Societal attitudes

Despite legislative changes after accession to the EU, the attitude towards immigrants in the Czech Republic remains restrictive. Critical psychosocial assistance is largely the responsibility of under-financed non-governmental organisations (NGOs) and volunteers.^{Reference Brožová, Jurečková and Pacovská4} The media greatly influences public opinion about immigrants and refugees in Czech society. Selective reporting of facts about immigrants highlights a narrative of crime, burden to others and dangerousness, contributing to xenophobia and negatively affecting the process of integration.^{Reference Kušniráková and Čižinský5} Psychosocial stressors that refugees face include pre-migration factors such as persecution, torture and war trauma; migration factors such as separation, physical danger and unsatisfactory living conditions; and post-migration factors, including uncertainty, detention and xenophobic prejudices in the host country. These psychosocial factors are associated with morbidity and ill health. A country-specific Czech study on immigration and its impact on mental and physical health supports the general assertion that psychosocial stressors erode the health of immigrants.^{Reference Záleská, Brabcová and Vacková6}

The state's integration policy

The government body responsible for integration policy in the Czech Republic is the Ministry of the Interior. It assigns tasks and responsibilities to other bodies, such as ministries, regions, municipalities and the newly established Centres for the Support of the Integration of Foreigners. None of these provides comprehensive psychosocial care at present. The updated national legislation on integration also fails to address long-range impact factors, such as the question of immigrants' inclusion into the public health insurance system, nostrification of international university diplomas and degrees, and political participation by immigrants.⁷ This level of neglect may compound unemployment risk, social distress, lack of adequate access to healthcare and consequent psychological distress.

Healthcare professionals’ attitudes and training

Healthcare professionals may be ill equipped to work with immigrants and refugees owing to insufficient awareness of similarities and differences, resulting in cultural misalignment, language and non-verbal communication barriers, and a rudimentary understanding of how cultural background and belief systems influence mental health. Examples of nuanced areas that merit training and heightened attunement include concepts of trust, authority, dignity, self-image, gender roles, role of family and society-specific taboos. Of importance are also immigrants’ unrealistic expectations associated with the host country, disappointment and working through frustration after confronting reality.

There is an obvious need for a comprehensive system of psychosocial care, cultural competence and willingness to understand the complex problems of new fellow Czech citizens. Mental health clinicians recognise the importance of establishing a trusting therapeutic alliance to ensure treatment adherence and achieve better clinical outcomes. Stigma and discrimination of vulnerable immigrants unnecessarily adds to suffering, alienation and psychological distress. Alcohol and other substance use disorders and psychotic episodes are highly prevalent among immigrants admitted to Czech psychiatric hospitals.^{Reference Dobiášová and Hnilicová8} Traumatic and stress-related disorders are probably underdiagnosed in these cohorts as well. At present, NGOs provide almost all of the psychosocial support for immigrants in the Czech Republic. Psychiatrists are usually involved only as volunteers. NGOs provide supportive psychotherapy, social services, law counselling and specially designed programmes for children and adolescents and seniors. Multicultural support groups, festivals and ethnocatering services serve the purpose of networking and enhance support. Cultural awareness programmes designed for the general public may support ease of integration through education. These could include open discussion workshops, targeted talks and cultural exhibitions. Ethnocultural pedagogical seminars for clinicians and volunteers could maximise effectiveness of clinical services.