Working Group for Mental Health and Forced Migration

Chair

Professor Cornelius Katona MD FRCPsych

Cornelius Katona is Honorary Medical and Research Director of the Helen Bamber Foundation, a human rights charity working with asylum seekers and refugees. He is the RCPsych lead on refugee and asylum mental health.

Members

Dr Piyal Sen

Consultant Forensic Psychiatrist and Medical Director, Elysium Healthcare, Honorary Professor, Brunel University and Visiting Academic, the Institute of Psychiatry, Psychology and Neuroscience, King’s College, London. He has a special clinical, research and medico-legal interest in immigration detention and foreign national prisoners. He is the chair of the Special Committee on Human Rights of RCPsych. He delivers talks and workshops on issues related to asylum and contributes actively to policy responses and position statements developed by the group.

Ana Asatiani

Ana is a co-partner of A&M Consultancy which is a partnership of two consultants with lived experience of the UK asylum system. She is a researcher, scholar, campaigner, advocate, evaluator, communicator, and writer with over six years of professional and volunteering experience. She has lived experience of navigating the UK’s asylum system. She has an extensive focus on the meaningful involvement of people with lived experience in campaigns and advocacy, co- production, organisational strategy, grassroots/community level organising, campaigning, and movement building.

Mishka Pillay

Mishka is a co-partner of A&M Consultancy which is a partnership of two consultants with lived experience of the UK’s asylum system. He is an advocate, researcher, evaluator, and writer with a focus on refugee rights, immigration detention, and deportation systems in the UK. Mishka has first-hand experience of navigating the UK's immigration and asylum system and has a particular focus and expertise in the meaningful involvement of people with lived experience in campaigns and advocacy, co-production and co-delivery.

Dr Jane Mounty FRCPsych

Consultant Psychiatrist specialising in Rehabilitation and Systemic Therapy. She has worked with Medical Justice and the Helen Bamber Foundation preparing medico-legal reports since 2011. She has been a member of the RCPsych working group since 2013. She is also conference organiser for the volunteering and international psychiatry special interest group (VIPSIG). She has interests in anthropology, group therapy and the therapeutic effects of storytelling and the recording of oral histories.

Dr Rukyya Hassan

Consultant General Adult Psychiatrist working in the North West. She has an interest in the mental health of minority and marginalised groups, including asylum seekers and refugees. She also works as a volunteer medico-legal report writer for Freedom From Torture.

Dr Sarah Majid

Consultant Psychiatrist, Manager of Tavistock Immigration Legal Service

Dr Susannah Fairweather

Consultant Child and Adolescent Psychiatrist working at The Tavistock and Portman NHS Foundation Trust. She works in the Child and Family Refugee Team and is the manager and Clinical Lead for the Returning Families Unit, a national specialist unit for British national families returning from the Syrian and Iraq conflict. She regularly acts as an Expert Witness for the Asylum and Immigration Tribunals and since 2015 has been particularly involved in Family Reunification cases of minors across Europe under Dublin III Regulation.

Dr Lauren Waterman

Consultant psychiatrist at Camden and Islington NHS Foundation Trust. She is currently doing research into the mental health consequences of immigration detention, the healthcare and safeguarding processes within UK immigration detention centres, and the continuity of care for migrants after release from UK detention centres. She has written medicolegal reports for asylum seekers and currently leads the medical service at the Asylum Seeker Drop-In charity project in North London.

Dr Lucia Chaplin

Psychiatry Higher Trainee at Cambridgeshire and Peterborough NHS Foundation Trust. She completed an MA in Refugee and Forced Migration Studies in 2019. She has been secretary of the group since May 2020 and has been involved in organising the group’s study days, as well as the writing of a College Report on the Nationality and Borders Act. She co-facilitates the Refugee and Asylum Mental Health Network. 

Dr Hugh Grant-Peterkin

Consultant Psychiatrist currently working in Older Adult Liaison Psychiatry in East London. He has previously been a trustee of Medical Justice and previously a trustee of Medact. He has been a member of the RCPsych working group since its inception.

Dr Sophie Quarshie

Consultant in Liaison Psychiatry, in the North East of England. She has been volunteering for Medical Justice for several years.

Dr Ramy Daoud

Consultant Psychiatrist and Psychotherapist Plymouth Rehabilitation Service & Asylum Seeker Refugee (ASR) Service.

Dr Grace Crowley

Professor Rohit Shankar

Dr Nidhita Singh

Dr Rajiv Reddy

The working group meets online, approximately four times a year. 

