We need a more co-ordinated approach to refugee mental health

This World Refugee Day, June 20, the Mental Health Foundation stands in solidarity with the 59.5 million forcibly displaced refugees worldwide.

So far this year alone, 203,981 people have fled dangerous conditions in their home countries, embarking on the journey across the Mediterranean Sea which is said to claim one in 23 lives of those attempting the crossing, according to figures released by the UN Refugee Agency.

Refugees’ mental health is greatly at risk as a result of their displacement, arrival in a new and unknown country and the experience of navigating the asylum process. Given the significant amount of emotional turmoil they are likely to have experienced, immediate mental health problems are common and post-arrival factors such as being immersed in a new culture and experiences of discrimination may create additional strain on their mental health. There is substantial evidence that trauma and loss may have profound and ongoing effects on refugee’s mental health. Recognising this, we need to ensure that upon arrival, their mental wellbeing is protected through appropriate policies that recognise their heightened vulnerability in society.

This is an often overlooked aspect of the dialogue around refugees in the media and beyond, clearly indicating that greater awareness of their mental health needs is required. We believe that a rights-based, person-centred response should be at the centre of the support network available for refugees, and from this, policy that reflects the severity of psychological and social stresses often experienced by refugees. We need to ensure refugee voices are heard within their new communities and to do this, it is crucial to harness the energy of individuals, families, communities and public services to recognise how mental health can be supported and mental health problems prevented. World Refugee Day offers the perfect opportunity to explore the barriers to refugees voices being heard, and how these could be overcome looking forward to grow understanding across society of the reality of life as a refugee.

The Government’s increased focus on reducing inequalities, and health inequalities more specifically, is a step in the right direction but actions to address the particular vulnerabilities of refugees must be factored into strategy and reflected in policy. Access to decent housing, the health service and mental health support, and integration into the community can all be much more difficult for those who are new to a country but also face additional stigma. The result is that many refugees are left both socially and emotionally isolated.   

Access to safe housing is central to our mental health and wellbeing. It provides us with stability and security as well as enhancing social inclusion and forms the basis for a private and family life. Unfortunately, many refugees find themselves in poor or inappropriate housing. The Government’s report ‘No Health Without Mental Health’ stresses the importance of housing to support good mental health. Evidence of this correlation can be clearly identified for those who have experienced displacement. Identifying and mainstreaming examples of appropriate housing policies would be a positive step towards amending existing services and ensuring the mental health and wellbeing needs of refugees are reflected across housing policy. Further to this, all local authorities should consider the mental health impact for refugees and asylum seekers when planning and delivering housing services locally.

Difficulties in accessing healthcare services, lack of awareness of entitlement, self-stigma and the absence of a common language can all act as barriers that result in refugees not receiving the mental and physical healthcare they might need. Some of these health inequalities are of course shared by many other disadvantaged and/or vulnerable groups, however it remains important to recognise the multifaceted impacts of being displaced and the increased risk this places on refugees as compounding social and economic inequalities. Increased coordination among health practitioners and training for frontline staff could speed the evolution of effective mental and physical health services, helping to tackle stigma around mental health and wellbeing as well as enabling greater levels of integration of refugees into their new communities.

Feeling that you belong to your community is central to all of our mental health and even more so for refugees that have left their support networks and communities behind. Having a sense of cultural togetherness can help to combat this social isolation by helping to forge a sense of identity and belonging. The Mental Health Foundation has led the Amaan project working with minority communities in Scotland for almost a decade and with asylum seekers and refugees for over five years. Working together with valuable partnerships, community groups and affected individuals, this programme has worked with refugees to create mental health improvement solutions. Amaan has had great success in helping women refugees find their voice through the use of arts activism and working with partners such as Freedom from Torture, the Scottish Refugee Council  and the Legal Services Agency has devised and delivered community based programmes applying our ‘Community Conversation approach where refugees themselves take on leadership roles. With the support of Scottish Refugee Council, the NHS and Strathclyde Centre for Health Policy, the Mental Health Foundation has shaped Scotland 'New Scots' social inclusion strategy, directly addressing the negative impact social isolation can have on mental wellbeing.

It is of the utmost importance that the Government places mental health at the centre of its work to respond to the ‘refugee crisis’. The Government needs to ensure its policies incorporate the needs of refugees across all departments and recognise that only by taking this integrated approach will we be able to achieve a more cohesive and supportive society that can be more responsive to the acute needs of refugees, enabling them to live healthy and safe lives.