Through the eyes of immigrants and health professionals: Coping and treatment experiences of men of immigrant background living with co-occurring substance use and mental health problems in Norway

Abstract

Recent years have seen an increase in the immigrant population of Norway. Immigrants, due to a variety of pre- and post-migration factors, are considered at risk of developing psychological distress and therefore involvement in substance use, leading to cooccurring substance use and mental health problems (co-occurring problems). Further, there is lower utilization of mental health and addiction services, lower treatment engagement, higher dropout rate and less frequent hospitalizations among immigrants than in the general population. In addition, immigrants face barriers in seeking and accessing mental health and addiction services. No previous studies have been conducted on the subjective understanding of co-occurring problems (COP) in the coping and treatment context in Norway, which implies a clear need to generate this knowledge. Further, health professionals are crucial in providing and promoting mental healthcare in this group. Knowledge is thus also needed on the experiences of health professionals in order to enhance access and engagement in mental health and addiction treatment in Norway.

This thesis has sought to increase scientific knowledge of the experiences of immigrants living with COP, with a particular focus on coping and treatment experiences, in addition to the perspectives of health professionals. The overall aim was to explore the coping and treatment experiences of immigrant men living with co-occurring substance use and mental health problems in Norway, from the perspectives of immigrants and health professionals. This overall aim resulted in two sub-studies and three scientific articles with the following aims: (1) To explore the lived experiences of being an immigrant and living with co-occurring problems in Norway, (2) To explore the treatment experiences of immigrant men living with co-occurring problems in Norwegian mental health and addiction services, and (3) To explore health professionals’ experiences with treatment engagement among immigrants with co-occurring problems.

This qualitative project was inspired by phenomenology, using a collaborative approach, and consisted of two sub-studies. Sub-study 1 (resulting in Articles 1 and 2) consisted of ten individual, in-depth interviews with immigrant men living with COP who had treatment experience from Norwegian mental health and addiction services. Sub-study 2 (resulting in Article 3) consisted of three focus group interviews with health professionals (HP) who had provided various mental health and addiction services to immigrants with COP. Both sub-studies were conducted in the same local context in Norway. A competency group of three persons with lived experience of COP and experience as a family member was involved throughout this project. Individual and focus group interviews were analysed using systematic text condensation.

All three articles that form the basis for this thesis provided enhanced understanding of the experiences of immigrants living with COP and the health professionals involved. These findings suggest the need for more person-centred and culturally competent approaches in Norwegian mental health and addiction services. Professional interpreters are called for, in addition to strategies that can develop personal skills among immigrants living with COP. Strategies to reduce stigma and racism in different institutions are also needed in order to enhance immigrants’ sense of belonging and participation in mainstream Norwegian society.