The interviews provided rich accounts of the diverse and multifaceted impact the COVID-19 crisis has had on migrants in Borgerhout and Antwerpen-Noord, as well as on the working realities of the professionals in the local psycho-social care sector. We present our findings in three sections. First, we summarise the severe impact of the COVID-19 pandemic among migrants, to understand how mental health was inextricably interlinked with broader hardship and precarity across life domains. Second, we discuss how the interviews are testament to the unique value and indispensability of local-level services and organisations in providing mental-health related services, particularly in a crisis context like the COVID-19 pandemic. Qualities and characteristics of local-level organisations and initiatives that emerged to be particularly important included their awareness of local needs; their flexible nature which allows them to address bottlenecks and fill gaps left by other services; their capacity to respond to a broad spectrum of needs; their ability to offer culturally sensitive care and support; and their physical accessibility. Third, we discuss the fragility and fragmentation of these local-level services and initiatives. In the face of the COVID-19 crisis, this related to serious challenges to the necessary physical accessibility of organisations’ services; services and initiatives becoming overloaded; and lack of oversight of the available services forming a real barrier for both service users and providers.
Complex drivers of mental health impact
Looking back on the years following the outbreak of the pandemic, the respondents note how the mental health impact of the COVID-19 crisis has been heterogeneous yet far-reaching. Key drivers of poor mental health that emerged from the interviews included social isolation and loneliness; health concerns related to the COVID-19 virus; working conditions; financial hardship; housing and the built environment; and increasing digitisation related to COVID-19 measures and restrictions.
The interviews highlighted that a key driver of poor mental health among migrants during the pandemic was social isolation. Some migrants in particular were severely impacted by the social restrictions associated with the pandemic, such as those who lived alone or far from their families, were unable to access online support, and faced language barriers. For many migrants, efforts to integrate and find their place in Belgium were halted by the pandemic. For example, a man from India pointed out that:
It is hard to learn a language when you live alone and have to stay at home every day, not talking to other people, especially as I have no internet at home and no laptop. Then I started drinking alcohol. I like to talk to people. Not stay at home. I have problems if I stay at home.
Since many first-generation migrants typically have more limited support systems and networks, closure of childcare facilities and other support organisations also disproportionately impacted them and this has created a lot of stress and anxiety. A woman from Somalia explained:
I was home alone with my sons. I had nothing to do, I couldn't go outside. I thought I was really going to die. I thought, no I have two kids. It was so hard, 2020, 2021. I was always crying. I'm going to die, I thought. And then what are my kids going to do?
In addition to an exacerbation of experiences of loneliness and isolation, the impact of COVID-19 on employment was also a key driver of poor mental health. Some of the interviewed migrants were laid off as a result of the pandemic, while others’ search for work was made more difficult because of the economic consequences of the pandemic. A woman from Uzbekistan who used to work in a restaurant explained that she was not eligible for government compensation when the restaurant closed: “I could not get money because I worked ‘in interim’, it was a day contract.” The financial impact of the COVID-19 crisis was even more challenging for undocumented migrants without papers, who cannot work legally or access unemployment benefits. Unemployment caused financial worries for those interviewed, and many migrants also described lacking structure, routine and purpose, which impacted negatively on their mental health. Consequently, due to people’s own difficulties, it was sometimes more difficult to support people in one’s near social circles, as illustrated by this quote from a man from Morocco:
I have my own problems with my papers, my health… everything. But I always remain happy. Problems, pfff, yes (laughs). I will speak with you and listen a few times, but if it is constant, then no. I don’t want it to become my own problem. I will just leave. I have many problems of my own. If it was my girlfriend, okay, but if it is another person, sorry no. Just once or twice I would speak to you, no more.
Ability to cope with the impact of the COVID-19 crisis was also challenged by migrants’ living situation and the built environment. For many respondents living in cramped housing, public spaces such as parks are particularly important: “Normally after school we can go to the park with the kids for basketball together, cycling, soccer. But then everything stopped” (Man, Afghanistan). Conversely, for those interviewed who lived in a bigger house, had a garden or close access to a park, expressed that these factors significantly contributed to their mental well-being.
