Mental health
Mental health issues in asylum seekers and refugees
There is growing concern about the lack of support for asylum seekers and refugees with mental health problems. Such problems are not always short-lived; some can last a lifetime and some may even have an influence on the children of those affected. Refugees are often people with strong determination to survive, which is why they became refugees. Accessing services early and getting appropriate support is therefore crucial.
When making a mental health assessment it is important to:
- Maintain an open mind over a longer period of assessment
- Check how the asylum seeker or refugee defines a mental health problem from their culture; also find out what the culturally appropriate responses might be to what they have experienced
- Include an assessment of the risk of suicide and any issues of child protection
- Recognise there may be cultural and religious taboos regarding talking about self-harm
- Consider that cultural differences and difficulties with language and communication may increase the possibility of a misdiagnosis of mental illness
- Realise that the questions used to diagnose mental illness may not be reliable when used in translation or cross culturally
- Note that black and minority ethnic (BME) people in the UK have been shown to be disproportionately diagnosed with schizophrenia, sectioned under the Mental Health Act and given high doses of anti-psychotic drugs rather than talking therapy
It is important to consider beliefs about the causes of mental illness. People believe many different things cause mental illness including biological, psychological, social, migration, cultural and religious factors. They may be important cultural points to consider when assessing people from cultural backgrounds different from your own. The World Health Organisation (2003) suggests five rules to assist health professionals to understand how to identify and manage mental illness in refugees. The U.S. Department of Health and Human Services has developed some guidelines for mental health screening during the domestic medical examination for newly arrived refugees, and these can be adapted by local services to develop their own assessment tools.
Resources
Mental Health Services
Mersey care
5 Boroughs Partnership
Family Refugee Support Project
PSS - Asylum Seekers and Refugee Counselling Services
COMPASS
Freedom from Torture
Refugee Mental Health and Wellbeing Portal
General issues in children and young asylum seekers and refugees
Refugee children and young people will have experienced a wide range of stressors and traumatic events prior to their arrival in UK. They include:
- coming under combat fire and bombing
- destruction of homes and schools
- perilous journeys
- sudden disappearances of family members or friends
- loss of family members in violent circumstances
- threat of harm to family members and friends
- refugee camps
- witnessing violence and death
- forced conscription
- physical injury
- arrest, detention or torture
- sexual assault.
This may manifest itself in children in a number of ways, including:
- withdrawal, lack of interest and lethargy
- aggression, anger and poor temper control
- tension and irritability, poor concentration
- repetitive thoughts about traumatic events
- poor appetite, overeating, breathing difficulties, pains and dizziness
- regressions (e.g. return to bedwetting), nightmares and disturbed sleep
- crying, nervousness, fearfulness and proneness to startle
- poor relationships with other children and adults, lack of trust in adults
- clinging, school refusal
- hyperactivity and hyper-alertness.
Under the Children Act 1989, support for separated young people is the responsibility of local authority social services departments, regardless of the child’s immigration status. In Liverpool, a specialist team are responsible for the care and support of these young people. For children and young people who are being looked after by parents or adult carers in asylum seeking or refugee families, any need for services or safeguarding issues should be referred via the City Council Careline service in the normal way.
