrimination makes it more likely for immigrants to develop mental health problems and long-term illnesses.

3. Treatment and Interventions

Several European studies found that, immigrants use less mental health services as compared to native population (Der, 2016 & Lindert et al., 2008). However, these findings varied among the type of services, reasons of migration and ethnic groups. General findings state that immigrants are less likely to use outpatient care for mental health ailments (Derr, 2016 & Koopmans et al., 2013).

Finland provides a broad range of healthcare with health coverage for people living in the country and outpatient mental health services provided are often free of charge (GBD, 2017). Finnish municipalities provide and organize public health care awareness services, and all resident are entitled to it. Healthcare services in Finland are divided into primary and specialized medical care. Patients are then referred to occupational physician or general practitioner afterwards, if necessary. Private healthcare services are less common especially for mental health issues.

According to THL (2021) there is need to provide more attention to certain groups for prevention and treatment of mental health issues. These groups may include asylum seekers and refugees, older adults, less educated people, financially weak people, people who have arrived in Finland recently and people with language issues.

Same diagnosis and treatment methods of mental health problems that are used for general population, can be used for immigrants as well. However, studies show that more attention should be given to the issues that influence these mental illnesses, communication between patient and physician and intercultural knowledge can also help to provide better mental healthcare (Kleinman, 2006). Some clinical strategies can be effective in diagnosing and treating mental health issues among immigrants. For example, providing professional language interpreters, treatment with inclusion of family and community organizations etc. (Flores, 2005). Although, some of the health services are provided in English upon request, there is still a need to have more interpreters while addressing mental issues. Immigrants do not always speak English and this can make it difficult to explain their feelings or concerns, to describe symptoms and talk about their treatment plan. All of the immigrants with less knowledge of Finnish or English should be encouraged to use interpreters. Feldman (2006) found that not using interpreter is considered as the most common barrier for new immigrants to get proper health services.

A large number of immigrants in Finland are from cultures where the health of a family member is discussed with other family members. It can be very helpful if a family member of a patient is involved in the mental health treatment and plan. However, rules of confidentiality and privacy should always be kept in mind. Including a family member in discussions and treatment plans can strengthen the trust between patient and physician and provide the assistance and support needed for such patients (Kirmayer, et al., 2011).

Moreover, policies and practices play a vital role in settlement after migration to a new country. So, community organizations, religious centres and support groups can help migrants in adaption and it can positively impact their mental health and decrease isolation and discrimination (Beiser, 2009). It is suggested that immigrants who come to a new culture, where high proportion of immigrants from their own culture are living, are at relatively low risk of mental health issues and adjust to the new culture easier (Beiser, et al., 1995).

4. Effect of Pandemic

All the countries globally introduced the strategies to reduce the number of Covid-19 infected patients in 2019. Although Covid-19 is not limited to only one country, it has different effects for the economic and mental health of natives compared to immigrants. A survey named as MigCovid, was done during the second wave of Covid pandemic in Finland, between October 2020 and February 2021. (THL, 2021). MigCovid was done to examine quality of health, living and the use of services among immigrants or foreigners. According to this survey the effect of Covid-19 on the health and wellbeing of immigrants was significantly higher than the native people. Immigrants in Finland had poorer health and significantly greater mental strain than the local Finns mainly because of the immigration challenges. Moreover, survey indicated other concerns like loneliness, sleeping problems and losing hope for future etc. were also comparatively more common in immigrants in Finland (Natalia et al., 2021).

There are some factors that have a huge impact on immigrants’ mental health after Covid-19 pandemic. For instance, economies are struggling globally in overcoming the effect of pandemic. Families of the immigrants are usually dependent on them and once they lose jobs due to pandemic, it has a potential role in the mental health issues for immigrants in Finland (Mia, 2020). International labour organization (2020) stated that immigrants will be the first in line to lose their jobs in order to overcome the economic damages done by Covid-19 pandemic.

Moreover, immigrants tend to leave their families in the country of origin and during the pandemic, when it was impossible to travel and visit the family members back home, which also has a huge impact on immigrants’ mental health (THL, 2021). Moreover, losing some of the family member back home, without being able to visit for the funerals, due to Covid-19 has also massively impacted the mental health of immigrants. Especially when Finland has put very strong restrictions on travelling back to the country (YLE News 2020).

This situation has affected the mental health of immigrants to a huge extent as compared to the local population. The fear of losing job, not being able to support their families, death of loved ones in the country of origin and not even be able to visit back home, are some of the factors that increased the risk of poorer mental health among immigrants. As mentioned above, being an immigrant, itself comes with a huge risk of mental problems, Covid-19 affect have increased such risk to a great level.

5. Mental healthcare available in Finland:

It is recommended to talk to a professional psychologist, if someone is facing mental health issues. A professional can help an immigrant without criticising and judging them, no matter who they are. Finnish mental healthcare system is designed to assist patients differently in different situations. Finnish mental healthcare system may seem complicated even to Finnish person, so it can be more difficult to understand for an immigrant.

Language barrier may become one of the most difficult issues when it comes to mental healthcare. In Finland, every immigrant is entitled to use interpreter when speaking to a health professional. Language interpreters can be provided upon request.

In Finland, as in general healthcare, it is advised to use help from one’s own healthcare centre first. In the healthcare centre, a doctor will assess the patient situation and refer further to a mental health specialist. These specialists include psychologists, psychotherapists, psychiatric nurses and psychiatrists. However, appointments are not easily available for mental health services, but private mental health services are easily available with a fee that patient should pay. Serious mental health care is provided by specialists after the doctor referral. In Finland, if someone is dangerous to others or self-destructive, he/she can be taken to the mental emergency department immediately. Moreover, Finnish authorities are trustworthy and they treat everyone in the same manner.   (THL 2022)

6. Conclusion

The discussion above steered the conclusion that immigrants face serious mental health issues compared to the native people in Finland. These issues even increase during situations such as Covid-19 pandemic when immigrants lost their jobs and face loneliness at a broader level. The findings are important and very beneficial for the health authorities and other government personnel to formulate the strategies accordingly, to address these mental issues among immigrants.

Addressing these issues will help immigrants to overcome such mental issues and as a result they can be more productive and a healthy part of a society. Especially, it is very important to understand that immigrants are supporting many dependent people in their countries of origin and losing their jobs can cause massive mental stress and disorders. Hence, it is of utmost importance to make sure they have some source of income in such situations so that they stay motivated and contribute positively.

Finnish organizations like THL are already trying to understand and address these issues the best possible way but the pandemic was a relatively a new situation. I believe the recent research studies will help the authorities to better understand the phenomenon and to come up with better strategies in the future. These strategies can generally help local Finns and particularly immigrants with different backgrounds and skills. Moreover, providing integration facilities can also help immigrants to mingle with local people. Additionally, it is also a good idea to provide religious and social gathering facilities where immigrants can get together, celebrate, and socialize. These factors can play a wide role to improve the mental health among immigrants.

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