Improving Mental Health Support for Asylum Seekers and Refugees
News and presentations from today’s conference developed by the Tavistock and Portman NHS Foundation Trust in collaboration with MIND, the Refugee Council and Médecins du Monde, and chaired by Guglielmo Schinina, Head of Mental Health, The International Organization for Migration.
The Refugee Perspective
Paul Cilia La Corte, Senior Psychotherapist and Coordinator, The Rimba Therapeutic Project
The Refugee Council Therapeutic Services offers a holistic, person-centred framework to asylum seeking and refugee people presenting with mental wellbeing needs. We apply a psychosocial approach inspired by a range of therapeutic perspectives to respond to the multiple needs of this client group. Our primary preoccupation is to reduce distress and enhance wellbeing. Our service is culture and gender sensitive.
Improving Mental Health Support for Asylum Seekers and Refugee Communities
Maurice Wren, Chief Executive, Refugee Council
The Government’s approach to refugee resettlement remains resolutely ‘utilitarian’, with its narrow focus on providing housing and basic subsistence only. For the four out of five refugees who are not on resettlement programmes, Government policy on integration is equally blinkered, with inadequate provision for ESOL, employment, education and help with mental wellbeing. The underlying assumption is that key mainstream services – health, welfare, education - are equipped and able to respond appropriately to refugees’ needs.
The failure to appreciate the effect on asylum seekers and refugees of trauma, whether the result of experiences in their home countries, while on their journeys to exile or in the countries where they have sought protection and safety, also has a major, but unrecognised, impact on the functioning of the asylum system, and the 28 day move-on deadline for newly granted refugees militates against effective integration by making destitution a likely outcome, thereby exacerbating refugees’ uncertainty and anxiety.
Our response must be to develop the kind of specialist provision that we would wish to see mainstreamed and use the evidence generated by those services to illustrate and demonstrate to Government that in the case of mental health support, the provision of appropriate and accessible services as an integral element of the asylum and refugee system in the UK is in its interest as well as that of refugees.
The Refugee Council seeks to work with Government as both a specialist therapeutic service provider – working therapeutically with separated children, women seeking asylum who have survived sexual violence, single men in the asylum system – and as an advocate of refugee rights, using our experience as the evidence base. We are consciously using the high profile Syrian Resettlement Programme as a means of increasing the Home Office’s understanding and appreciation of the value of developing pathways to early, specialist, provision, with the aim of convincing Government that improving access to mental health support must be an integral element of a well functioning refugee integration strategy.
Developing local services and responses
Karen Mellanby, Director of Networks & Communities, MIND
The presentation is an opportunity to share learning from Mind’s work, introduce guidance and tools and support people to use these tools to ensure e effective prioritisation, needs assessment and service provision for vulnerable migrants.
Mind has a longstanding history of focusing on the mental health needs of vulnerable migrants, working in partnership with a number of organisations for over 10 years. Throughout this period we have undertaken work with a focus on the commissioning process, producing guidance to help local decision makers to commission better services for local vulnerable migrant communities. We have piloted meaningful engagement of both local communities as well as Clinical Commissioning Groups to better understand how they can improve their understanding of local needs and co-produce effective responses building on community assets.
The aims of this work are to ensure:
· Appropriate and accessible mental health services are available for all migrants
· Policy-makers, commissioners and service providers are aware of the key issues affecting migrants and barriers to accessing mental health care.
· Migrant communities inform needs assessments and service design and delivery.
· Health and social care professionals have the skills and awareness to effectively support vulnerable migrants
The key learning from this work is:
· Take a multi-agency partnership approach
· Capture need in Joint Service Needs Assessments and Joint Health and Wellbeing Strategies
· Review new and existing services
· Build capacity in migrant communities to engage on needs, service specifications, monitoring and provision of services
· Embed equality impact assessments at every stage of the process
A summary of key points:
· Need to develop better awareness and understanding of the challenges that vulnerable migrants face
· Need to understand that working with vulnerable migrants is core business (equality duty)
· Need to provide opportunities to engage with communities
· Need to develop a culturally competent workforce with the skills and knowledge to build tailored approaches to supporting people
· Need to fund services that effectively meet the needs of vulnerable migrants (including peer support)
Delivering psychosocial support to refugees
Dr Nazee Akbari, Executive Director, Barnet Refugee Service
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.
