New centre will improve treatment of traumatised refugees
OPINION: A new competence centre for transcultural psychiatry will integrate research with the treatment of traumatised refugees.
Fatima is 38 years old and has lost the will to live, as haunting memories of the war in her native Afghanistan plague her day and night.
She rarely gets more than four hours of sleep, which has ruined her ability to remember and concentrate to such a degree that she can neither work, learn new languages nor be around other people for extended periods.
In the more than 14 years that she has lived in Denmark, she has been through numerous forms of treatment and activation schemes, which has neither improved her mental health nor brought her any closer to the job market.
Insufficient research on traumatised refugees
Fatima suffers from severe posttraumatic stress disorder (PTSD), a diagnose she shares with some 35,000-50,000 refugees in Denmark. Although there has been some research into the causes and symptoms of PTSD, only little is known about what treatment is best for helping refugees with this sometimes debilitating disorder.
The lack of research in the area is probably due partly to the extensive and resource-intensive work required to collect research data. Furthermore, a misunderstanding of these patients’ frail condition often means that they are not asked to participate in research projects, based on the view that ‘They have suffered enough; there’s no need to add to their burden.’
Conversely, however, one could also argue that it is stressful for the patients to undergo long treatment courses that haven’t been proved to work, or which haven’t been adapted to the individual’s situation.
TRIM offers new opportunities
To overcome these hurdles, we at the Competence Centre for Transcultural Psychiatry have developed TRIM.
TRIM is an acronym for ’Treatment and Research Integrated Model’ – a system where clinicians collect all the data that’s normally entered into medical records and organises the information into checklists instead. From here, the data can be entered directly into a research database.
The Competence Centre for Transcultural Psychiatry (CTP) opened on 1 January 2013 in Gentofte, Denmark.
The CTP’s primary objectives are to increase our understanding of the effect of medical and psychological treatment for traumatised refugees, to shorten waiting lists and to make treatment more cost-effective.
TRIM makes it possible to carry out research on a shoestring budget, and another advantage is that the patients who agree to take part in the research are not stressed by extra activities in connection with their participation.
Model ensures best practice treatment
With this model we can also ensure that our refugee patients consistently receive best practice treatment based on the latest research findings.
This has so far led to revisions of the psychologists’ treatment manual for the cross-cultural target group, and also to the development of a questionnaire which will improve our understanding of how physiological, psychological and social factors affect the outcome of the treatment for the individual patient.
Treatment should be culturally adapted
To date, the clinic has carried out three randomised trials using the TRIM model:
- One which aims to determine whether combined medical and psychological treatment has a greater effect than the two treatment forms separately.
- One which tested various types of psychological treatment.
- One which tested various types of medical treatment.
Overall, we expect that the results from these three trials will provide us with new and unique information about which elements of the treatment actually work for this group of patients and which don’t.
This data will be used to create a culturally adapted and effective treatment for traumatised refugees.
International demand for effective treatment
By better matching patients with treatments we may avoid that patients like Fatima have to undergo lengthy and expensive treatments that have no positive effect on their health and their quality of life.
With our new clinic, the patients avoid the long waiting lists that we see today in Denmark’s many refugee treatment centres, where some patients have to wait for up to a year before receiving treatment.
At the same time, we will also be able to treat more patients without spending more money. Improved treatment may also lead to a decrease in public health spending elsewhere in the system, for instance because the patients may not need to visit their general practitioner as often as they used to.
Our work has also attracted interest internationally, and on that basis, we are currently setting up a collaboration with researchers in Australia, Germany and New Zealand.
Soon we will be travelling to Norway with an Australian professor to talk about our research, so that our method can help refugees and therapists in other countries too – and then we can really get this research up and running internationally.
Translated by: Dann Vinther