Working towards mental health equality for asylum seekers and refugees in Norfolk

For World Refugee Day 2023, Dr Yasir Hameed, Dr Hannah Fox and Izobel Clegg from the Norfolk and Suffolk NHS Foundation Trust talk us through how their pioneering clinic is advancing the mental health equality of asylum seekers and refugees in Norfolk.  

“A person who owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.” 

- The 1951 United Nations Convention Relating to the Status of Refugees 

Earlier this year, a refugee who had recently arrived in the UK attended the Asylum Seekers and Refugees Clinic at the REST hub, Norwich, clinic in flip-flops and shorts. He had no other clothes, no phone and no way of contacting his loved ones. He carried the trauma of the persecution that caused him to flee his home country, nearly dying crossing the channel, and of leaving everything and everyone he knew behind. 

The profound trauma that refugees experience results in many wanting to seek care from primary and secondary mental health services. However, treating the mental health of refugees isn’t something British medical health professionals are trained to deal with, and this can mean that they are often unsure how to treat refugees effectively. 

The origins of the clinic 

Norwich has welcomed many refugees and asylum seekers over the last ten years as part of the Syrian resettlement scheme (the Vulnerable Persons Resettlement Scheme) and the Afghan Citizens Resettlement Scheme. More recently, a large group of asylum seekers have been housed in hotels. Many of these forced migrants experience mental health problems and find it difficult to access help due to many barriers.  

In 2018 Dr Yasir Hameed, a consultant psychiatrist from Norfolk and Suffolk Foundation Trust, started volunteering with a local charity to help refugees in the area. His passion for working with refugees was based on his own personal experiences. Initially, he was asked to provide ad-hoc pro-bono mental health consultations, but this was forced to stop in 2020, due to the COVID-19 pandemic.  

In April 2022, Dr Hameed started seeing refugees to support their mental health once more, but this time it was from a formalised clinic, with support from other clinicians and healthcare workers.  

In 2022, the Norfolk and Suffolk NHS Foundation Trust had signed up to be part of the College's Advancing Mental Health Equality (AMHE) Quality Improvement (QI) Collaborative. The AMHE Collaborative joined the team with a wider group of academics and clinical leads, working to advance equalities in the trust. The team also had regular QI coaching that helped them conceptualise their vision for the clinic.  

How the clinic works 

The clinic now meets once a month in a hub run by Mind in central Norwich – an intentionally non-medical setting. The clinic has no limits on the referrals it can receive or who they can receive them from, although there is a limit on the number of patients they can see at each clinic. Referrals come in from social services, primary and second health services, charities, community organisations and universities. Care at the clinic is multifaceted and holistic, provided by a team who are experienced in working with people with trauma and are culturally competent when delivering care.  

When a patient is referred to the clinic, every aspect of their situation is considered before deciding on the next steps are for the patient in terms of their onwards referral and care. The clinic staff think about which partner organisation is best placed to help deliver treatment and they manage other contributing factors to adverse mental health. This could include helping people access school or college or connecting them with refugee support groups. The clinic then manages the person’s support, treatment and care with the help of the relevant partner organisation.  

Between April 2022 and 31 March 2023, the clinic has received 59 referrals, the average number of referrals per month was 4.9 and the average of appointments per month was 9.5. These numbers started to increase gradually as more professionals became aware of this service.  

The clinic’s benefits, challenges and future 

The work of this clinic has shown many benefits. First, it enables asylum seekers and refugees to have their mental health needs met. Second, by providing the care needed by this group of patients, the clinic has been able to relieve potential pressure in other parts of the health and social care system, which helps to save resources.

The holistic approach that the clinic takes means the individualised care given to each patient has a long-term outlook. It has also enabled clinicians to learn about the needs of forced migrants, increasing their confidence in delivering care to this patient group, though there are still many challenges for clinicians working with refugees, such as understanding the complexities of the asylum system.  

An unexpected benefit has been that the clinic created a space for advocacy for the needs of asylum seekers and refugees. The individual stories and challenges of each patient have been transformative for the staff’s perspectives.  

After a year of successfully advancing the mental health equality of refugees and advocating on their behalf, the team presented their data to the trust (supported by the AMHE Collaborative and the engagement of senior stakeholders such as the Integrated Care Board lead on inclusion health). The clinic received six months of funding to continue their work that, previously, was run by volunteers from the team. It is hoped that the clinic will be able to secure longer-term funding.  

While the clinic has been very successful, it's also important to acknowledge how challenging the work has been for the team. It’s difficult to hear the stories of trauma and see the systemic issues that forced migrants face, from the asylum system to poverty, and continuous movement around the country, often at the very last minute.  

With an eye to the future, we see a clear need for this model of care for refugee mental health to be expanded to other NHS trusts, and for the workforce to be upskilled to work with refugees and asylum seekers. Refugee mental health matters as much as all citizens, and it is in crisis.