Although some of the mental health drivers of migrants were similar to those experienced pre-pandemic, access to resources to help deal with these problems was severely hampered by the COVID-19 crisis. One issue which was frequently mentioned related to difficulties caused by increased digitalisation from COVID-19 and the closure of physical spaces. For parents with children studying from home, accessing the internet and providing equipment was a problem. In addition, making appointments online was very difficult for some migrants with limited language or computer skills. A Somali woman explained:
I am bad with computers. To make appointments is difficult when everything is online. There were no more appointments during corona, I couldn't come here [to local wellbeing organisation]. It was very difficult.
In short, many structural drivers of mental health problems were exacerbated during the COVID-19 pandemic. Increased isolation, combined with stressors related to work, finances, and caring responsibilities, negatively impacted respondents’ mental health. In addition, the physical spaces and organisations that could typically provide assistance were often closed or more difficult to reach.
Unique value and indispensability of community-based organisations and initiatives
Although our case study revealed the disproportionate mental health impact faced by migrants in Borgerhout and Antwerpen-Noord, their resilience and the importance of support from community-based organisations working directly with them also clearly emerged from the interviews. Firstly, the interviews highlighted that community-level actors are knowledgeable about the direct and indirect effects of the COVID-19 crisis on their target groups and have a thorough understanding of the various needs that have emerged as a consequence. For example, a social worker working at a local CSO branch noted the increased need for psychological support immediately following the outbreak of the COVID-19 pandemic in 2020: “We saw a large increase in psy-requests, a lot of people with stress complaints… really an increase with the period before”.
Professionals in the local psycho-social care sector agreed that their organisations’ accessibility was key in allowing them to be closely in touch with the impact of the crisis. A coordinator of a local psycho-social care organisation branch pointed out that the array of mental health services on offer is complex, and that many people struggle to navigate the system: “when it comes to mental health problems, finding your way around that entire landscape is not easy. I think they come to us more easily, especially people with little financial means”. Another respondent, who is a trained psychologist and founder of a local drop-in centre for young people and women, emphasised accessibility as a key strength of her organisation:
For example, a woman might pass by who is not feeling well at the time, who has never come here before. But she sees a dynamic, so she comes in and says, ‘what is it all about, what do you all do?’ Then we start telling her, and all at once a very big story emerges. ‘I've been through this and this, and I'm alone, and I don't feel so good and I don't know which organisations I can turn to.’
A shared sentiment among the respondents working in the psycho-social care sector was that a core strength of their organisations is their capacity to respond to a broad spectrum of needs. Many of the professionals interviewed take a coaching approach to mental-health related issues. Particularly in the COVID-19 crisis, when many support services became more difficult to access, respondents felt one of their key responsibilities was to link clients to support across different life domains. A psychologist working with children and families explains that this includes not only professional services, but also people’s personal networks:
That is our vision, to try to activate people’s own network. Can someone be approached, someone at school, a neighbour, or someone else? We work with people to see how support can be strengthened in different life domains.
As such, helping people improve their psychological wellbeing was widely recognized as requiring an approach tailored to a person’s unique situation and their social network. Respondents underline the psychosocial nature of their work, which frequently combines offering practical and therapeutic support. A social worker at a local CSO branch said:
Yes, it really is psycho-social work, even with people who are not specifically looking for psychological support. People have a lot of baggage and have a need to talk [...], to just feel heard.
Most of the community-level organisations had already been in existence for several years prior to the pandemic and had built up strong ties with the neighbourhood, which was a significant asset in the COVID-19 crisis situation. National and regional governments focused heavily on vulnerability in terms of physical health status, particularly in the early stages of the pandemic, yet professionals attuned with their local neighbourhood had a more nuanced understanding of which groups of migrants were particularly vulnerable. This included an understanding of gendered differences, such as the caring responsibilities shouldered predominantly by women, as well as the unique challenges faced by undocumented migrants in the neighbourhood. A social worker at a local CSO branch noted that “the government was busy with other things”, and grassroot organisations were left to pull a lot of weight in working with people “who do not appear in government statistics, but who are actually there” such as undocumented migrants and other marginalized groups.
