Exploring the Use of Hospital and Community Mental Health Services Among Newly Resettled Refugees

Importance: Resettled refugees in high-income countries represent a vulnerable population. It is known that refugees have high rates of trauma-related mental health issues; however, ad hoc research has generally revealed low rates of health services use among refugees. Such research usually samples a population at a single point in time and is based on targeted surveys. Because refugee populations change over time, such research becomes expensive and time-consuming for agencies interested in routinely publishing statistics of mental health services use among refugees. The linking of large administrative data sets to establish rates of use of mental health services among resettled refugees is a flexible and relatively inexpensive approach. Objective: To use data linkage to establish rates of mental health services use among resettled refugees relative to the general population. Design, Setting, and Participants: This cross-sectional study implemented data linkage from the Refugee Health Nurse Program for 10 050 refugees who resettled in Sydney, Australia, from October 23, 2012, to June 8, 2017, with data concerning use of community mental health services and mental health hospitalization from New South Wales Health databases. Data were analyzed between June 1, 2019, and December 31, 2021. Main Outcomes and Measures: Rates of service contacts with community mental health services among the resettled refugees were compared with those of the general population by age, sex, and the most common International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis codes. Length of community mental health service sessions and rates of mental health hospitalizations were also compared. Results: Among the 255 resettled refugees who had contacts with community mental health care services and were not missing data (median age, 35 range, 4-80 years; 117 64% male and 138 54% female), 153 (60%) were born in Iraq and 156 (61%) were Arabic speaking. This population was less likely to use mental health services than the general population and had shorter community mental health consultations. The rate of contacts with community mental health services for depressive disorders among the resettled refugee population was 40% (95% CI, 33%-46%) lower than that among the general population. Rates of same-day hospitalization per 10 000 person-years were not significantly different between the refugee population (4 95% CI, 2-8) and the general Australian population (7 95% CI, 7-7). However, the refugee population was 17% (95% CI, 6%-29%) more likely than the general Australian population to interact with the community mental health system for severe stress- and adjustment disorder-related diagnoses. Conclusions and Relevance: These findings suggest that refugees who have resettled in Australia tend to use fewer mental health services than the general population except for services devoted to stress- and adjustment disorder-related diagnoses. These findings also suggest that it is possible to successfully leverage data linkage to study patterns of mental health services use among resettled refugees.