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Compared with the majority group in a given population, migrants and their descendants have an increased chance of experiencing mental disorders. Most refugees and asylum-seekers face serious obstacles, such as a lack of prospects, poverty, and discrimination, in accessing comprehensive health services, including mental health ones. Therefore, immigrants need assistance from the host countrys health professionals in order to cope with stress and become accustomed to the new home. The purpose of this essay is to propose theory-based strategies to improve the mental health of immigrants.
Health Promotion and Ecological Systems Theory
Health promotion is a significant part of public health and an fundamental element in any healthcare strategy and program. According to World Health Organization (WHO) (n. d.), health promotion can be defined as the process of enabling people to increase control over and to improve their health (para. 3). A single factor does not determine good physical and mental health. A variety of factors, such as economic, social, environmental and political conditions have an effect on health. These factors do not only influence on health but can also make it more difficult or easier for a person to make changes to his/her health.
The aim of health promotion is to encourage both patients and health workers to make efforts to improvement of health indicators and the health system, as a whole. It also aims at reducing inequalities and differences among people and providing health resources for every individual.
One of the theoretical frameworks of health promotion is the ecological systems theory that was designed in the 1970s by the developmental psychologist, Urie Bronfenbrenner (Tudge & Rosa, 2019). The idea behind the approach is that the development of an individual is affected by everything that surrounds him. Under Bronfenbrenners theory, there is a bunch of layers or ecological systems that influence human health and development. The bunch consists of four systems: the microsystem, mesosystem, exosystem, and macrosystem (Eriksson, Ghazinour, & Hammarström, 2018).
The microsystem is the environment in which a person lives. It has a direct impact on the individual on a daily basis. According to Lin (2017), the microsystem refers to a series of social roles, physical activities, and the closest interpersonal relationship between individual and his/her surroundings (p. 32). Examples of these environments would be someones home, school, workplace, peer groups, and community. The mesosystem is defined as relationships between microsystems, for instance, between home and workplace, family, and church (Lin, 2017). The exosystem is the relationships existing between two settings: one is an immediate one, and the other is one where the person does not play an active role (Obasi & Hill, 2016).
For example, there is a relationship between the parents job and the kids school. If the parents have fluctuating work hours, or have to work very long hours, the child is not directly involved in the parents workplace, but this will affect whether the parents are able to volunteer in the childs school. According to Obasi and Hill (2016), the macrosystem constitutes the culture, subculture, belief, or ideology within society influencing an individuals developmental lifespan (p. 90). It means that the system is the broader social and cultural context. For example, it can be the culture of an ethnic group, national culture, or the culture of rural vs. urban areas.
Bronfenbrenners ecological systems theory can be considered as a public health approach to providing support for individuals with mental health disorders. From the perspective of mental health issues among immigrants, the ecological systems theory is a tool to develop a strategy to help refugees and asylum-seekers with mental health disorders to receive necessary medical care. By using this approach, health professionals may give comprehensive advice on how to prevent a particular mental health disorder for a specific target group. The ecological framework can be used to develop a vision of healthy environments that contribute to promoting and providing mental health to immigrant groups.
Program of Mental Health Promotion in Immigrants
Considering health promotion through the perspective of the ecological systems theory enables policy-makers to propose solutions to deal with low-quality healthcare for immigrants. According to Fry and Zask (2017), there are some action areas in health promotion, such as strengthening community actions, creating supportive environments, reorienting health services, and developing personal skills.
Within the Bronfenbrenners ecological systems theory, developing personal skills can be seen as the microsystem of an immigrant. Developing personal skills focuses on supporting the inner development of refugees and aims to help them to strengthen their personal qualities in order to know ways to cope with stress on their own. It can be done through education, providing information, enhancing personal skills to make advantageous health choices. Example of these are classes that teach migrants on how to become more confident in the new environment, far from home. Also, mental health support groups organized by medical staff may enhance the life skills of refugees and asylum-seekers, helping them to change their attitudes towards the stressful situation.
Creating supportive environments and strengthening community activities can be considered from the perspective of the exosystem because these strategies have an indirect effect on the well-being of immigrants. From the standpoint of health promotion, supportive environments aim to increase the ability of immigrants to make health-promoting choices while being in poor and/or post-conflict settings. Some examples are activities, such as strengthening relationships between people and environments through free joint activities, like workshops, community health fairs, and sport programs. Strengthening community activities refer to the efforts of a group of people to enhance their health.
It is significant to make residents and health professionals participate in these activities to encourage immigrants to ask for help and develop a plan to treat mental health problems ( Strengthening communities , 2017). Creating a supportive environment may also help to reduce migrants stress about finances and the lack of support from the host countrys residents.