Apart from their proximity and long-standing embeddedness in their locality, a unique value of community-level organisations is their relatively flexible nature and ability to rapidly adapt their services in response to changing needs. This quality turned out to be particularly important in a crisis context, as it allowed organisations to address bottlenecks and fill gaps left by other services and governmental agencies. Particularly at the beginning of the pandemic, when many governmental services closed their front-offices, community-level organisations found themselves having to adapt the scope of their work. A psychologist and founder of a local CSO explains: “At that time, we were no longer just doing youth work, but we also became social services... and we tried to deal with all the questions that came in as best we could”. She feels that filling this gap was much needed:
I think that with our open drop-in house, we really were a beacon of hope. People said: ‘we can go there, we can talk, we can get help, at least they are physically open. We don't have to call or talk to them online, we can really go to them.’ At the very beginning there was nothing open at all, but we gave them a bit of perspective.
As many of the local-level organisations and initiatives are relatively small, it was easier for them to rapidly adjust their services to meet their target groups’ needs. Several respondents remarked that the City of Antwerp government facilitated tailored responses through providing funding for a diverse array of psycho-social support measures through the Coronababbels (“Corona chats”) scheme: “All kinds of organisations were given the chance to develop initiatives, for example around the theme of loneliness” (Psychologist who established a CSO during the COVID-19 pandemic). Indeed, the Coronababbels funding scheme exemplified how grassroots level funding for psychosocial support interventions can facilitate the promotion of initiatives that share a common vision while adopting targeted approaches.
The interviews also highlight the importance of culturally sensitive support when dealing with the mental health impact of the COVID-19 pandemic. This includes awareness of the stigma surrounding mental health issues, which can impede support seeking. A psychologist and founder of a local CSO points out that “many people are very ashamed of their situation”, and might not seek social support from friends and family because “it always has to go well for you, it is not OK if it goes badly for you”. It should be noted that there was significant diversity in the type of care and support the interviewed migrants perceived as appropriate. Although many of the interviewed migrants conceptualised mental distress during the COVID-19 pandemic primarily as a normal reaction to difficult circumstances, rather than a distinct psychological condition requiring professional support, others did endorse biomedical labels for mental distress:
“If a friend was feeling depressed, I would recommend they speak to a specialist, a doctor. [...] Depression is a sickness. It is difficult to advise without knowing the causes, because there are many crises now. Are you depressed because of the pandemic? Why? Financial, less freedom? These problems also need to be addressed. I can’t give general advice that would work for everyone.” (Man, Syria)
As highlighted by this quote, many migrants felt mental health issues were most appropriately tackled by understanding and addressing their underlying causes. Assisting with structural challenges could then also provide an opening to discuss mental health issues, regardless of how someone might label them. One of the psychologists interviewed underlined that culturally sensitive support often requires a move away from “the Western model of how psychopathology works”, and being open to the different ways in which people make sense of their mental health. Many community-level services represent the diversity of the neighbourhood, helping them to offer culturally sensitive care and support and overcome language barriers, as shown by this quote of a psychologist and founder of a local CSO:
There are many people here in Borgerhout who do not speak the language and who cannot find their way in the services on offer. People really seek us out, because we work in a culturally sensitive way. […] We have a Ghanaian working with us, we have Belgian people working with us, we have Moroccan, Turkish people working with us, so we are actually very diverse in our team. This means that we really reach the different target groups and can help them, because we are approachable and we know the language.
Working with a multi-lingual team, sometimes including interpreters, was described as a key prerequisite for offering culturally sensitive services. Combined with organisations’ nuanced awareness of a broad spectrum of local needs and their flexible nature, this was considered a key strength of community-level initiatives.
Fragility and fragmentation
Community-level organisations and initiatives also faced challenges during the COVID-19 pandemic. Fragility and fragmentation were related to physical accessibility and digitalisation; services and initiatives becoming overloaded; and lack of oversight of the available services forming a real barrier for both service users and providers.
The interviews with community-based organisations highlighted how physical accessibility is an absolute must for these services to function and reach their target groups, yet the pandemic seriously challenged this. One issue which was frequently mentioned by migrant residents of Antwerpen-Noord and Borgerhout related to difficulties caused by increased digitalisation from COVID-19 and the closure of physical spaces, as illustrated by an Afghan man:
My [language] school was online, that is why I didn't pass. Because sometimes my Wi-Fi works, sometimes it doesn't work. This was a problem. [...] You always had to make an appointment. Everything was closed. To come here [local wellbeing organisation], became more difficult.
