Aims

The aims of this study are threefold: to undertake a needs assessment of mental health services for asylum seekers and refugees in the London borough of Haringey; to gain a better understanding of their perspective on mental health services; and to estimate the numbers of asylum seekers and refugees who are in need of mental health services in the borough.

Methodology

The research methodology involved two needs assessment frameworks. The epidemiological approach was used to establish the number and proportion of refugee and asylum seeker mental health service users in Haringey. Data from Haringey Council's asylum seekers service were used to estimate numbers receiving support, and the number of mental health consultations requiring interpreters was used as a proxy indicator of asylum seeker and refugee service use. These figures were compared with the total numbers of refugees and asylum seekers in Haringey based on data from the Greater London Authority, the Health of Londoner's Project and previous work conducted in Haringey. The second framework was the corporate approach, which was used to determine need for services from the user perspective. Semi-structured interviews were carried out with ten community representatives, purposively sampled using Haringey Council's contacts. Grounded theory was used to analyse the interviews.

Key findings

The numbers of asylum seekers in Haringey are estimated to be between 20,000 and 35,000 with a best estimate of 31,000. Anecdotal evidence from Haringey's asylum seekers service indicate that one-third to a half of asylum seekers and refugees need substantial support in dealing with their circumstances, that is between 10,000 to 15,000. The numbers of appointments requiring interpreters in a local day care facility for mental health in 2002 were 776 out of 4072 total appointments, suggesting that roughly 19% of sessions are for recent immigrants, who are most likely to be asylum seekers.The user's perspectives are divided into three sections. A selection from each follows. With regards to accessing services, it was found that delays in receiving treatment are incurred due to the time it takes to register with a general practitioner [GP] through primary care trusts [PCTs]. Some clients are reluctant to access mental health services because they feel stigmatised by doing so; this is particularly true for male clients. Regarding predominant mental health problems, it was found that much of the mental ill health is related to the asylum process and isolation as a result of living in an unfamiliar environment and culture. Lack of integration was found to be a potential cause of stress. Regarding issues with services, the respondents revealed a lack of confidence in health services feeling that treatment is often ineffective. Female patients would prefer to be seen by female health professionals.

Conclusions and recommendations

There is a need for trained counsellors from within refugee communities and a greater involvement of community leaders in service planning. Rather that focusing on intensive psychological support, practical solutions to problems must be sought such as engaging the unemployed and support for language and vocational training. Better information regarding numbers of refugees and asylum seekers is needed in order to plan services more effectively. Awareness of issues facing refugees and asylums seekers should be raised with service providers, especially cultural barriers and stereotypes.