The voices not heard: thematic analysis of asylum seekers’ explanatory models of mental illness as elicited by the Cultural Formulation Interview

Background Asylum seekers have difficulty gaining access to mental healthcare. Lack of understanding of asylum seekers’ mental illness explanatory models appears to be an important barrier. Gaining a better understanding of these explanatory models is crucial for ensuring the inclusion of asylum s...

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Main Authors: Lukas Claus, Mario Braakman, Meryam Schouler-Ocak, Laura Van de Vliet, Bernard Sabbe, Seline van den Ameele
Format: Article
Language:English
Published: Cambridge University Press 2025-03-01
Series:BJPsych Open
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Online Access:https://www.cambridge.org/core/product/identifier/S2056472424008664/type/journal_article
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author Lukas Claus
Mario Braakman
Meryam Schouler-Ocak
Laura Van de Vliet
Bernard Sabbe
Seline van den Ameele
author_facet Lukas Claus
Mario Braakman
Meryam Schouler-Ocak
Laura Van de Vliet
Bernard Sabbe
Seline van den Ameele
author_sort Lukas Claus
collection DOAJ
description Background Asylum seekers have difficulty gaining access to mental healthcare. Lack of understanding of asylum seekers’ mental illness explanatory models appears to be an important barrier. Gaining a better understanding of these explanatory models is crucial for ensuring the inclusion of asylum seekers in healthcare services. The Cultural Formulation Interview (CFI) might help to explore asylum seekers’ explanatory models of mental illness. Aims To analyse asylum seekers’ explanatory models as elicited by the CFI. Methods The CFI and its first supplementary module were carried out with asylum seekers with mental health problems. Transcriptions of the interviews underwent reflexive thematic analysis within a social constructivist framework. Results In the analysis of 25 illness narratives, three major themes characterising asylum seekers’ explanatory models were identified: a burden of the past, a disenabling current reality, and a personal position and individual experience. Conclusions The interplay among pre-, peri- and post-migration experiences, having a continuous impact on asylum seekers’ mental health, was highlighted by the themes ‘a burden of the past’, and ‘a disenabling current reality’. The theme ‘a personal position and individual experience’ revealed how the CFI enables self-determination in clinical encounters by embracing uncertainty and questioning the medicalisation of distress. The analysis characterises asylum seekers’ symptoms as a personal idiom of distress within socio-relational contexts. The CFI provides a clinically useful framework for exploring asylum seekers’ explanatory models and fostering dynamic understanding.
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spelling doaj-art-837de58e0b734fb7a173f37adcb2fb362025-08-20T03:02:29ZengCambridge University PressBJPsych Open2056-47242025-03-011110.1192/bjo.2024.866The voices not heard: thematic analysis of asylum seekers’ explanatory models of mental illness as elicited by the Cultural Formulation InterviewLukas Claus0https://orcid.org/0000-0003-1818-0671Mario Braakman1Meryam Schouler-Ocak2Laura Van de Vliet3Bernard Sabbe4Seline van den Ameele5Collaborative Antwerp Psychiatric Research Institute (CAPRI), Universiteit Antwerpen (UA), Antwerp, Belgium Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, BelgiumDepartment of Criminal Law, Tilburg Law School, Tilburg University, Tilburg, The NetherlandsDepartment of Psychiatry and Psychotherapy, Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, GermanyPOZAH Project (Asylum Seekers Mental Healthcare), St-Alexius Psychiatric Hospital, Grimbergen, BelgiumCollaborative Antwerp Psychiatric Research Institute (CAPRI), Universiteit Antwerpen (UA), Antwerp, BelgiumCollaborative Antwerp Psychiatric Research Institute (CAPRI), Universiteit Antwerpen (UA), Antwerp, Belgium Department of Psychiatry and Medical Psychology, Brugmann University Hospital, Brussels, Belgium Background Asylum seekers have difficulty gaining access to mental healthcare. Lack of understanding of asylum seekers’ mental illness explanatory models appears to be an important barrier. Gaining a better understanding of these explanatory models is crucial for ensuring the inclusion of asylum seekers in healthcare services. The Cultural Formulation Interview (CFI) might help to explore asylum seekers’ explanatory models of mental illness. Aims To analyse asylum seekers’ explanatory models as elicited by the CFI. Methods The CFI and its first supplementary module were carried out with asylum seekers with mental health problems. Transcriptions of the interviews underwent reflexive thematic analysis within a social constructivist framework. Results In the analysis of 25 illness narratives, three major themes characterising asylum seekers’ explanatory models were identified: a burden of the past, a disenabling current reality, and a personal position and individual experience. Conclusions The interplay among pre-, peri- and post-migration experiences, having a continuous impact on asylum seekers’ mental health, was highlighted by the themes ‘a burden of the past’, and ‘a disenabling current reality’. The theme ‘a personal position and individual experience’ revealed how the CFI enables self-determination in clinical encounters by embracing uncertainty and questioning the medicalisation of distress. The analysis characterises asylum seekers’ symptoms as a personal idiom of distress within socio-relational contexts. The CFI provides a clinically useful framework for exploring asylum seekers’ explanatory models and fostering dynamic understanding. https://www.cambridge.org/core/product/identifier/S2056472424008664/type/journal_articleAsylum seekerscultural formulation interviewexplanatory modelsthematic analysismental health
spellingShingle Lukas Claus
Mario Braakman
Meryam Schouler-Ocak
Laura Van de Vliet
Bernard Sabbe
Seline van den Ameele
The voices not heard: thematic analysis of asylum seekers’ explanatory models of mental illness as elicited by the Cultural Formulation Interview
BJPsych Open
Asylum seekers
cultural formulation interview
explanatory models
thematic analysis
mental health
title The voices not heard: thematic analysis of asylum seekers’ explanatory models of mental illness as elicited by the Cultural Formulation Interview
title_full The voices not heard: thematic analysis of asylum seekers’ explanatory models of mental illness as elicited by the Cultural Formulation Interview
title_fullStr The voices not heard: thematic analysis of asylum seekers’ explanatory models of mental illness as elicited by the Cultural Formulation Interview
title_full_unstemmed The voices not heard: thematic analysis of asylum seekers’ explanatory models of mental illness as elicited by the Cultural Formulation Interview
title_short The voices not heard: thematic analysis of asylum seekers’ explanatory models of mental illness as elicited by the Cultural Formulation Interview
title_sort voices not heard thematic analysis of asylum seekers explanatory models of mental illness as elicited by the cultural formulation interview
topic Asylum seekers
cultural formulation interview
explanatory models
thematic analysis
mental health
url https://www.cambridge.org/core/product/identifier/S2056472424008664/type/journal_article
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