Role of NGOs & CSOs in Healthcare for Migrants & Ethnic Minorities: Health Services in Denmark

1. Role of NGOs & CSOs in healthcare for migrants & ethnic minorities: Health Services in Denmark: Co-operation between different sectors? Rashmi Singla Cand.Psych., M.Sc., Ph.D.,Specialist in Psychotherapy Associate Professor Department of Psychology & Educational Research Roskilde University , Denmark

2. Agenda • Introduction • Major aspects incl. ethical underpinnings • Danish Red Cross: Asylum Seekers • T.T.T.: Minority Youth • Challenges • Conclusion Rashmi Singla, Intervention & Good Practices, Spring 2009

3. Introduction “ Whatever structural, social and cultural factors lie upstream in the sequence of causes and health determinants, at some point downstream there are psychological and biological processes at work, linking the macro contextual determinants (such as the political context, immigration policies) with the micro-worlds of intervention experience (trauma, mental illness)” - Singla, 2004 NGOs and CSOs mediate between these levels.. Meso level - comment in COST policy meeting, Malmö, Sweden, November 2007 Rashmi Singla, Intervention & Good Practices, Spring 2009

4. Introduction Dealing with the health & health promotion issues Focus on two NGOs with different structures & target groups: • Danish Red Cross: Asylum seekers • T.T.T. (Transcultural Therapeutic Team) Ethnically diverse youth, especially those experiencing psychosocial problems Rashmi Singla, Intervention & Good Practices, Spring 2009

5. Introduction Status quo versus social change ? Culture (as meaning) centered approach, Dutta, 2008 Rashmi Singla, Intervention & Good Practices, Spring 2009

6. Introduction Danish Welfare State can be characterised as ‘universal’, providing high quality social care and benefits to all members of the society - creche to grave services Welfare state has taken over many of the tasks of independent care providers yet occlusions in the regime of governmentality Rashmi Singla, Intervention & Good Practices, Spring 2009

7. Major Aspects including ethical underpinnings • Understanding the social exclusions in the broad welfare state context • Empowerment by highlighting the connection between the individual / micro and collective / macro levels, thus transcending the individualisation of powerlessness (Andersen & Larsen, 1998) Rashmi Singla, Intervention & Good Practices, Spring 2009

8. Major Aspects including ethical underpinnings Empowerment defined as processes through which • People attain greater control and participate in decisions affecting their lives • Social groups improve their ability to create, master and deal with material, social, cultural and symbolic resoources (Andersen & Larsen, 1998) Rashmi Singla, Intervention & Good Practices, Spring 2009

9. Major Aspects including ethical underpinnings Factors important in the service provision aimed at promoting the health of vulnerable groups: • Access and promotion of the services among the target groups • User involvement- recommended by international bodies • Continuity of care • Multi-agency coordination • Cultural sensitivity • Advocacy • Monitoring and evaluation (Watters and Ingleby, 2004) Rashmi Singla, Intervention & Good Practices, Spring 2009

10. Major Aspects including ethical underpinnings Other salient aspects • Interventional focus at the different categories of exclusion: ageism, sexism as well as racism • Simultaneous perception on the user/patient as a unique person in spite of the anthropological and social psychological knowledge about the group, through asking questions • Ethnocentrism and power asymmetry to be countered by focus on the professional’s ethical standards (Singla, 2007) Rashmi Singla, Intervention & Good Practices, Spring 2009

11. Major Aspects including ethical underpinnings • “Top down” approach in Holland Systematic, stratified and hierarchically organised negative features - not much variation • “Bottom up” approach in the UK Grassroots oriented Negative features: chaotic and problems in organising programmes for dispersed groups Danish situation - A combination? Rashmi Singla, Intervention & Good Practices, Spring 2009

12. Red Cross: Asylum Seekers On request from the state, based on seven principles of humanity, impartiality, neutrality, independence, voluntary action, unity and universality Rashmi Singla, Intervention & Good Practices, Spring 2009

13. Red Cross: Asylum Seekers • Medical reception of asylum seekers • Danish Red Cross offers voluntary physical and mental screening of all newly arrived asylum seekers, high acceptance rate • Asylums department manages the centres, the asylum seekers, teaching, activating and health - responsible for the asylum seekers healthcare in cooperation with the Danish Immigration Service, having drawn its own set of instructions, outlining asylum seekers’ medical rights. Rashmi Singla, Intervention & Good Practices, Spring 2009

14. Red Cross: Asylum Seekers Asylum seekers do not have the same legal rights to medical care as Danish citizens in case of non-acute sickness. However, they also have access to non-acute treatment by applying to the Red Cross • Practically they have limited access. Barriers - gap between ideals and practice Rashmi Singla, Intervention & Good Practices, Spring 2009

15. Red Cross: Asylum Seekers CSOs have been critical about Red Cross´s role in managing these rules rather restrictively Commitment to prevent and alleviate human suffering? Acceptance of detrimental conditions? Neutrality? Rashmi Singla, Intervention & Good Practices, Spring 2009

16. TTT: Ethnic Minority Youth Psychosocial service for minority youth and their families in Copenhagen, since 1991 - Grass root NGO by a group of psychologists with ethnically diverse backgrounds but academically with similar background, based on the three principles • Focus on Multiple Identity • Inclusion of Family and Network • Inclusion of the Broad Social Context Rashmi Singla, Intervention & Good Practices, Spring 2009

17. TTT: Ethnic Minority Youth Ideally all services should be accessible to and appropriate for all ethnic groups but in the climate where issues of race and culture are inadequately addressed, it is inevitable that services geared for specific ethnic groups must exist side by side with more generic services (Fernando, 1995) TTT´s evaluation underlined the significance of understanding, sympathetic communication, ‘process of being listened to’, also negative experiences of exclusion Rashmi Singla, Intervention & Good Practices, Spring 2009

18. TTT: Ethnic Minority Youth Barriers related to optimal use, limited resources, continued existence, collaboration with the state and mainstream organisations Rashmi Singla, Intervention & Good Practices, Spring 2009

19. Challenges “ (…) it is not enough to simply provide people with a telephone number: they need to know what is on the other end of the line” Ingelby, 2007 Rashmi Singla, Intervention & Good Practices, Spring 2009

20. Challenges ”A person may cause evil to others, not only by his actions but by his inaction, and in either case he is justly accountable to them for the injury” John Stuart Mill NGOs ethical responsiblity: Millenium Development Goals for 2015… key targets in health provision likely (non-) achievemnts NGOs should focus on the hindrances and realistic solutions (Erica Burman, 2009) Rashmi Singla, Intervention & Good Practices, Spring 2009

21. Conclusion Good Practices • Simultaneous focus at the different levels • Micro and macro • Personal, interpersonal and structural • Understanding and social change categorising of applying culture in the context of health • Empowerment and user involvement in different phases with dialogues and generating an understanding of health meanings, transforming the structures constraining the health experiences Rashmi Singla, Intervention & Good Practices, Spring 2009

22. Conclusion Changes at European and National levels: Rapid increase in attention on the topic • Recommendation by Ministers of Council of Europe: Health care in a multicultural society • Migrant health, important element of health programme (EU Lisbon conference, September, 2007) In Denmark, several projects about ethic minority health at different levels: (www.sehat.dk and www.sundhed.dk etc.) Rashmi Singla, Intervention & Good Practices, Spring 2009