Aims

This report aims to:

• describe the types of mental health problems that are common amongst refugees;

• give background information about causal factors;

• focus on issues of access to healthcare;

• describe mental health issues from the perspective of two refugee communities;

• detail positive strategies to improve the mental health of refugees;

• provide case studies of some services that have been developed. Further, the report seeks to be informative for those who wish to understand mental health and trauma amongst refugees, provide key considerations and effective approaches for those hoping to develop services for refugees with mental health problems and to be influential to policy makers responsible for changing current asylum seeking arrangements.

Methodology

First, a literature review was undertaken about refugees and mental health in the UK. Case studies were used as the means of collecting primary data. In total, 38 interviews took place with different projects providing services to refugees with mental health problems. Of these case studies, 24 are included in Appendix E. The case studies explored the history of what prompted services to be set up, described the range of services and how they differed from and linked to mainstream mental health services and asked those interviewed to describe key issues, the factors which needed to be taken into account, unmet needs and which strategies work best. In order to achieve a user focus on refugees and mental health, four refugee community groups were identified: Bosnian, Latin American, Somali and Zairean [Congolese]. Interviews were conducted with 14 community groups and with other agencies specifically focused on one of these populations. The findings of the report are broken into three subsections: issues, factors and conditions and approaches.

Key Findings

The prevalence of mental health issues amongst refugees is very high and includes a number of extreme manifestations such as self abuse and suicide. The factors that make mental health common amongst refugees may include the fact that refugees had mental health problems in their country of origin, factors associated with political upheaval such as torture or imprisonment, loss of "one's native land" and the process of trying to rebuild a life in a new country. Key themes emerged surrounding issues of refugees and mental health including acculturation, unmet expectations, family values/intergenerational conflict, insecurity/instability, poverty/practical needs and racism. There is a danger that refugees will all be seen as mental health cases or victims due to their experiences. In considering and designing appropriate mental health services for refugees, appropriate "pathways to care" must be considered. Specific factors were discovered to bring about mental well-being for refugees including: contact with family members, social support and links with community groups, strong religious or political ideology and those with proactive, problem-solving styles and those who are active.

Conclusions and recommendations

The report contains numerous recommendations some of which are highlighted here. In terms of the role of refugee organisations and individuals:

• refugees bring skills and qualifications in mental health disciplines from their countries of origin which should be utilised;

• there is a danger in assuming that community resources are adequate to deal with the major problems they face, so investment in primary and secondary heath care is essential;

• it is essential to learn from various communities about perceptions of mental health;

• the image of refugees should be put forth as ‘active survivor’ rather than passive victim. In terms of cultural considerations:

• assessment should be based on familiarity with cultural norms and the language of the person being assessed;

• different refugee communities may experience and express mental ill health in different ways;

• mental health services should learn from and utilise coping mechanisms used in the country of origin.

In terms of outreach, heath awareness and prevention strategies:

• early intervention and community based preventative measures are under-developed;

• outreach is a key tool in refugee communities to make contact with isolated individuals.

Regarding practical support myths and misinformation about mental health will need to be tackled. Poverty and poor housing can impact negatively on mental health and helping to ameliorate these circumstances may improve mental health. Regarding assessment arrangements refugees should automatically be offered an overall health check upon arrival. Children and young people may need separate services. Regarding counselling, a number of factors make counselling an appropriate tool for supporting refugees. Cognitive behavioural therapy is effective because it works with user's own belief systems; tradition and faith healers can also be enlisted to help. Counselling should be conducted in the client's mother tongue. Religion is a key factor in counselling for many refugees; further, it may be helpful to link users into traditional spiritual advisors and rituals where they are available in the UK. In terms of clients occupying themselves, distraction or getting a user involved in activities may help reduce problems in the long run. Finally, there is a critical need for formal links between community organisations and clinical services which may include putting trained workers into community settings and employing refugees with mental health qualifications in NHS settings.