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Mental Health Support for Asylum Seekers and Refugees

News and presentations from today's conference focusing on improving Mental Health Support for Asylum Seekers and Refugees including providing Emotional First Aid for Refugees.

The Refugee Perspective
Dr Jane Brake Hunt, Lead Doctor, Medical Advisory Clinic, The Helen Bamber Foundation

Dr Brake Hunt discussed post migration difficulties saying health needs can be worsened because of isolation, loss of status, culture shock, uncertainty, racism, hostility, housing difficulties, poverty, loss of choice and control.

She said; Mental health issues are prevalent and ongoing, they don’t just go away when the refugee arrives in the host country....Physical and psychological problems are deeply entwined – terrible physical injuries, linked to psych problems e.g brain injuries leading to MH problems, malnourishment, infections, injuries from rape – all can have psych consequences.

Pre-event abstract
The hostile environment experienced by refugees and asylum seekers during the present time in the UK will be examined, looking at the legal, social and health issues that this particular vulnerable group experience. We will look particularly at barriers to healthcare as well as other post migration difficulties. We will gain a broad overview of the mental and physical health issues seen in this group and we will look at how the Helen Bamber Foundation works within a model of integrated care to address these myriad issues, concluding that “a robust mental health response to the refugee “crisis” must lie in a combination of clinical vigilance, recognition of vulnerability factors, and, above all, a determination to minimise the aggravating effects of post-migration experiences.”

Delivering psychosocial support to refugees
Dr Nazee Akbari, Executive Director, Barnet Refugee Service
Full power point presentation

Pre-event abstract
Refugees and asylum seekers are the most vulnerable members of society with complex needs. Every year thousands of people arrive in the UK to seek refuge. Escaping persecution, disruptions and wars, the majority of them have experienced torture, trauma and loss. Many have been subjected to violence and rape or witnessed their family and friends being tortured or killed. Leaving their home, belongings and all that they were familiar with behind, they come to the UK facing so many other challenges, the main one being building new lives for themselves in an unfamiliar and sometimes hostile environment with poor linguistic skills and little or no knowledge of their rights and entitlements.
Numerous research studies including Nazee Akbari’s own Doctorate research 
Confirmed that majority of refugees and asylum seekers are suffering from depression and Post Traumatic Stress Disorder due to their past experiences including experiencing torture.  In addition language barriers, financial difficulties and poverty, homelessness or poor accommodation, cultural barriers and lack of employment were the main factors hindering them from rebuilding their lives and achieving their full potential, hence poorer mental health.
As the concept of mental health support might not be known to many refugees the psycho-social activities proved to be the best framework to support this client group with their mental welbeing. 
Psychosocial support usually refers to approaches to support survivors of disasters, violence and other adverse situations by helping the person coping with the situation and by fostering resilience of communities and individuals. Psychosocial support aims at enabling people to restore normal life and empower affected people. The psychosocial framework of the International Federation of Red Cross (IFRC) defines psychosocial support as “a process of facilitating resilience within individuals, families and communities.” By respecting the independence, dignity and coping mechanisms of individuals and communities, psychosocial support promotes the restoration of social cohesion. 
Barnet Refugee Services’ “Integrated Holistic Model of Support” provides mental health support to refugees and asylum seekers and was developed on Abraham Maslow’s five stage model of Hierarchy of Basic Human Needs which aims to acknowledge the whole person and all their physical, social, emotional and spiritual needs. This model promotes self-management by clients themselves as well as peer support. An assessment followed by a “personal Plan” for each individual focuses on prevention and early diagnosis/identification taking into consideration social, physical, spiritual and psychological elements of each client. Majority of support is through psycho-social activities as the best way of tackling mental health issues.

Providing access to healthcare for refugees arriving in the UK, mental health crisis support, and meeting IASC Guidelines
Dr Peter Gough, Doctors of the World UK, Part of the Médecins du Monde Network
Full power point presentation

