MIGEP: Migration and Institutional Change in the German Health Care System in the Field of Psychiatric and Psychotherapeutic Care of Refugees

Headed by:
Dr. Renate Reiter
Prof. Dr. Annette Elisabeth Töller
Project Status:
2018-2021 (3.5 years)
Supported by:
Bundesministerium für Bildung und Forschung (BMBF; Federal Ministry of Education and Research)
Prof. Dr. Dr. Thomas Gerlinger (Bielefeld University)
Prof. Dr. Constanze Janda (German University of Administrative Sciences Speyer)

Project website (German) [external link]

Project Outline

People who flee their homeland are often confronted with a multitude of traumatizing events in their country of origin and during their flight. These include experiencing war, violence, loss, and extreme poverty in their home country and over the course of their displacement. Once they arrive in their host country, refugees are often exposed to further stressors, such as an uncertain residency status, cramped living conditions, racism, discrimination, and limited participation in society. The accumulation of traumatizing factors contributes to an increased likelihood of developing trauma sequelae. Corresponding mental illnesses occur far more frequently among refugees than in the wider population. Access to adequate treatment options for these illnesses is not only necessary from a humanitarian perspective but is also an important prerequisite for the successful integration of this group into German society.

The sharp increase in numbers of asylum applications in 2015 and 2016 compared to previous years revealed considerable deficits regarding the psychiatric and psychosocial care – among other aspects – of people who experienced flight. These deficits include considerable regional differences both in the availability of suitable services and in the application of legal frameworks; often inadequate preparation of care facilities for the requirements of culturally and linguistically sensitive treatment; and uncertainties about whether funding institutions would cover the costs of services. As a result, affected persons are often not treated at all, or are treated late or incorrectly.

Against the background of this problem, the project addresses whether and how functions of psychiatric and psychosocial care of refugees can be institutionalized. The focus is on the question whether the increased number of asylum applications since 2015 and the associated administrative problems have led to or contributed to institutional change. The situation of refugees with respect to psychiatric-psychotherapeutic care is regarded as a stark example of the health care situation of migrants in general.

Specifically, the following research questions are examined:

  1. What degree and forms of institutionalization had psychiatric and psychotherapeutic care for refugees achieved up to and including 2014?
  2. What forms of institutionalization have emerged since 2015 and what institutional change, if any, has accompanied it?
  3. How can the occurrence or absence of institutional change be explained? What inhibiting and facilitating factors can be identified in the process of institutionalization in general?
  4. To what extent do the institutional arrangements of psychiatric-psychotherapeutic care for refugees influence the direction, pace, and form of institutionalization of health care for migrants in general?

This project is funded by the Bundesministerium für Bildung und Forschung (BMBF, Federal Ministry of Education and Research) as part of topic II “Diversity and institutional change through migration” under the “Migration and social change” program. It is carried out as a joint project by the FernUniversität in Hagen with Bielefeld University and the German University of Administrative Sciences Speyer.

Hanno Hahn | 01.12.2022