Mental Health amongst migrants

This week (19-25 June) is Refugee Week. The team from the Cardiff Refugee Health Project, a student-led project raising the profile of refugee and asylum seek health through education and advocacy, have written for RCPsych Wales.

This refugee week we’re talking about mental health amongst migrants. Currently, the mental health situation for migrants in the UK remains problematic, with ever-increasing hostile policies. However, there is tangible action healthcare professionals can take to ensure those in need of help receive it.

Refugees are five times more likely to have mental health needs than the general population (1). The reasons for this are broad and can relate to experiences throughout resettlement. This includes the trauma of leaving home, the journey to the UK or the ongoing stress of the asylum process in the UK.

Across the UK refugees with approved status can access all NHS care for free. However, it is more complicated for failed asylum seekers and undocumented migrants. Over 200,000 children living in the UK are undocumented and vulnerable. It is important to note there is a range of migrant groups, all equally deserving of accessible mental health support where necessary. 

Healthcare is not exempt from the effects of political agendas as we see undocumented and failed asylum seekers rendered illegible for universal health coverage of many elements of NHS care. Over recent years the UK government has adopted hostile environments such as the Nationality and Borders Bill, Rwanda deportation and detention creating and worsening existing barriers to access for vital healthcare and sanctuary. As healthcare workers, we must appreciate how such a political environment can impact the health of our vulnerable patients, especially mental health- an already taboo and challenging topic for many.

On top of hostile policies to navigate, migrants may be subject to discrimination and lack access to education and sociocultural networks. Asylum seekers or undocumented migrants may also fear people in authority, including health care professionals, or be worried that information could be shared with the Home Office or previous perpetrators. Despite these obstacles, all healthcare workers can play a vital part in improving the situation- starting with our practice.

Firstly, talking about previous trauma and the many varied traumatic stress symptoms can be difficult. The RCPsych’s ‘psychological first aid kit’ provides some simple tips to make the discussions easier - it's worth having a read and sharing with colleagues. Other resources to become familiar with include the BMA’s Refugee and asylum seeker patient health toolkit.

Language barriers provide an extra challenge. Some cultures may not have comparable terms for common mental health conditions, and there may be stigma attached to having mental health needs. It is vital to ensure an appropriate professional interpreter is present for consultations and familiarising ourselves with different cultural backgrounds and contexts to approach migrant mental health with the sensitivity and respect it deserves.

Other non-NHS services can support asylum seekers and refugees, so referring people to appropriate local charities for support with the logistics of attending appointments and understanding the letters received is fundamental. This includes the Refugee Council, Freedom from Torture and the Helen Bamber Foundation.

When planning care, remember that asylum seekers are often moved around, making delivering long-term therapy challenging. Long wait times face everyone, but asylum seekers may feel this is because of their status, so it’s important to reiterate to those we come into contact with that asylum seekers and refugees are welcome in the NHS - this refugee week and always!