‘Unheard voices’: listening to Refugees and Asylum seekers in the planning and delivery of mental health service provision in London.

‘Unheard voices’: listening to Refugees and Asylum seekers in the planning and delivery of mental health service provision in London. A research audit on mental health needs and mental health provision for refugees and asylum seekers undertaken for the Commission for Public Patient Involvement on Health (CPPIH). Researched and written by David Palmer & Kim Ward For information contact: david@mrcf.org.uk London Region Ground Floor 163 Eversholt Street LONDON NW1 1BU T: 0207 788 4900 F: 0207 788 4988 1 Contents List of tables 3 Acknowledgements 4 One Introduction 5 Context: Key concepts and issues 10 Mental health of refugees and asylum seekers 17 Two Research Methodology 22 Findings 27 Three Good Practice Guide Emerging themes and priorities 46 Partnership working 47 Working holistically 50 Accessibility and Engagement 55 Cultural sensitivity and understanding 59 Care provision 64 Evaluation, consultation and planning/funding future services 66 SUPPLEMENTARY SECTION: Mental health provision for asylum seekers detained 68 in Immigration Detention Centres. Appendices: 1: Interviewee information 2: Questionnaires/topic guides 3: Information on Advocacy 4: Alternative treatment options 5: Consultation event Bibliography 2 List of Tables: Table 1: Health Entitlements for Refugees and Asylum seekers 13-14 Table 2: Service users: demographic data 27 Table 3: Service users: range of difficulties experienced 28 Table 4: Service providers: organisation data 36 3 ACKNOWLEDGEMENTS The research for and writing of this study was undertaken by David Palmer with Kim Ward. The project was very much assisted by the advice of a steering committee consisting of: Rosie Newbigging – London Region CPPIH Mike Loosley - South London and Maudsley MH PPIF Maurice Hoffman - Central and North West London MH PPIF Judy Lever - Hillingdon PPIF Doplih Burkens and David Hindle - Barnet, Haringey and Enfield MH PPIF Jane Barratt, Ruth Appleton and Karen Clark - Camden and Islington MH PPIF Nick Nalladorai - South West London and St George`s MH PPIF In addition to some of the above, the following people also contributed to the consultation: Maureen Brewster - Voluntary Action Camden Nursel Tas – Derman Puck de Raadt – the bail Circle/Churches Commission for Racial Justice We would like to give thanks to the following organisations who participated in the study: Derman Ethiopian Health Support Association Health Support Team, Lisson Grove Health Centre Iranian Association Kurdish Association Migrant Refugee Community Forum MIND in Harrow Refugee Support Service Traumatic Stress Clinic Vietnamese Mental Health Service A special thank you to the St. Pancras Refugee Centre for assisting with the study and for allowing access to service users. Thank you to all the service users who participated in this research, for supporting the project and for sharing so much information. Confidentiality has been maintained. A big thank you to Deborah Haylett and Finn, Ermias Alemu, Sasha Rozansky and Mahi Salih and Ben Gatty of Islington Metamporhis and Paul Burns of Mind in Harrow for advice, support and so much patience. If wish to make any comments on this report, please contact david@mrcf.org.uk 4 PART 1: INTRODUCTION Research into the mental health needs of asylum seekers and refugees has shown that they are likely to experience poorer mental health than native populations1 and are amongst the most vulnerable and socially excluded people in our society.2 In terms of known factors that might predispose an individual to develop mental health issues, including serious and enduring problems, refugees are a group with high indicators of mental health need. Refugees are likely to have experienced war, persecution or inter-communal conflict, resulting in multiple losses including: family, friends, home, status and income.3 Reports have also highlighted the continued difficulties this group may experience in exile.4 The Department of Health has identified Post Traumatic Stress Disorder (PTSD) as the most common problem amongst asylum seekers and refugees and has also reported that because of these mental health issues the risk of suicide amongst asylum seekers and refugees is raised in the long term.4 However, PTSD is controversial and has been criticised for not taking in to account the ongoing difficulties of individuals; for focusing too much on a limited range of reactions; for undermining traditional coping strategies; and for ignoring the role of culture in shaping meaning.5 Whilst recognizing the limitations of PTSD as a diagnostic category it is not the aim of this guide to specifically add to this discourse.6 Researching the mental health needs of Refugees and Asylum seekers In recent years interest in the provision of mental health services for refugees and asylum seekers in the UK has increased.7 Previous research conducted for the Commission for Public, Patient Involvement in Health (CPPIH) demonstrated the lack of service provision 1 Tribe, R. (2002) Mental health of refugees and asylum-seekers. Advances in Psychiatric Treatment, 8, 240–247. Burnett, A. and Peel, M. (2001) Asylum seekers and refugees in Britain. Health needs of asylum seekers and refugees. BMJ, 322:544-547 2 Ibid. 3 Warfa, N. and Bhui, K.(2003) Refugees and mental health care. The medicine Publishing Company Ltd. pp26-28 4 Burnett, A. and Peel, M. (2001) Asylum seekers and refugees in Britain. Health needs of asylum seekers and refugees. BMJ, 322:544-547 Burnett A, and Peel, M. (2001). Asylum seekers and refugees in Britain: The health needs of survivors of torture and organized violence. BMJ, 332: 606-609 Carey-Wood, J., Duke, J., Kar,V. and Marshall.T. (1995). The settlement of refugees in Britain. Home Office Research Study 141. London: HMSO Books. 5 Burnett A and Thompson K. (2005) Enhancing the psychosocial well-being of asylum seekers and refugees. In Barrett K, George B (eds). Race, Culture, Psychology and Law. California: Sage Publications. 6 Eastmond, M. (1998) Nationalist discourses and the construction of difference: Bosnian Muslim refugees in Sweden. Journal of Refugee Studies, 11, 161–181. Gorst-Unsworth, C. and Goldenberg, E. (1998) Psychological sequelae of torture and organised violence suffered by refugees from Iraq. British Journal of Psychiatry, 172, 90–94. Kirmayer, L. and Young, A. (1998) Culture and somatization: clinical, epidemiological and ethnographic perspectives. Psychosomatic Medicine, 60, 420–429. Summerfield, D. (1999) A critique of seven assumptions behind psychological trauma programmes in war-affected areas. Social Science and Medicine, 48, 1449–1462. Summerfield, D. (2001) The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category. BMJ, 322, 95–98. Tribe, R. (2002) Mental health of refugees and asylum-seekers. Advances in Psychiatric Treatment, 8, 240–247. 7 Burnett, A. and Peel, M. (2001) Asylum seekers and refugees in Britain. Health needs of asylum seekers and refugees. BMJ, 322:544-547 Burnett A, and Peel, M. (2001). Asylum seekers and refugees in Britain: The health needs of survivors of torture and organized violence. BMJ, 332: 606-609 Burnett A and Thompson K. Enhancing the psychosocial well-being of asylum seekers and refugees. In Barrett K, George B (eds). Race, Culture, Psychology and Law. California: Sage Publications. 5 ... - tailieumienphi.vn