A new report has found that restrictive and contradictory government policies have severe implications for the mental health and well-being of refugees and asylum seekers.

According to research conducted by Mind, the mental healthcare system in the UK is ‘regularly failing refugees and asylum seekers’ by not responding adequately to the numerous barriers that they face when accessing mental health services. The report, A Civilised Society: Mental health provision for refugees and asylum seekers in England and Wales, also finds that the asylum process itself can cause further mental distress, creating an environment which has ‘devastating effects on the mental health, well-being and long term integration prospects of refugees and asylum seekers’.

Inaccessible healthcare provision

Refugees and asylum seekers have often experienced extreme levels of trauma before arriving in the UK. Sexual violence, torture, imprisonment and political persecution are common experiences among many, and new challenges of adapting and integrating into a new and often hostile environment can further endanger an individual’s mental health. While the high levels of mental distress experienced by refugees and asylum seekers in the UK has been well-documented, Mind observes that refugees and asylum seekers have particular difficulties in accessing the necessary mental healthcare provision from both the statutory healthcare and voluntary sectors.

The research highlights that language is one major barrier to the effective provision of mental health services for refugees and asylum seekers. Face-to-face interpreting services are enormously varied in quality and availability, and in areas of the country that are not traditionally diverse, interpreters that cater for a wide range of languages are difficult to source, often resulting in an unwillingness from the service users to engage fully. Furthermore, equality and diversity training in primary care trusts and local health boards has been wholly inadequate in equipping staff with knowledge and expertise about the needs and experiences of refugees and asylum seekers; indeed, it seems some staff are simply unwilling to deal with their mental health concerns. As one GP in Coventry states, ‘There is an attitude that if people are depressed it is to do with their asylum case and it is not their role to deal with it’.

Particularly worrying is the absence of service provision for failed asylum seekers, and the increasing use of detention centres in the asylum process, which currently have no specific guidelines about the provision of mental health services for detainees. While immigration guidelines state that vulnerable people, such as those with serious medical conditions, children, victims of torture and mental ill health, should only be detained in exceptional circumstances, the research shows that ‘in practice many vulnerable people are being detained’, sometimes for an indeterminate amount of time. Post-traumatic stress disorder, depression, anxiety, and threats or attempts of suicide and self-harm are typical concerns among those who have been detained for long periods. Service provision in detention centres is often minimal, with unsuitable facilities and poorly trained staff, meaning that those vulnerable individuals dealing with crisis and trauma are often simply neglected.

Trauma of the refugee experience

Crucially, the report does not shy away from denouncing the severe repercussions that the process of seeking asylum in the UK has on the mental health and well-being of those involved, and as such, highlights what it calls an ‘inherently contradictory’ government policy regarding the mental health of refugees and asylum seekers; it is a system that on the one hand seeks to acknowledge the increased vulnerability of asylum seekers and refugees, while systematising an environment that facilitates mental distress on the other. The lengthy and seemingly arbitrary nature of the process are ‘major causes of stress and insecurity’ among asylum seekers, and people often live in fear of detention and deportation at any time. The policy of dispersal often sends asylum seekers to isolated areas of the country, and fails to acknowledge the importance strong familial and community networks for mental well-being. Asylum seekers receive around £35 a week in income benefits and have been prohibited from working since 2002, leaving many living in poverty and being denied the possibilities of integration that employment can provide. This can have severe negative implications for self-esteem, confidence and mental health, especially for men. These policies simply foster further exclusion and marginalisation and, in turn, can have a devastating effect on mental health.

The inherent contractions in the governments approach to this issue makes it difficult for Mind to make practical recommendations that can tackle the distressing nature of the asylum process head on (with regards to the policy of detaining individuals with existing mental health conditions, for example, it calls only for a ‘review’ of current practice). It does, however, call for increased funding for the development of services that specifically address the needs of refugees, and for the provision of full access to healthcare to all asylum seekers regardless of legal status. And for more effective provision of mental healthcare across primary care trusts and local health boards, Mind is able to be more specific, calling for compulsory training for all relevant staff in areas with refugee populations, increased provision of therapies in multiple languages, and a more flexible and freer pathway to primary and secondary care for refugees and asylum seekers who are too often unsure of what care they are entitled to.

Related links

Download a copy of A Civilised Society: Mental health provision for refugees and asylum seekers in England and Wales here (pdf file, 312kb)

Mind