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Legal Conditions for Refugees’ Mental Health: Implications of Legislative Changes in Programs for Newly Arrived Refugees in Sweden

Department of Health Sciences, The Swedish Red Cross University College, Hälsovägen 11, 141 57 Huddinge, Sweden
Historical and Contemporary Studies, Södertörn University, 141 89 Huddinge, Sweden
Author to whom correspondence should be addressed.
Challenges 2023, 14(3), 32;
Submission received: 8 February 2023 / Revised: 9 June 2023 / Accepted: 11 July 2023 / Published: 14 July 2023


As the number of refugees in the world is increasing and it is known that social inequality negatively impacts mental health, it is important to study integration policies, such as labour market measures. In this article, the strategic interventions of the Swedish Public Employment Service are analysed to determine how the agency’s management handled and implemented the legal changes in the new support document for its case workers. The focus is on the effects of the changes in the legal text that transferred the responsibility for establishment initiatives for newly arrived migrants to the agency and, as a result, changed the conditions for newly arrived refugees’ mental health in the new establishment programme. Eight people representing different management functions at the agency were interviewed. The results show that the intention in the new programme to view newly arrived refugees in the same way as all other unemployed people, rather than as a special category, has meant that less attention is paid to the refugees’ mental health, and the opportunities for the agency’s street-level bureaucrats to help clients have decreased. In the face of predicted growing numbers of people having to abandon their homes due to conflicts and climate changes, governmental strategies such as these needs to be revisited in order for societies worldwide to be better prepared for that challenge.

1. Introduction

According to the World Health Organisation (WHO), risk factors for mental health problems largely stem from social inequality [1]. Refugees are a particularly vulnerable sub-group in this regard, and therefore it is pivotal to evaluate integration policies with regard to refugees’ mental health [2,3,4,5]. With 103 million people forcibly displaced, and 1.5 million children born to refugees between 2018 and 2021 alone, it is undoubtably one of the major challenges of our time [6]. Migration movements are driven by multiple factors and involve global political processes [7], although they also drive political changes and call for adaptations and the scrutiny of laws and regulations. It is therefore essential to study policies relating to migration and integration, such as labour market measures.
This article revolves around how the central management of the Swedish Public Employment Service dealt with the change when their mandate from the government was altered and their responsibilities were extended in 2018. The Act that was part of a governmental policy package announced in 2015 and valid up to 19 July 2021 and meant fewer grounds for protection, the granting of temporary residence permits as a general rule rather than permanent ones, limited opportunities for family reunification and stricter maintenance requirements for family reunification [8,9,10]. The temporary Act generally implies a sharpening of policies, especially those regarding border controls, legal entry and stay. Despite this, the ambitions of the integration policies are still high, even though they are strongly focused on the labour market and finding employment, as previously indicated.
When studying the mental health of refugees and asylum seekers, it is important to consider the legal texts and the support documents that interpret them to see how and whether they affect the ways in which bureaucrats can help to strengthen and support integration processes and if they make it difficult for refugees to access the benefits they are entitled to. This article discusses the relation between integration policies, social participation and mental health and explores how the relations between them are articulated by the people involved in the writing of the administrator support document that is used by case workers at the Swedish Public Employment Service. What this support document is and what it is supposed to do are discussed in full in the results section. To summarise, the document can be seen as a way of communicating between the different parts of the organisation, first and foremost between the management and the case officers to try to ensure the equal treatment of all job seekers at one of the largest government agencies in Sweden.
This article is the second of four interlinked studies. The first article—an analysis of the administrator support document—shows that changes in the legal text, and hence the support document, mean that less attention is given to the mental health and social participation of refugees in the new establishment programme [11]. The research project as a whole aims to understand how the amendment of the laws regulating residence permits and the conditions for social participation affect the mental health of newly arrived refugees (Act 2017: 584 replacing Act 2010: 197 and resulting in Ordinance 2017: 820) [12,13,14]. The new Act implied an extended mandate of the Swedish Public Employment Service motivated by a politically articulated need for accelerated efforts around labour market integration. Correspondingly, they have also changed the integrational efforts of the government to a more limited focus on integration as entry into the labour market, which is often alleged to be a sign of accomplished establishment in a new country [15]. Newly arrived refugees are usually covered by the Establishment Initiatives Act for a period of two years, which entitles them to professional support for learning Swedish, finding employment and managing their own livelihoods [8].
Newly arrived refugees, as well as other groups such as asylum seekers, have been pointed out as an especially vulnerable category, both in terms of health and social conditions [16,17]. Social capital and the requirement of a network (not least of potential employers) have always been regarded as factors related to finding employment, and there are indications this might be especially important in Sweden [18]. The understanding of social participation in this article derives from a model of different aspects of the concept resulting from a scoping review undertaken within the same research platform as the current study. This was an attempt to define “the concept of social participation as: access to, and active involvement in key social dimensions within the host societies, including not only the host society’s formal and established organizations and institutions, but also in social settings constructed on the basis of refugee communities’ own shared characteristics, preferences, and needs” [19].
Research on refugee health mainly concerns mental health and is often focused on the effects of flight and forced migration [20,21,22,23]. In comparison, efforts to understand factors affecting mental health and the socioeconomic integration of refugees in the host country are less prominent in the research literature [19]. Regarding employment, research in Sweden has shown that when refugee trauma results in mental illness it affects cognitive functions, thereby making it harder to learn the language and retain employment [24]. Newly arrived refugees can experience social exclusion due to not being able to speak the host society’s language, not having a job, or by experiencing discrimination and a lack of access to important social resources, which in turn implies an increased risk of mental ill health and distress [24,25]. However, in the Swedish context, there are also studies, albeit on unaccompanied minors, showing how schools are important arenas for young refugees’ development of resilience [26].
Many refugees experience abuse and ill treatment during their journey to a safe haven [27]. Building trust between societal organisations and refugees is therefore important, especially for health institutions [28,29] and is something that becomes apparent in the health-seeking behaviour of the group [30]. Mistrust of the host society is a common feature amongst refugees, whereas trust in God and religious beliefs often help them to become active survivors rather than passive victims [31]. Apart from that, international research from diverging settings such as refugee camps in Jordan and general society in Canada has shown that participation in social networks and activities reduces mental illness among refugees [32,33]. Further, social participation in communities consisting of individuals with the same ethnic background (in the host society and/or in transnational networks) and intergroup activities with groups of migrants have been found to improve mental health, as well as integration into the society and labour market of the host country [34,35,36,37,38,39,40].
In this article, health is not only considered as the absence of disease, but also as a relationship between the individual and society. As the lack of social participation has been shown to contribute to ill health and psychosocial stress due to social isolation and exclusion [41], it is vital to look at the role of societal arenas where social participation is seen to enhance resilience, re-establish social lives and act as a protective factor against poor mental health outcomes [19]. One such dimension is government funded introduction programmes, which when aptly designed have proved crucial for refugees in their introduction to the labour market in Canada, Italy and the Netherlands [42,43]. Reception programmes are also gateways to societal systems, especially language courses [36], and create benefits for refugees in the labour market in the long term [44].
This study departs from the idea that the temporary law and the changes it brings will affect the social participation and mental health of refugees and asylum seekers. Here, we analyse the strategic interventions of a central actor in the Swedish labour market—the Swedish Public Employment Service—to determine how the agency’s management handled and implemented these legal changes. In conclusion, the implications of this study in a global context will be discussed.

2. Materials and M