Unmet need for mental health medication within the migrant population of Northern Ireland: a record linkage study.

BACKGROUND: Migrant populations are particularly at risk of not receiving the care for mental ill-health that they require for a range of reasons, including language and other barriers to health service access. This record linkage study compares, for migrant and settled communities, the likelihood that a person in Northern Ireland with poor mental health will receive psychotropic medication. METHODS: A cohort of 78 267 people aged 16-64 years (including 1736 migrants) who reported chronic poor mental health in the 2011 Census records was followed for 15 months by linkage to a centralised prescribing data set to determine the rates of pharmacological treatment. Logistic regression analyses quantified the relationship between psychotropic medication uptake and migrant status, while accounting for relevant demographic and socioeconomic factors. RESULTS: Overall, 67% of the migrants with chronic poor mental health received at least one psychotropic medication during the study period, compared to 86% for the settled population; this equates to an OR of 0.32 (95% CI 0.29 to 0.36) in the fully adjusted models. Adjustment for English proficiency did not significantly alter these models. There was also considerable variation between individual migrant groups. CONCLUSION: Although this study suggests substantial unmet need for treatment of poor mental health among the migrant population of Northern Ireland, further qualitative studies are required to better understand how different migrant groups respond to mental ill-health.

Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project.

BACKGROUND: The uptake, implementation, and maintenance of effective interventions promoting physical activity (PA) and a healthy diet and the implementation of policies targeting these behaviors are processes not well understood. We aimed to gain a better understanding of what health promotion professionals and policy makers think are important factors facilitating adoption, implementation, and maintenance of multi-level interventions and policies promoting healthy eating and PA in Belgium, Germany, Ireland, Norway, and Poland. METHODS: Six interventions and six policies were identified based on pre-defined criteria. Forty semi-structured interviews were conducted with stakeholders from various sectors to elicit information on factors impacting adoption, implementation, and maintenance of these interventions and policies. All interview transcripts were coded in NVivo, using a common categorization matrix. Coding in the respective countries was done by one researcher and validated by a second researcher. RESULTS: Active involvement of relevant stakeholders and good communication between coordinating organizations were described as important factors contributing to successful adoption and implementation of both interventions and policies. Additional facilitating factors included sufficient training of staff and tailoring of materials to match needs of various target groups. The respondents indicated that maintenance of implemented interventions/policies depended on whether they were embedded in existing or newly created organizational structures in different settings and whether continued funding was secured. CONCLUSIONS: Despite considerable heterogeneity of interventions and health policies in the five countries, stakeholders across these countries identify similar factors facilitating adoption, implementation, and maintenance of these interventions and policies.