At the meetings, we discuss any ongoing work and plans for future work. The meetings are chaired by Professor Katona and minuted by Dr Chaplin.

Usually, the work that is planned is then carried out by individuals and small groups between meetings. The individuals and small groups report back at the next meeting, allowing further actions to be planned.

Members of the working group regularly contribute to academic, educational and professional conferences and meetings, helping to disseminate and improve knowledge, skills and attitudes regarding the assessment and management of people seeking asylum and refugees. For example, apart from symposia and master-classes organised by the Royal College, members have contributed to meetings of the BMA and Amnesty International.

The group also arranges annual Study Days which are publicised by the Royal College.

College Reports, Position Statements, and Consultations

• The Position Paper on Capacity in Immigration Detention (PDF) was published in 2017, and members were involved in developing this statement of concern about detained asylum seekers who lack relevant decision making capacity, alongside consultant with legal experts.
• Members of the Working Group submitted detailed written responses to the Shaw Review on Immigration Detention of Vulnerable People (PDF) published in 2015. And to the follow-up report in 2018, following which members provided input to the Home Office convened group tasked with reviewing progress with particular reference to the Home Office ‘Adults At Risk’ policy and the ‘Rule 35’ processes for identifying vulnerable detainees:
• The Working Group contributed to the College’s consultation response to the Government Legal Department regarding the feasibility and problems associated with expert reports based on psychiatric assessments by video link, in 2019.
• The Working Group made a submission and recommendations to the Independent Review of the Mental Health Act regarding the use of the Mental Health Act in the Immigration Removal Centre context in 2019.
• In June 2019, the Working Group submitted a detailed response to the Consultation on Removal Centre Rules which addressed the rules governing the operation of Immigration Removal Centres
• Members of the group drafted the mental health standards (including one addressing capacity issues) that form part of the Faculty of Forensic and Legal Medicine (FFLM) care standards for the care of victims of torture in detention settings (PDF) in 2019.
• The Working Group prepared a revision of the College Position Statement on detention of people with mental disorders in Immigration Removal Centres (PDF), informed by the College’s submission to the two Shaw reviews on the immigration detention of vulnerable people and the Home Offices’ ‘Adults At Risk’ policy:
• An audit tool for assessing the quality of such MLRs was developed at the Helen Bamber Foundation and members of the Working Group supported in ‘field-testing’ this.
• In collaboration with Medact, the Working Group submitted a paper to the College expressing its concerns regarding the impact of the NHS Charging Regulations on vulnerable people with mental health problems who were ‘failed’ asylum seekers or undocumented migrants
• Members of the Working Group were involved in offering a statement to contribute to the All-Party Parliamentary Group on Immigration Detention in 2021
• The Working Group is currently working on writing a College Report on the Nationality and Borders Act, with a view to highlighting some of the damaging aspects of the Act and offering thoughts on how psychiatrists may be able to best mitigate these effects. Professor Katona was involved in supporting a couple of Peers in their responses in the Lords Debate when the Bill was being debated.
• Members of the working group wrote a response to the Home Office consultation on their 2008 ACDT (suicide watch policy). The revisions have not yet been published:
• An audit tool for assessing the quality of such MLRs was developed at the Helen Bamber Foundation and members of the Working Group supported in ‘field-testing’ this.

Research

• The group’s systematic review on screening for PTSD in people with Intellectual Disabilities was published in 2020. A small discussion group with and intellectual disability specialist clinical psychologists generated potentially fruitful related research projects:

Education

• The Refugee Asylum Network runs regular online events on various subjects such as International Refugee Law, The Nationality and Borders Act, Medico-legal report writing, NHS Charging for overseas visitors, and conversations with experts by experience.
• The Working Group has been involved in the development of the CPD Online Module based on CR199 (Preparing medico-legal reports (MLRs) in the refugee and asylum context)
• The Working Group submitted suggestions to the committee who were working on the re-development of the RCPsych Training curriculum to incorporate learning outcomes related to asylum seeker and refugee mental health. Working Group members have previously attended NICE meetings to discuss training needs for psychiatry trainees.
• Members of the Working Group have run talks and workshops at RCPsych International Congresses in the last few years.

Public engagement

• In 2017 Professor Katona was on BBC’s Panorama investigation into Immigration Removal Centres which garnered widespread media interest
• In 2018, Professor Katona organised public engagement meeting on mental health and immigration detention at the Royal Society of Medicine.