Pre-event abstract
Doctors of the World UK, part of the international Medecins du Monde network, runs programmes in both the UK and overseas supporting, amongst other groups, vulnerable migrants who struggle to access healthcare. Our east London clinic for vulnerable migrants sees over 1500 people a year. Many of the people we see struggle to access basic health services, despite being entitled to them, something that often has a negative impact on the mental health of people who are already amongst society’s most vulnerable.
 Our international projects use the IASC’s layered intervention pyramid as a guide to service delivery, ensuring that in all situations the most basic MHPSS responses are integrated into our interventions as soon as possible after an emergency, in cooperation with other actors.  People are affected in many different ways by emergencies and often require different kinds of supports hence the need for this layered approach to interventions.
 For the Syrian Vulnerable Persons Resettlement Programme, WHO projections estimate that there would be 60 – 80 people with severe mental health disorders and 300 – 400 with mild to moderate mental health disorders arriving into the UK, and that is not taking into account that the programme purposefully selects those with vulnerabilities in health.  As well as assessing for and treating those that already have mental health needs we need to be incorporating interventions for the prevention of mental health problems later on.
 Providing mental health and psychosocial support for refugees and migrants along the migration route has been necessary but very challenging.  The refugees are in transient both physically and mentally meaning interventions have had to be innovative, holistic and tailored to the needs of the population e.g. MHPSS bolt-ons to all primary healthcare interventions, partnerships with multiple actors, psychological first aid and focused psychosocial for unaccompanied minors.  
 In designing the response to the migrant crisis, many agencies were guilty of overlooking one of the key groups in need of support – namely the staff and volunteers working with refugees. 
For many, volunteers and interpreters particularly, this was their first experience of working in humanitarian programming and in such a crisis scenario and, as a result, there was a high risk of vicarious trauma and burnout. In response, DOTW developed and implemented a programme specifically designed to support the mental wellbeing of caregivers, including trainings and supervisions – both in group work and individually. DOTW worked closely in partnership with a number of local partners to provide support to their staff and volunteers

Delivering psychosocial first aid to refugees: applications from the Red Cross
Kathryn Baldacchinno, Anti Trafficking Manager, British Red Cross
Full power point presentation

Pre-event abstract for delivering psychosocial support to refugees: applications from the Red Cross
Recent years have seen an unprecedented increase in protracted conflicts and the largest  global displacement of people since World War 2.  Refugees fleeing conflicts, trauma and persecution encounter further crises and challenges on their way, including: family separation, the risk of trafficking, lack of control and information, lack of legal advice, disorientation, isolation, mental and physical ill health, homelessness, long term destitution and detention.  The British Red Cross is one of 191 National Societies within the Red Cross and Red Crescent Movement who work together around the world to assist people impacted by migration, including people seeking asylum irrespective of their legal status, whose survival, dignity or mental health is under threat.  The aim is to prevent and reduce the vulnerability of migrants, and protect them against abuses, exploitation and denial of rights.  
In the UK, the British Red Cross has a long tradition of supporting vulnerable refugees and asylum seekers.  We are now the biggest single, non-contracted provider of this support in the UK; reaching out to more than 30,000 people every year in 60 towns and cities.  We help people adjust to life in a number of ways, from providing emergency food to restoring family links and delivering psychosocial support to enable people settle in to new and unfamiliar places.  
This presentation considers the global and UK contexts for refugees and trafficked people, and provides a summary of the services that the Red Cross provide across Europe and the UK.  The British Red Cross has its own psychosocial framework which underpins the way that services are delivered.  The framework, known as CALMER provides a holistic and integrated approach to delivering person centred care.  The way that CALMER is used to respond to refugees and trafficked people will be introduced, along with the resources that the British Red Cross has evolved to supporting people to manage the impact of the work on those who support refugees.

Adapting trauma-focused CBT for refugees and asylum-seekers
Dr Hannah Murray, Research Clinical Psychologist, Oxford Centre for Anxiety Disorders and Trauma, University of Oxford

Pre-event abstract
Refugees and asylum-seekers often experience psychological problems, including post-traumatic stress disorder (PTSD). Trauma-focused psychological therapies are highly effective in treatment of PTSD, but questions remain about whether they can be successfully applied to refugees and asylum-seekers. In this talk, Hannah Murray will draw on research and clinical data to argue that trauma-focused CBT can and should be used to treat PTSD in this population, and to demonstrate adaptations to existing treatment approaches to maximise the effectiveness of psychological therapies. 

Working with asylum seekers and refugees who have experienced trauma
Nsimire Aimee Bisimwa, Specialised Systemic Psychotherapist, The Tavistock & Portman NHS Foundation Trust

Improving Mental Health Support for Asylum Seekers and Refugee Communities
Maurice Wren, Chief Executive, Refugee Council

Developing local services and responses
Marcel Vige, Head of Equality Improvemernt, Mind
Full power point presentation

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