The value of health advocacy in cross-sector collaboration for PTSD-affected and unemployed refugees in Denmark

Background: Many refugees resettling in Denmark suffer from post-traumatic stress disorder (PTSD) – influenced by both traumatic experiences and post-migration stressors such as unemployment, social isolation and difficulties navigating health and social care systems. Such stressors can undermine health as much as exposure to trauma itself. Refugees resettled in Europe also experience poor coordination of care and report that their life circumstances are rarely considered as part of mental health treatment. This calls for PTSD-treatment that reaches beyond the mental health care sector to include close collaboration with municipal services focusing on formulating shared plans that bring more focus to post migration stressors. How such cross-sector collaboration is experienced and valued by all the actors involved remains understudied and is the aim of this article. Method: This qualitative study draws on interviews with 24 unemployed refugees receiving PTSD treatment, 11 medical doctors, and 21 municipal employment consultants. They all participated in a series of network meetings as part of PTSD treatment to discuss a shared plan for trauma treatment and managing post-migrations stressors, including taking into account the consequences of PTSD when making an assessment of employability. Interviews were transcribed and imported into NVivo for thematic analysis. This study is part of an evaluation of an integrated care model, which was co-developed by professionals from multiple sectors and patients provided feedback. Findings: Patients, medical doctors, and employment consultants described different roles and goals for the network meetings. Patients preferred a less active decision-making role and instead expected the professionals to reach decisions about necessary actions and priorities. In particular, the patients hoped for the medical doctors to be their advocates, explaining their mental health condition and life circumstances for the employment consultants. The medical doctors described having an advocating role and represent the patients’ complex perspectives. Employment consultants valued validation of mental health condition and the general overview that the network meetings provided. They also appreciated the possibility for feedback on how to proceed with employment case management. Conclusion and implications: Our findings suggest that the medical doctors have a significant health advocating role in cross-sector network meetings, which supports the patients’ preferred less active role in the decision-making process and at the same time provides employment consultants with a thorough overview and information important to their case management. Being aware of and training the health advocating role of medical doctors and their ability to provide concrete feedback useful to employment case management is an important next step to ensure high quality network meetings.