title: Mental health problems of undocumented migrants in the Netherlands: A qualitative exploration of recognition, recording, and treatment by general practitioners.
abstract: OBJECTIVE
  To explore the views and experiences of general practitioners (GPs) in relation to recognition, recording, and treatment of mental health problems of undocumented migrants (UMs), and to gain insight in the reasons for under-registration of mental health problems in the electronic medical records.
  
  
  METHODS
  Qualitative study design with semi-structured interviews using a topic guide.
  
  
  METHODS
  Sixteen GPs in the Netherlands with clinical expertise in the care of UMs.
  
  
  RESULTS
  GPs recognized many mental health problems in UMs. Barriers that prevented them from recording these problems and from delivering appropriate care were their low consultation rates, physical presentation of mental health problems, high number of other problems, the UM's lack of trust towards health care professionals, and cultural differences in health beliefs and language barriers. Referrals to mental health care organizations were often seen as problematic by GPs. To overcome these barriers, GPs provided personalized care as far as possible, referred to other primary care professionals such as social workers or mental health care nurses in their practice, and were a little less restrictive in prescribing psychotropics than guidelines recommended.
  
  
  CONCLUSIONS
  GPs experienced a variety of barriers in engaging with UMs when identifying or suspecting mental health problems. This explains why there is a gap between the high recognition of mental health problems and the low recording of these problems in general practice files. It is recommended that GPs address mental health problems more actively, strive for continuity of care in order to gain trust of the UMs, and look for opportunities to provide mental care that is accessible and acceptable for UMs.
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center , Nijmegen , the Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Teunissen
authors.forename: Eric
authors.initials: E
authors.lastname: Van Bavel
authors.forename: Francine
authors.initials: F
authors.lastname: Van Den Driessen Mareeuw
authors.forename: Anne
authors.initials: A
authors.lastname: Macfarlane
authors.forename: Evelyn
authors.initials: E
authors.lastname: Van Weel-Baumgarten
authors.forename: Maria
authors.initials: M
authors.lastname: Van Den Muijsenbergh
authors.forename: Chris
authors.initials: C
authors.lastname: Van Weel
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care; D004641:Emigration and Immigration; D005194:Family Practice; D005260:Female; D058005:General Practitioners; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008603:Mental Health; D008605:Mental Health Services; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D036301:Qualitative Research; D012017:Referral and Consultation; D014171:Transients and Migrants
keywords: General practice; Netherlands; mental health; qualitative research; transients and migrants