From monitoring migrant health to developing mental health services in Finland Päivikki Koponen Conference on Migrants and Health actions funded under the Health Programme and Lisbon

Objectives: Why specific surveys targeted to immigrants? In Finland 0.5% of total population in 1990 were of foreign origin, 5.9% in 2014 and projected 10% of by 2020 Population level information needed for developing research based health promotion activities and health & social services Comprehensive information needed to study e.g. association of integration and employment with mental health and wellbeing Register-based information not available due to the decentralized service system and no information on ethnic/migrant background in the statistics Health survey samples include persons of immigrant origin, but their proportion is too small and participation rates are too low to make any comparisons and conclusions  Specific studies on migrants are needed 2

The Migrant Health and Wellbeing Survey (Maamu) Coordinated by THL in collaboration with the Ministry of Social Affairs and Health, Finnish Institute of Occupational Health, Statistics Finland, The Family Federation (NGO), and municipalities Sample: persons, persons / group –Russian (largest migrant group) –Somali (largest group with refugee background) –Kurdish (largest group of quota refugees for the past 10 years) age 18–64-years, 6 cities, at least 1 year in Finland Comparison group (general population) from the Health 2011 survey (n=2276) Funding: European Social Fund, Social Insurance Institution of Finland, Finnish Work Environment Fund, National Institute for Health and Welfare, municipalities Aims: To study health and wellbeing, determinants and use of services among migrants, and to develop a monitoring system Participation in at least one part of the study: Russian 70.2%, Somali 51.2%, Kurdish 63.2%, General population 71 % The Migrant Health and Wellbeing Survey (Maamu)3

Prevalence of severe depression and anxiety symptoms, past 7 days (HSCL) The Migrant Health and Wellbeing Survey (Maamu)4

Experiences of the MAAMU Study 5 Strengths o Cooperation with municipalities o Bilingual staff o Culturally sensitive study protocol o Need and public interest in information on migrant health and wellbeing Weaknesses o Time-consuming fieldwork  financial prerequisites o Outdated addresses o Unexperienced fieldwork staff o Need for supervision Opportunities o Contacting participants and raising awareness o Personal referral to care o Bilingual staff for further studies o Implementation of study results o Developing survey methods o Building the monitoring system Threats o Distrust towards authorities o Low participation in some sub-groups o Limited resources for implementing study results after the project period o Populistic use of study results

Integration Migrant -barometer (Ministry of Employment and Economy) Migrants’ integration in Finland (register data/VATT Institute for Economic Research) Employment and Work Migrants’ success at work (Institute of Occupational Health/Maamu) EU-LFS (Statistics Finland) Discrimination EU-MIDIS (Ministry of the Interior, Ministry of Justice) Health and Wellbeing Maamu, Regional Health and Wellbeing Survey ATH (THL) EU-EHIS (THL) Living conditions and social benefits MAMELO (Statistics Finland) EU-SILC (Statistics Finland) Benefits (The Social Insurance Institution of Finland)

Survey on work and well-being among people of foreign origin (UTH) Conducted in in collaboration: Statistics Finland, THL and the Finnish Institute of Occupational Health Funding: EU Integration Fund, National Institute for Health and Welfare, Statistics Finland, Ministry of Education and Culture Based on the LFS, additional random sample of 5449 individuals, all over Finland, participation rate: 66% –Age years –Both parents (or only known parent) born outside of Finland  study includes 2. generation migrants Structured face-to-face interview by multilingual fieldwork personnel, in 12 languages: Finnish, Swedish, English, Estonian, French, Russian, Arabic, Somali, Kurdish (Sorani dialect), Persian, Thai, Chinese Comparison with the general population: Labour Force Survey (LFS & Ad Hoc Module), Regional Health and Wellbeing Survey (ATH), Work and Health Interview study, Working conditions study UTH7

Prevalence of being mentally distressed (MHI5) Work and Wellbeing among people of Foreign Origin (UTH)8

Developing National Actions to promote Mental Health among Refugees, PALOMA Project Aim: to develop a national model for effective mental health services for refugees in Finland –Reception centers –Health promotion and primary care in municipalities and NGO`s –Specialized care in hospital districts and University hospitals Collaboration with THL, The Finnish Association for Mental Health (NGO), Kuopio and Helsinki University Hospitals, and the municipality of Hämeenlinna Duration Supported by The European Union, the Asylum, Migration and Integration Fund (AMIF) 9

Best practices: collaboration in migrant health surveys to develop services 10 III. Contacting and motivating participation II.Survey fieldwork: bilingual staff, contacts with communities and NGOs IV. Interviewing (and health examination): referrals and feedback when needed VII. Developing actions & services VI. I.Survey planning: multidisciplinary study team, networking V. Reporting: participants, communities, services, ministries Communication and sharing information