One of the main focuses of the efforts of members of the working group – individually and collaboratively – has been in leading world-class research on the mental healthcare of forced migrants. Here is a selection of some of the working group’s publications in the last two years from 2020:

• Sen P, Waterman LZ, Crowley G, Pillay M, Katona C. Clinicians caring for migrants need more support. BMJ 377:e071007 23 May 2022 (Journal article) Author URL

• Sen, P., Crowley, G., Arnell, P., Katona C., Pillay M., Waterman L., & Forrester A. The UK’s exportation of asylum obligations to Rwanda: a challenge to mental health, ethics and the law. Medicine, Science and the Law, 2022; 62(3), 165-167.
  

• Katona C. When They Came for Me International Review of Psychiatry 1 pages 06 May 2022 (Journal article) View record in Web of Science

• Kaufman KR, Bhui K, Katona C. Mental health responses in countries hosting refugees from Ukraine BJPSYCH OPEN 8(3):4 pages Article number ARTN e87 01 Apr 2022 (Journal article) View record in Web of Science

• Clark E, Fox H, Gillam TB, Clarry C. Quantifying the health needs of migrants in vulnerable circumstances registered with a nurse-led primary care service. Journal of Research in Nursing. 2022;27(3):231-241. doi:10.1177/17449871211034548

• Fox H., Sivasathiaseelan D (2022) Access to health care for migrants: why restrictive policies are failing. BGJPLife online
  

• Evans H, Sadhwani S, Singh N, Robjant K, Katona C. Prevalence of complex post-traumatic stress disorder in survivors of human trafficking and modern slavery: a systematic review EUROPEAN JOURNAL OF PSYCHIATRY 36(2):94-105 01 Apr 2022 (Journal article) View record in Web of Science

• Waterman LZ, Pillay M, Sen P, Crowley G, Forrester A, Katona C. It is time to expand community alternatives to immigration detention BMJ-BRITISH MEDICAL JOURNAL 376:1 pages Article number ARTN o458 24 Feb 2022 (Journal article) View record in Web of Science

• Waterman LZ, Arnold F, Pillay M, Katona C. Home Office and detention centre healthcare providers must do their own research and service evaluation The BMJ 01 Jan 2022 (Journal article)

• Chisholm A, Mark I, Unigwe S, Katona C. Rituals as a Control Mechanism in Human Trafficking: Systematic Review and Thematic Synthesis of Qualitative Literature Journal of Human Trafficking 01 Jan 2022 (Journal article)

• Jowett S, Argyriou A, Scherrer O, Karatzias T, Katona C. Complex post-traumatic stress disorder in asylum seekers and victims of trafficking: Treatment considerations BJPsych Open 7(6) 01 Nov 2021 (Journal article)

• Brady F, Chisholm A, Walsh E, Ottisova L, Bevilacqua L, Mason C, von Werthern M, Cannon T, Curry C, Komolafe K, et al. Narrative exposure therapy for survivors of human trafficking: feasibility randomised controlled trial BJPsych Open 7(6) Article number e196 Nov 2021 (Journal article) Publisher URL

• de Silva U, Glover N, Katona C. Prevalence of complex post-traumatic stress disorder in refugees and asylum seekers: systematic review BJPSYCH OPEN 7(6):11 pages Article number PII S2056472421010139 15 Oct 2021 (Journal article) View record in Web of Science

• Sen P, Crowley G, Moro C, Slade K, Khan AA, Katona C, Forrester A. Mental health in immigration detention: A comparison of foreign national ex-prisoners and other detainees CRIMINAL BEHAVIOUR AND MENTAL HEALTH 31(4):275-287 01 Aug 2021 (Journal article) View record in Web of Science

• Moore T, Burgess R, Katona C. Finding agency in limbo: a qualitative investigation into the impact of occupational engagement on mental health and wellbeing of asylum seekers in the U.K. Transcultural Psychiatry 30 Apr 2021 (Journal article)

• Waterman LZ, Pillay M, Katona C. Sharing health data for immigration control affects marginalised communities BMJ-BRITISH MEDICAL JOURNAL 373:1 pages Article number ARTN n1042 26 Apr 2021 (Journal article) View record in Web of Science

• Abbas P, Von Werthern M, Katona C, Brady F, Woo Y. The texture of narrative dilemmas: Qualitative study in front-line professionals working with asylum seekers in the UK BJPsych Bulletin 45(1):8-14 01 Feb 2021 (Journal article)

• Brady F, Katona C, Walsh E, Robjant K. Psychotherapy and Refugees In Oxford Textbook of Migrant Psychiatry. Editors: BHUGRA, Dinesh. Oxford University Press, USA 07 Jan 2021 (Chapter)

• Fox H, Oxley B (2021) ‘5.3 Considerations in the initial healthcare assessment for new arrivals’ In Orcutt M et al., Handbook of Refugee Health For Healthcare Professionals and Humanitarians Providing Care to Forced Migrants 1st Edition, Taylor & Francis
  

• Waterman, LZ. Cultural competence in vaccine rollout: migrants would face difficulties accessing covid-19 vaccines. BMJ 26 Jan 2021;372:n220.

