In Turkey, currently host of 3.6 million Syrian refugees, family physicians play a crucial role in primary health-care services, often serving as a first contact for refugees in need of health care. Family physicians are often also the first ones who can adequately identify mental health issues and needs.
"Mental health care is extremely important. The scope of the mental health impacts of the COVID-19 pandemic will without a doubt be far-reaching," explains Dr Akfer Karaoglan Kahiloğulları, Project Manager for Mental Health at the WHO Country Office in Turkey. "Vulnerable populations such as refugees and migrants have been hit especially hard by its consequences, as public health measures such as social distancing, isolation, food and medicine insecurity, and quarantine can act as triggers of past traumas."
In order to respond to the particular needs of refugees and migrants more comprehensively, both Turkish and Syrian health-care professionals at the primary health-care level are being trained through a new programme adapted and implemented by the WHO Country Office in Turkey and the Turkish Ministry of Health with financial support from the European Union.
Building on experience
In Turkey, WHO has facilitated trainings in the Mental Health Gap Action Programme (mhGAP) for Syrian and Turkish general practitioners, community health workers and mental health staff to empower them in identifying and treating common psychological conditions.
"We want to equip primary health-care providers, especially family physicians, with improved knowledge and updated practices of diagnosis, referrals and treatment processes when addressing the mental well-being and psychosocial needs of refugees," says Dr Esra Alataş, Head of the Mental Health Department at the Turkish Ministry of Health. "This is what the programme is all about."
Family physicians have been part of preparations from the start. Building on past experiences, the mhGAP trainings have been further developed into a new training programme (RSGÜÇ).
"I think the success of the new training is clearly related to its multidisciplinary preparation and implementation," explains Dr Naim Erhan Özgüler, one of the psychiatry experts who played an active role in the planning and the delivery of the trainings. "With this united approach, we can clearly see that, thanks to these trainings, family physicians are able to provide faster and more efficient interventions, preventing mental health issues from deteriorating, especially in cases of migration-related mental health problems."
Asking the right questions
Dr Ramy Sheikhmuhammed, who works as a family physician at the Ankara Alemdag Migrant Health Centre, is one of the Syrian health workers who participated in the RSGÜÇ trainings. He explains, "In the centres, we mostly provide service to refugees, 80% of whom are women and children. Refugees often experience trauma and depression related to the war and the migration process. We deal with trauma, gender-based violence or, for instance, early childhood and developmental disorders. We provide health services without language barriers. Receiving mental health care in one's own language is of crucial importance."
Dr Sheikhmuhammed adds, "In the centres, we work together with psychologists and social workers, and now we, the family physicians, are also able to assess the patients' mental condition and offer our support. Our beneficiaries are both happy and relieved to receive mental health care in their native language because then we are able to work on solutions together for their problems regarding socialization and mental health."
Dr Nuri Seha Yüksel, a family physician from İzmir, agrees. "These trainings are very beneficial for us primary health-care professionals, as we are often the first to notice changes in a patient's mental well-being since we see them often because of frequent follow-ups. This training equipped us with the right questions to ask to detect mental health problems."
Dr Kahiloğulları concludes by pointing to the impact of the programme. "The number of professionals trained and the amount of resources put into the RSGÜÇ training are unprecedented. Because of COVID-19, we now continue our trainings online. Our manual has been translated into Turkish to serve as a guideline for thousands of Syrian and Turkish health workers. Overall, 722 health professionals have benefited from the RSGÜÇ trainings, marking it as the greatest training effort related to mental health and psychosocial support in Turkey in the recent years."