Psyquiatric Care For Work Inmigrants

Isr J Psychiatry Relat Sci Vol 46 No. 3 (2009) 172–181

Psychiatric Care in Restricted Conditions for Work Migrants, Refugees and Asylum Seekers: Experience of the Open Clinic for Work Migrants and Refugees, Israel 2006
Ido Lurie, MD

Shalvata Mental Health Center, Hod Hasharon, Israel
Abstract: In the last few decades, the State of Israel has become a target for work migrants, refugees,asylum seekers and victims of human trafficking, as part of the trend of world immigration. Immigration is a process of loss and change with significant socio-psychological stress, with possible effects on the immigrants’ mental health. The Physicians for Human Rights – Israel (PHR) Association operates a psychiatric clinic as part of the Open Clinic for Work Migrants and Refugees. This article willpresent major clinical issues regarding psychiatry and immigration in Israel according to the data collected at the clinic. Trauma and stress-related psychopathology was found to have a high prevalence in immigrant patients treated at the clinic; prevalence of PTSD (post-traumatic stress disorder) in immigrants was high (23%) and even higher in refugees (33%). Female immigrants are at higher riskfor psychiatric hospitalization. The relative rate of African patients at the clinic is significantly higher than patients from other continents. A significant association was found between psychiatric hospitalization and suicide attempts. Immigrant patients present a combination of psychiatric, socio-economic and general medical conditions, which demands a holistic view of the patient. Theevaluation of an immigrant patient must take into account the stress related to immigration, gender, culture of origin and the risk for suicide and hospitalization. Treatment recommendations include awareness of cultural diversities, acquiring information regarding the pre-immigration history, preferably using cultural consultants with background in the immigrants’ culture and community.Decision-making about medication and diagnostic evaluation should be as inexpensive as possible. Basic human needs (food, shelter) and family support should be included in the decisions about treatment.

Introduction: Immigration to Israel
The total number of immigrants world wide has doubled since the 1970s, and reached 175 million in the year 2002 (1). Most of the immigrants move from developing, poorercountries to more developed and economically established ones. Among those immigrants are work migrants, refugees and asylum seekers. A work migrant is any person who is engaged in a remunerated activity in a state of which he or she is not a national. A refugee is a person who escaped to a foreign land in order to avoid danger or persecution (2). An asylum seeker is a person who has left his/hercountry of origin, has applied for recognition as a refugee in another

country, and is awaiting a decision on his/her application (3). According to the UN High Commissioner of Refugees, in the year 2004, the total number of refugees was 9.6 million, 838,000 asylum seekers and about 1.5 million stateless people (4). As a part of the world trend of immigration, Israel has become a target countryfor immigrants. Since the late 1980s, hundreds of thousands of work migrants have arrived in Israel. This was encouraged by local geopolitical changes (closure policy in the occupied territories and toughening the criteria for work permits for Palestinians following the first and second Intifadas). These workers are mainly employed in low-wage, physically and

Address for Correspondence: ShalvataMental Health Center, POB 94, Hod Hasharon, 45100 Israel. E-mail: ido.lurie@gmail.com

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