A new report has been published by the Commission for Patient and Public Involvement in Health (CPPIH) on the provision of mental health services to asylum seekers and refugees in London, the most ‘vulnerable and socially excluded people in our society’.
The research for the report, Unheard Voices- listening to the views of asylum seekers and refugees, was carried out on behalf of the network of eleven Mental Health Patient and Public Involvement Forums in London and is based on interviews with thirty-one asylum seekers and refugees in London.
Unheard Voices, written by David Palmer (Migrant Refugee Community Forum) and Kim Ward (ICAR), finds that previous research into the mental health needs of asylum seekers and refugees has shown that they are likely to experience poorer mental health than native populations. All those interviewed ‘reported that factors such as housing and poverty and adverse social circumstances played a major role in their mental health problems.’ Destitution is a very real problem faced by many asylum seekers and the authors found that ‘economic deprivation can impact negatively on mental health’.
Anxiety about legal status is a key issue in mental ill health. ‘The experience of uncertainty means that for many months and sometimes year’s individuals live with a fear that they may be returned to their country of origin. Daily and persistent anxiety over the possibility of deportation and dealing with the complex legislation and decision-making process has resulted in an increased level of mental distress and demoralisation for many of those interviewed. This inevitably impacts on integration, mental well-being and emotional and behavioural responses. The challenge of dealing with the monolithic institution of the immigration system can encourage feelings of helplessness and despair most likely due to a lack of control over the situation.’
Furthermore, research around the health of detainees in removal centres found that healthcare in most centres was provided by private agencies under contract to the Home Office and was therefore not provided by the NHS or regulated by the Healthcare Commission. The authors found ‘a failure by health care staff to investigate that a detainee has been tortured; failure by IDC [immigration detention centre] staff to investigate and appropriately treat or refer a detainee with significant medical problems; detainees being obstructed in accessing a doctor of their choice.’
The report makes numerous recommendations around the themes of: Partnership working; Accessibility and engagement; Cultural sensitivity and understanding; Care provision; Evaluation, consultation and planning/funding future services, which include:
- That the role of refugees and asylum seekers should be recognised and supported in the development and implementation of mental healthcare;
- More long-term support should be given to voluntary projects;
- Housing providers, including NASS, must establish a regular method of inspecting accommodation, emergency, temporary and long-term to ensure that accommodation providers are meeting adequate standards in terms of amenities and environmental health standards;
- Refugees and asylum seekers with a disability should be allocated to suitable and, where appropriate, supported accommodation;
- Financial assistance for those who are destitute or outside immigration rules should be given;
- The immigration process to be improved so claims are decided equitably and as fast as possible, therefore mitigating against anxiety, fear, demoralisation and destitution;
- Permission to work immediately should be granted to those who have submitted an application for asylum;
- The responsibility for medical care of detainees should be transferred from the Home Office to the NHS;
- Home Office policies about vulnerable individuals, (e.g. children, torture survivors and people with severe mental health problems) that they should not ‘ordinarily be detained’, should be rigorously complied with.