• Waterman LZ, Pillay M, Katona C. The mass release of migrants from UK immigration detention during the COVID-19 pandemic: What can be learned? BJPsych Bulletin 01 Jan 2021 (Journal article)

• Hunt J, Witkin R, Katona C. Identifying human trafficking in adults BMJ-BRITISH MEDICAL JOURNAL 371:6 pages Article number ARTN m4683 22 Dec 2020 (Journal article) View record in Web of Science

• Cohen J, Katona C, Bhugra D. National data on suicide must include ethnicity A simple policy change could help identify and protect high risk groups BMJ-British Medical Journal 371:2 pages Article number ARTN m4105 27 Oct 2020 (Journal article) View record in Web of Science
  

• Howells S and Sen P (2020) Feasibility Study of Determining Prevalence of Common Mental Health Disorders in Male Immigration Detainees, SAGE Research Methods Cases: Medicine and Health DOI https://dx.doi.org/10.4135/9781529735604

• Chaplin L, Ng L, Katona C. Refugee mental health research: challenges and policy implications BJPSYCH OPEN 6(5):3 pages Article number PII S2056472420000903 01 Sep 2020 (Journal article) View record in Web of Science

• Walker S, von Werthern M, Brady F, Katona C. Mental health of forced migrants recently granted leave to remain in the United Kingdom INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 9 pages Article number ARTN 0020764020939610 20 Jul 2020 (Journal article) Author URL

• Chatterjee H, Clini C, Butler B, Al-Nammar F, Al-Asir R, Katona C. Exploring the psychosocial impact of cultural interventions with displaced people In Refuge in a Moving World. Tracing Refugee and Migrant Journeys Across Disciplines. Editors: Fiddian-Qasmiyeh, E.. UCL Press 01 Jun 2020 (Chapter)

• Mavranezouli I, Megnin-Viggars O, Grey N, Bhutani G, Leach J, Daly C, Dias S, Welton NJ, Katona C, El-Leithy S, et al. Cost-effectiveness of psychological treatments for post-traumatic stress disorder in adults PLOS ONE 15(4):e0232245-e0232245 30 Apr 2020 (Journal article)

• Waterman LZ, Katona C, Katona C. Assessing asylum seekers, refugees and undocumented migrants BJPsych Bulletin 44(2):75-80 01 Apr 2020 (Journal article)

• Mavranezouli I, Megnin-Viggars O, Daly C, Dias S, Welton NJ, Stockton S, Bhutani G, Grey N, Leach J, Greenberg N, et al. Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis Psychological Medicine 1-14 01 Mar 2020 (Journal article) Author URL
  
  

Members of the Working Group have been involved in developing an RCPsych webpage on this topic, which can be found here.

Organisations that provide medical or medico-legal assistance for forced migrants, people detained in IRCs and victims of torture:

• Doctors of the World UK (DOC) 
• Freedom From Torture
• Helen Bamber Foundation
• Medical Justice

Organisations that campaign for the health rights of forced migrants:

• DocsNotCops (DOC) 
• Medact

Other resources:

• Book: Seeking Asylum and Mental Health: A Practical Guide for Professionals - Cambridge University Press. 2022.

If you would like to join the working group then please email Martha Kelly. All doctors and professionals working with people seeking sanctuary are very welcome.  

There is a broader network of health professionals who are currently working with people seeking sanctuary, or who are interested to do so, working under the name 'Refugee and Asylum Mental Health Network'. It has no formal affiliation to the Royal College of Psychiatrists but runs educational evening sessions, and serves as a way for professionals to network on clinical, research and advocacy subjects.

We have invited speakers from oganisations and charities working with people seeking sanctuary, and have heard from experts by lived experience. If you are interested to be part of this broader network, which is based primarily on a WhatsApp group, please contact Lucia. 

You can see previous and upcoming events run by the Refugee Asylum Network on their Eventbrite page.

Should you have any further queries, please do not hesitate to contact Martha.