The aim of reorienting health services is to make systems of health more be focused on supporting the needs of every person and community. Reorienting health services are applied to reduce risk factors, strength protective ones and improve current health situation of a target group (McFarlane, Judd, Devine, & Watt, 2016). These services consist of training medical workers to educate and assess patients to deal with the lack of vitamins and/r minerals in order to improve physical and mental health. Reorienting health services also include establishing roles of health educators to organize activities to prevent and improve access to health goods and services for linguistically and/or culturally diverse populations.
Implementation Plan
Developing a strategy is one of the most significant steps that an organization can undertake. According to Kate (2017), implementation strategy or plan is the process of defining how to bring the strategic plan to life (para. 4). The implementation plan allows health practitioners to achieve specific actions towards the management of mental disorders among immigrants. The strategies mentioned above can be expressed in a five-step process to help medical professionals implement the plan to get positive results. The first step is to identify what is planned to be achieved, over what time frame, to what success criteria, and how the results would be measured.
The main objective of the program of mental health promotion within immigrants is to decrease the number of immigrants suffering from mental health problems, such as post-traumatic stress disorder, depression, and anxiety within one year. The program will be considered successful if there is a reduction in the number of migrants with disorders mentioned above by 10 percent. The results would be measured with the help of Centers for Disease Control and Preventions data and statistics.
The second step is to plan the effective use of resources, such as finance and staff. Each hospital will be required to provide five health workers to support the program. The government of each US state will provide two million dollars to ensure that all strategies are implemented. The third step is to develop fundamental control mechanisms to evaluate the programs progress. These will be monthly surveys and interviews of immigrants and health workers about their attitudes towards activities carried out, and weekly meetings with health professionals to speak about problems arising during the implementation period.
The next step is the process of implementation and operating the program. First of all, a health support group will be created in every hospital. Workshops, seminars, lectures on various subjects of health, like vitamin deficiency, diet, mental support, will take place once a week. The final step of the implementation plan is the evaluation of results through the evaluation program.
Evaluation Program
The primary purpose of any evaluation program is to look at the outcomes of program design. Researchers note that program evaluation is the process of systematically collecting, analyzing, and using data to review the effectiveness and efficiency of programs. (Program Evaluation, n. d., para. 2). There are five steps in evaluation practice, and the first one is the description of the program based on the implementation plan prepared.
The second step is the evaluation of the implementation design of the program through its purpose, strategies, resources used, and outcomes. The third step is looking at the implementation of the program or service. The fourth step is looking at an outcome evaluation of the program and gathering credible evidence through various sources, such as Centers for Disease Control and Preventions data and statistics, and interview and questionnaire results. The fifth step is evaluating the efficiency of the program, critical assessment of the effects, and suggestions on possible ways to avoid problems encountered in the future.
Conclusion
Refugees and asylum-seekers are more vulnerable to mental health problems because of their migration experience, as well as difficulties experiencing in their new country. Numerous barriers are faced by immigrants to get access to health care services, including mental ones. Through the various strategies and activities for health promotion, health professionals are able to support displaced migrants and help them to overcome social, economic, and phycological obstacles. The implementation plan helps to transform theoretical findings and strategies into actions to improve the quality of immigrants lives.
References
Eriksson, M., Ghazinour, M., & Hammarström, A. (2018). Different uses of Bronfenbrenners ecological theory in public mental health research: What is their value for guiding public mental health policy and practice? Social Theory & Health, 16(4), 414-433.
Fry, D., & Zask, A. (2017). Applying the Ottawa Charter to inform health promotion programme design. Health promotion international, 32(5), 901-912.
Kate Eby, K. (2017). From strategy to execution: How to create a sustainable, repeatable implementation plan. Webn.
Lin, K. L. (2017). Exploring childrens lived experience of resilience in public preschools in Taiwan: The lens of Bronfenbrenners Ecological Systems Theory (Doctoral dissertation, Griffith University, Brisbane, Australia). Web.
McFarlane, K., Judd, J., Devine, S., & Watt, K. (2016). Reorientation of health services: enablers and barriers faced by organisations when increasing health promotion capacity. Health Promotion Journal of Australia, 27(2), 118-133.
Obasi, S. N., & Hill, T. (2016). By design: Using comics to teach ecological systems theory. Family Science Reviews, 20, 87-97.
Program Evaluation. (n. d.). Web.
Strengthening communities. (2017). Web.
Tudge, J., & Rosa, E. M. (2019). Bronfenbrenners ecological theory. The Encyclopedia of Child and Adolescent Development, 1-11.
World Health Organization. (n. d.). The Ottawa Charter for Health Promotion. Web.
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