General practitioners’ repertoires of patients with a migration background and mental health problems

Purpose Despite a higher prevalence of mental health problems among people with a migration background, recent studies indicate these patients have more unmet medical needs and are under-represented in mental health services. General practitioners (GPs) are central gatekeepers in treatment and referral to specialised mental health care. However, their recommendations can be influenced by beliefs, social norms and practices that might prejudice people with a migration background. This study aims to examine GPs’ accounts of patients with a migration background suffering from mental health problems and their related decision-making processes. Design/methodology/approach Thirty-nine in-depth interviews were conducted with Belgian GPs. An analysis based on critical discursive psychology was performed to (a) examine how GPs discursively construct their decision-making regarding patients with a migration background and (b) identify how GPs position these patients. Findings The authors identified three distinct interpretative repertoires in GPs’ accounts: the legal-political repertoire, the culturalising repertoire and the humanitarian repertoire. GPs often view patients’ health beliefs and integration as obstacles to proper care, focusing primarily on biological and psychological aspects while neglecting social elements. This can lead to cultural stereotyping and prejudicial treatment outcomes. Even when adopting a humanitarian stance, GPs can diminish patients’ agency and impede patient-centred care. Originality/value These findings have implications for policy, medical training and future research. Policies should address biases and stereotypes in health care by promoting the inclusion of social elements without diminishing patients’ agency. Medical training should emphasise the biopsychosocial model, recognising and addressing biases, promoting patient-centred care and fostering therapeutic relationships based on shared power and responsibility. Future research should explore the impact of patients’ cultural health capital on medical interactions and outcomes.