A social worker at a local CSO branch explained how digitisation poses a big threshold particularly “for people who are vulnerable, who do not speak the language, or who are illiterate”. She notes that the digitalisation trend which accelerated during the COVID-19 pandemic now seems to continue:
I can also see that the digitalisation of the COVID pandemic is now continuing, and a very large number of people simply fall by the wayside. They end up with social services or with a voluntary organisation that has to do it for them, because they cannot do it themselves.
Professional respondents described how particularly in the early stages of the pandemic, organisations encountered significant difficulties in remaining in touch with their target groups while respecting physical distancing rules. This caused frustration, since many did not consider digital communication to be effective. A psychologist and founder of a local CSO mentioned: “The only thing we could do was to talk to them online or via WhatsApp, but we noticed very quickly that that didn't really do much”. Indeed, a key take-away of the pandemic for many respondents is that face-to-face contact with their target groups is absolutely essential, as indicated by a coordinator of local community centre:
“What has become clear to me is that even when things are complicated, when there are restrictive measures, personal contact must be maintained. […] The loss of personal contact has been very difficult for many people here, so the main challenge is to find ways to make personal contact possible, in any way possible.”
The relatively small size of many local-level organisations and services also meant that they quickly became overloaded, especially when demand increased due to the COVID-19 pandemic impact. The closure or digitalisation of other (governmental) services put more pressure on community-level services that did remain open. In the face of a deluge of questions for help, which were frequently outside of organisations’ regular scope of work, many respondents described feeling overwhelmed. A social worker at a local CSO branch recalls:
“A lot of organisations and social services were closed, so we saw a very high demand. Organising access to healthcare is our organisation’s core business, but if a client says: ‘I have received a reminder from the bailiff and there will be additional costs if I don't respond within fifteen days", then I'm not going to say: ‘It’s not my job to help you with that’. Of course I will take that on.” – Social worker at a local CSO branch
The quote above demonstrates how holistic support was not always officially part of organisations’ mission, which meant its provision depended on the personal commitment of professionals, sometimes at a personal cost. Professional respondents were acutely aware that they were unable to meet the needs of all the people who sought support, let alone those who did not reach their organisations. Indeed, many respondents expressed a sense of powerlessness to help their target groups tackle the underlying causes of mental health issues. They prioritise supporting people in the short term, which a psychologist characterised as “an intermediate step, a bit of a fire-fighting exercise”, but are often unable to offer the holistic long-term support they feel people require.
Finally, the interviews showed how fragmentation and lack of oversight of the available services is a real barrier for both service users and providers. Some respondents felt the COVID-19 crisis had boosted collaboration between different organisations working on similar issues:
“During COVID, because we were so limited in our possibilities, we asked each other for advice, we talked to each other more, we worked together more. That sounds very, very basic, but we did rely on each other more. Like: ‘it's not going well here, can I refer this person to you?’ There was much more consultation.” – Psychologist and founder of a local CSO
Nonetheless, the consensus arising from the interviews was that significant fragmentation remains. A psychologist expressed how she sometimes refers to psychosocial support services that she knows, but that she feels it is hard to get a grasp of all the relevant services on offer:
But the thing is, I don’t know exactly what’s out there. […] For example, I recently referred a mother with postnatal depression to an organisation where I know they have Arabic-speaking staff, and she can go there with her baby to a support group and meet other mothers. So I thought that was good, but that was because I happened to have been there myself and I knew how it works.
The need to build bridges and break down walls was a frequently expressed wish for the future. Respondents noted that particularly when you aim to reach specific groups like migrant communities, a collaborative network of partners with local know-how is essential. A coordinator of a local community centre expressed the need for an increased focus on facilitators and building bridges, “because there are often walls and everyone just works within their own field, not looking beyond those walls”.
Two of the respondents work for organisations that ‘share’ staff with different agencies in the social and health services. Although this allows these organisations to have an excellent local network and pursue a multi-sectoral approach, it also poses organisational challenges:
“So for example, they work in their home team for 9 hours and then another 9 hours with us. And there are people who get lost in that, they feel they can’t focus enough when they are working here and there. We’re still learning about how best to tackle that, it is a challenge.” – Coordinator of local psycho-social care organisation branch
The locally tailored nature of the work of many community-level organisations thus also has downsides, as it leads to a fragmented landscape which is difficult to navigate and poses human resource challenges. Although this issue predates the COVID-19 pandemic, this fragility was highlighted during the pandemic when the everyday working realities of professionals in the psycho-social care sector were heavily disrupted.