Delivering psychosocial support to refugees: applications from the Red Cross
Kathryn Baldacchinno, Anti TraffickingManager, British 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 190 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 13,000 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 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 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.
By the end of the session, participants will have had the opportunity to develop:
• An appreciation of some of the UK and global contexts currently facing refugees
• An awareness of some of the services the Red Cross delivers in Europe and the UK
• An understanding of the way that CALMER is used to deliver psychosocial support to refugees
• An awareness of some of the organisational systems that can be useful to support people delivering services to refugees.
Providing access to healthcare for refugees arriving in the UK, mental health crisis support, and meeting IASC Guidelines
Peter Gough, Doctors of the World UK, Part of the Médecins du Monde Network
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.
Working with asylum seekers and refugees who have experienced trauma
David Amias, Consultant Systemic Psychotherapist – Refugee Service, The Tavistock & Portman NHS Foundation Trust
The recent upsurge of refugees and migrants seeking asylum in Europe, having been driven from their homes by political unrest, present manifold challenges for professionals and front-line workers. How can we help to build resilience for professionals and volunteers involved in this work? What skills, approaches and tools may be appropriate for providing services to people feeling intense insecurity with somatic, physical and psychological symptoms, torn away from their roots and supportive networks?
The Tavistock Refugee service is the only dedicated CAMHS for refugees and asylum seekers in the country, and the home of the first and longest running course in the country to offer masters level training in refugee care which attracts students from all around the world. In the light of heightened public concern about the plight of migrants and asylum seekers the service has received a considerable number of requests within the last three months to help train front–line workers in voluntary and statutory contexts in working with Unaccompanied and Separated Children (UASC).
This presentation with describe the clinical work and training of the team which offers a range of psychotherapeutic individual, family and group interventions drawing upon systemic, narrative and psychodynamic approaches. This includes the work of an Emotional Well-Being group for young people which incorporates psychosocial techniques as well as psychoeducational approaches to address physical symptoms of trauma.
Supporting Refugees & Asylum Seekers Who Hear Voices
Eve Mundy, Senior Development Worker, Mind in Camden
This presentation will explore the Hearing Voices Network ethos and approach to understanding voice-hearing, as well as other 'unusual' sensory experiences or beliefs. The relationship between trauma and voices, visions, and other 'unusual' sensory experiences or beliefs, will be discussed, along with the role of Mind in Camden's Voice Collective project in providing peer support to young people in distress. This presentation will highlight some of our achievements so far, including developing a Hearing Voices peer support group at Heathrow Immigration Removal Centre. It will also explore the specific challenges of setting up peer support groups for young refugees and asylum seekers, including the complexity of the trauma experienced by these young people, and the diverse cultural frameworks in which these experiences can be understood. It will consider how peer support spaces, alongside other forms of support, may help to provide safety, foster empowerment, and promote hope and recovery for young refugees and asylum seekers who hear voices.
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
High rates of Post-Traumatic Stress Disorder are found in populations of refugees and asylum-seekers. There is a strong evidence base for treatments developed to treat PTSD, such as Cognitive Therapy and EMDR. However, these therapies have primarily been developed and evaluated in westernised countries and research samples frequently exclude refugees and asylum-seekers. In this talk, the relevance of existing treatment models will be discussed in relation to refugee populations. It will be argued that trauma-focused treatments can and should still be provided to refugees and asylum-seekers suffering from PTSD, but that certain adaptations are required to account for problems such as social difficulties and multiple traumatisation. The adapted approach will be illustrated using a case example.
Future events of interest:
Early Intervention for Children and Young Adults: 2017 CAMHS National Summit
Dual Diagnosis: Implementing the NICE Guidance
Safeguarding Children: Level 3 Mandatory Safeguarding Training in Accordance with the Intercollegiate Guidelines
IAPT: Improving Psychological Therapies for Older People
Self Neglect and Adult Safeguarding
Towards Zero Suicide: Preventing Suicide, Saving Lives
22 May 2017