Barriers and opportunities for refugee mental health services: clinician recommendations from Jordan

BACKGROUND: Jordan has received more than three million refugees from bordering countries during times of conflict, including over 600 000 Syrian refugees between 2011 and 2021. Amidst this humanitarian crisis, a new mental health system for Syrian refugees has developed in Jordan, with most clinical services administered through non-governmental organizations. Prior studies have identified increased risk of psychiatric disorders in refugee populations and significant barriers for Syrian refugees seeking mental health treatment, but few have reviewed the organization or ability of local systems to meet the needs of this refugee population. METHODS: Qualitative interviews of mental health professionals working with refugees in Jordan were conducted and thematically analyzed to assess efficacy and organizational dynamics. RESULTS: Interviewees described barriers to care inherent in many refugee settings, including financial limitations, shortages of mental health professionals, disparate geographic accessibility, stigma, and limited or absent screening protocols. Additional barriers not previously described in Jordan were identified, including clinician burnout, organizational metrics restricting services, insufficient visibility of services, and security restrictions. Advantages of the Jordanian system were also identified, including a receptive sociopolitical response fostering coordination and collaboration, open-door policies for accessing care, the presence of community and grassroots approaches, and improvements to health care infrastructure benefiting the local populace. CONCLUSIONS: These findings highlight opportunities and pitfalls for program development in Jordan and other middle- and low-income countries. Leveraging clinician input can promote health system efficacy and improve mental health outcomes for refugee patients.