Spotlight on: Refugees, People Seeking Asylum and Mental Health

Samantha Powell leads on the work with Refugees and People Seeking Asylum within the Community Development Service and has written an article to explore some of the barriers they face when accessing services.

Since 1999 Leeds has been a main dispersal area for people seeking asylum in the UK. Lots of communities have settled, and continue to be dispersed to Leeds from all over the world. The biggest groups are from Afghanistan, Eritrea, Iran, Somalia, Sudan and Syria.
Due to their experiences people arrive with multiple and complex health needs. This is compounded by the complex UK asylum process as identified by The Royal College of Psychiatrists;
Mental Health
Refugees and people seeking asylum often experience complex mental health issues. Research indicates that this group is 5 times more likely to have mental health needs than the general population and more than 61% will experience serious mental distress.
Challenges for Mental Health Provision
The following are some of the key challenges when designing and delivering mental health provision for people from refugee and asylum seeker backgrounds:

• Clients experience ongoing multiple traumas, as a result of their experiences in their countries of origin and their migration journey. Trauma is heightened by the enduring insecurity created by the asylum process, risk of homelessness, detention and deportation.
• Limited entitlements and great uncertainty over what the future holds whilst awaiting decisions on their immigration status, adding to levels of stress and anxiety.
• Immediate hierarchy of needs e.g. food, accommodation and asylum case take precedence over mental health.
• Mental health intervention without advocacy provision (support around immigration advice, housing, finance, food, employment, benefits, language etc.) is often ineffective.
• People seeking asylum live on less than £5.30 per day (not always a cash payment) and therefore not able to fully participate in meaningful health and social activities e.g. difficulty attending appointments.
• Due to confusion of entitlement, mistrust of authority, fear of being charged, reported or detained some refugees and asylum seekers may wait until their condition reaches crisis levels before seeking help.
• Risk of crisis is increased for refugees and in particular asylum seekers due to reduced accessibility to healthcare and early intervention.
• The relationship between client and therapist is impeded by working through interpreters. In addition the challenge is securing an interpreter with the correct language and dialect.
• It is more difficult to achieve recovery and maintain good mental health with the lack of social connections and support networks and higher levels of social isolation.
• Recovery focused outcomes can be less effective for people seeking asylum. It is a more realistic to focus on stabilisation and building resilience as a more appropriate and effective intervention.
• Multiple assessments whereby clients are repeating and reliving a traumatic journey can be re-traumatising. This compounds client’s distressed and inappropriate referrals diminish confidence in mental health services ability to provide support.
• A lack of collaborative working within health and advocacy services can result in not meeting client needs, a duplication of work and confusion for clients.

Barriers Refugees and Asylum Seekers Experience
When accessing health care, barriers for refugees and people seeking asylum include:

• Lack knowledge of the system thus increasing anxiety when visiting services.
• Lack knowledge of their rights.
• Lack of support networks.
• Perceived effect of immigration status on quality of care provided.
• Lack knowledge of local areas therefore signposting can be ineffective.
• Lack of previous health records.
• Lack of documentation.
• Difficulty registering with GPs.
• Language and access to interpreters.
• Communication methods do not always meet the needs e.g. postal, automated telephone systems, making appointments.
• Mental health difficulties are not always recognised within different cultures.
• Stigma and discrimination – within communities about mental health and public perceptions of refugees and asylum seekers.
• Fear of negative impact on asylum case
• Fear of authorities and lack of trust of services.
• Fear of cost for healthcare.
• The above barriers result in clients feeling their opportunities to influence service is impeded.

Overcoming barriers

• When people seeking asylum arrive in Leeds they are, displaced, confused and have no local connections. It is essential for our local services to bridge the gap by understanding their needs and accommodate accordingly.
• Making GP registration easier and supportive.
• Inclusive healthcare practices where staff make allowances for language barriers and lack of understanding of the healthcare system.
• A “welcome to the practice” briefing with new patients especially in GP surgeries explaining procedures and ways of maximising appointments (with an interpreter if required) will pay dividends in helping both the patient and the practice understand procedures and needs.
• Supporting refugees and asylum seekers to know their rights and how to raise concerns/complaints.
• Gaining access to prevention and early intervention mental health support.
• Sector would benefit from services that can provide wrap around integrated therapeutic and advocacy care.
• Using a multi-intervention approach, e.g. working in partnership or a dedicated case worker – combining therapeutic care with advocacy support to case manage vulnerable clients.
• Longer term therapeutic care may be required to build trust and overcome language, cultural and other barriers.
• Access to longer appointments when using interpreters demonstrates good practice.
• Booking a consistent interpreter would enable the trust building process and support therapeutic interventions.
• Self management groups work well for some clients and can provide some ground work for stabilisation.
• It is particularly important for this client group that both physical and mental health needs are considered and jointly addressed.
• Service provider’s actively increasing knowledge and understanding of working effectively with refugees and people seeking asylum, their needs and how to overcome barriers.
• Creating a link to Refugees and Asylum Seekers Mental Health Network for intelligence, working relationships, training and support. Contact: cds@touchstonesupport.org.uk

Services – Click on link for website:
British Red Cross Leeds Office
Leeds Survivor Led Crisis Service (Dial House)
Dial House at Touchstone
Freedom From Torture
Leeds Asylum Seekers’ Support Network (LASSN)
Leeds City of Sanctuary
Leeds Refugee forum
Meeting Point Leeds
Positive Action for Refugees and Asylum Seekers (PAFRAS)
Solace
York Street Health Practice
Refugee Education Training Advice Service
Resources:
A blog providing information about refugees and asylum seekers in Leeds –   https://leedsmultiagency.wordpress.com/
Coventry City of Sanctuary have provided resources following a project in partnership with NHS Coventry to make GP surgeries more welcoming to refugees and other newcomers – http://coventry.cityofsanctuary.org/2010/03/04/welcome-in-practice