An ecosystemic view on refugee mental health care: on caring environments and their interaction.

Despite the burden of mental health problems among refugees, knowledge about mental health care for this group is limited. In this context, the comprehensive discussion is important because care is more than professional care, but takes place in everyday situations and between different groups of people. In this study, we look at expert views (based on profession and lived experience) on caring environments concerning refugees' mental health on different system levels. These levels include the individual level, family level, community level and the society. Additionally, we aimed to understand how these system levels interact. We conducted interviews with 11 psychotherapists from Germany and 12 participants who fled from Arabic-speaking countries to Germany. We analyzed transcripts following Braun and Clarke's reflexive thematic analysis. Interviewees shared ideas on how society in general (e.g. increase acceptance), professional actors (e.g. be sensitive about cultural differences), other refugees (e.g. exchange information), family/friends (e.g. provide emotional help) and refugees with mental health problems themselves (e.g. be open to involve others) could provide care. Participants provided examples of how system levels interacted, for example when legal norms made care among family members harder. The interactions between different system levels point to a multidisciplinary approach towards mental health care for refugees and call for building expert networks instead of viewing refugee mental health as a medical, psychiatric issue alone. To improve the mental health of refugees, different societal actors should keep in mind the interactions across different system levels and exchange their respective expert knowledge.