Mapping the provision of mental health services for asylum seekers and refugees in London: a report

Transcription

1 Mapping the prvisin f mental health services fr asylum seekers and refugees in Lndn: a reprt March 2005 Kim Ward & David Palmer Schl f Scial Science and Public Plicy King's Cllege Lndn Strand Lndn WC2R 2LS kim.ward@kcl.ac.uk ST.PANCRAS REFUGEE CENTRE Hly Crss Crypt Crmer Street Lndn WC1H 8JU (t) (f) (e) hcct.rg.uk

2 Intrductin The aims f this research are t map the prvisin f mental health services fr refugees and asylum seekers in Lndn, highlight any gaps in service prvisin and make recmmendatins n the mental health needs f refuges and asylum seekers. The research was carried ut fr the Cmmissin fr Patient and Public Invlvement in Health Lndn Regin. All research was undertaken by David Palmer wh is prject manager f St. Pancras Refugee Centre (SPARC) and by Kim Ward research and infrmatin fficer fr the Infrmatin Centre and Asylum and Refugees in the UK (ICAR). The mapping exercise Methds The mapping exercise was split up in t three cmpnents: (i) specialist mental health services prvided by the mental health trusts (ii) primary care trust (PCT) services imprving healthcare access fr refugees and asylum seekers (including mental health) and (iii) specialist mental health services utside the NHS (services funded by PCTs were included in this grup). In rder t lcate services falling within the first categry web-site searches were carried ut and the apprpriate teams r department were cntacted t btain infrmatin abut the specialist services available. The results f this exercise are cntained within Appendix 1. Where it was pssible t btain the infrmatin, waiting times have been included. Services falling in t the secnd categry were lcated by cntacting: the relevant cmmissining department, the equality and diversity team r manager, the cmmunicatins r infrmatin department, members f staff linked t PCT publicatins n asylum and refugee issues and by carrying ut web-searches n the PCT hmepages. In additin t this, all f the delegates frm Lndn PCTs that attended a cnference n refugee health in Nvember 2004 were ed fr infrmatin n the services that they are aware f. The results f this exercise are cntained within Appendix 2. Specialist mental health services utside the NHS were lcated using existing knwledge within SPaRC and ICAR and by carrying ut extensive web-searches including the Multikulti and Harp databases. Infrmatin was als btained by fllwing up infrmatin prvided by PCTs and ther health prviders and by using directries n refugee services in Lndn. The results f this exercise are cntained within Appendix 3. It is imprtant t establish a wrking definitin f specialist. In its simplest frm specialist can be defined as prfessinal r high quality and/r a persn wh specialises in a particular prfessin. 1 Hwever, a brader understanding f specialist is required fr the purpses f this study. Refugees are a vulnerable grup and they frequently present with cmplex needs that require a multi agency apprach t reslve sme f their issues. Prviding assistance in areas such as husing and supprt and can have a very psitive impact n the mental health f refugees and asylum seekers. Research has shwn that a mental health access pint and supprt services fr refugees can ften mst effectively be prvided thrugh a mre generic helping service. 2 Studies have shwn that 1 Cllins English Dictinary (1990) Cllins: Lndn 2 Watters C (2001) Emerging paradigms in the mental health care f refugees. Scial Science and Medicine 52 (11)

3 cmmunity grups play a majr rle in helping refugees cme t terms with resettlement and that access t a refugee cmmunity grup can reduce the severity and likelihd f mental illness. 3 Prviding hlistic supprt is acknwledged as an apprpriate way f delivering quality care t refugees. As a result, prjects that prvide culturally apprpriate services and facilitate scial integratin with a particular fcus n mental health needs are included under specialist services. 4 Findings The results frm the mapping exercise demnstrate that the mental health services fr refugees and asylum seekers in Lndn are limited. Only five f the eleven Mental Health Trusts prvide specialist services that are specifically designed with the needs f refugees and asylum seekers in mind. These services are prvided by: Central & Nrth West Lndn; Nrth East Lndn; Barnet, Enfield & Haringey; Tavistck & Prtman and Camden & Islingtn. The details f these services can be fund in Appendix 1. Sme f the services prvided by the ther Trusts, such as the Traumatic Stress Service (Suth West Lndn and St Gerges) and the Institute f Psychtrauma (East Lndn and the City) prvide specialist trauma services fr refugees and asylum seekers (wh make up abut 50% f their client grup), but they d nt have a team r an individual that wrks specifically with asylum seekers and refugees. Services fr refugees and asylum seekers within PCTs are very difficult t lcate. The research has shwn that equality and diversity managers are ften unaware f individuals r departments that have a special respnsibility fr refugees and asylum seekers. Sme cmmissining departments als seem t be unaware f services that the PCT funds. It is als very hard t lcate individuals, such as health visitrs, whse remit is t wrk with refugees and asylum seekers but wh are nt attached t a particular team wrking with this grup. With the exceptin f a handful f PCTs, there appears t be a general lack f awareness that refugees and asylum seekers are a grup that have distinct needs which are multiple and cmplex and that require specialist knwledge. There are nly a small number f specialist rganisatins utside the NHS that prvide culturally apprpriate services t this grup. The recmmendatins frm this sectin f the research are integrated in t the final recmmendatins presented at the end f this reprt. Findings The health f refugees and asylum seekers ften deterirates in the hst cuntry 3 Grst-Unswrth C, Gldenberg E (1998) Psychlgical sequelae f trture and rganised vilence suffered by refugees frm Iraq. Trauma-related factrs cmpared with scial factrs in exile. British Jurnal f Psychiatry, 172: Watters C (2001) Emerging paradigms in the mental health care f refugees. Scial Science and Medicine 52 (11)

4 Refugees and asylum seekers ften see the western mental health mdel as an alien cncept and psychiatric treatments are generally unfamiliar t them. Many d nt understand the treatments administrated. Mental health issues are ften assciated with madness and brings shame n the cmmunity The symptms f mental health are frequently presented as smatic cmplaints and presentatins f distress are ften culturally bund. Mst asylum seekers and refugees d nt understand the mental health system. Refugees and asylum seekers ften apprach cmmunity grups rather than the mainstream services when suffering frm mental health issues. Pverty, hmelessness, lss f scial status and the immigratin system were specifically mentined as factrs impacting n mental health. Psych-scial supprt, in the frm f practical help and scial activities, was seen as the mst effective way f reducing islatin and respnding t mental health issues. Refugees and asylum seekers have difficulties in accessing mental health services due t language difficulties and interpreting services were fund t be inadequate. There are ften cncerns abut cnfidentiality and trust and many refugees and asylum seekers are extremely anxius abut prviding infrmatin. Recmmendatins made by the respndents It is necessary t strengthen the capacity f rganisatins by prviding advcacy services t members f cmmunity rganisatins. Refugee cmmunities need t be given mental health awareness training s that it is easier fr them t recgnise the symptms f mental ill health. It is necessary t respnd t mental health issues by taking a hlistic apprach and by taking int accunt the scial factrs which impact hugely n mental health. Statutry and ther main stream rganisatins need t acknwledge that refugee cmmunity rganisatins are key players in prviding services t the cmmunity and shuld supprt them thrugh funding and invlve them in service planning and delivery. There is a need fr health awareness training prgrammes fr primary and secndary care prviders n refugees and the migratin prcess. Funding needs t be made available fr cunselling and ther culturally specific services s that they can be prvided within cmmunity rganisatins. Mre infrmatin needs t be prvided n hw t access services and n the mental health system.

5 There needs t be greater links between cmmunity grups and mental health services. There is a need fr bi-lingual health wrkers, interpreters and advcates.