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Academic article identifies hostile environment as a barrier to mental healthcare for asylum seekers and refugees in the UK


Authors say their study provides justification for a call to relax hostile environment policies

Date of Publication:
21 June 2021

Academic article identifies hostile environment as a barrier to mental healthcare for asylum seekers and refugees in the UK

21 June 2021

BioMed Central's International Journal of Mental Health Systems last week published an article on mental healthcare for asylum seekers and refugees in the UK.

You can read the open access article online here or download the PDF file here.

It was authored by Teresa Pollard of the London School of Hygiene and Tropical Medicine and by Dr Natasha Howard, who has dual associate professorship at the National University of Singapore and the London School of Hygiene and Tropical Medicine.

The article examines policies and guidance, healthcare practices, barriers and enablers of mental healthcare for asylum seekers and refugees residing in the UK (abbreviated to the acronym ASR in the article).

For the study, the authors conducted a review of the literature and held interviews with stakeholders from NGOs, academia, the NHS, and community groups.

Overall, the authors find that mental health problems are common among asylum seekers and refugees, particularly because the reason for seeking asylum usually a traumatic life episode, and there are a number of barriers to receiving treatment in the UK, including the Government's hostile environment immigration policies.

Indeed, the authors say that their study provides justification for a call to relax hostile environment policies.

Fear, trust and uncertainty are identified as being among the barriers to receiving mental health treatment, and the authors find that these are exacerbated by the hostile environment. They note: "The hostile environment created by tightened immigration laws and tracking has increased fear and reduced trust among ASR. This overlaps with health system constraints due to chronic underfunding (e.g. excess workload, salary freezes, staff shortages) and increasingly restrictive health policies, such as user-fees, which contributes to a lack of will to provide additional specialist services (e.g. interpreters). Recent NHS charging policies are not well understood by ASR or even by all health-workers, leading to inconsistencies across the UK."

In addition, the hostile environment negatively impacts the mental health of asylum seekers and refugees.

The authors observed: "Literature and interviewees indicated some mental health service needs could be reduced by better social support. Both described the psychological trauma ASR may experience arriving in the UK in hope of a new life, but instead encountering a hostile environment and difficulties with general living that affect their mental wellbeing. Better living conditions and ending hostile environment policies could reduce some pressures on mental healthcare services."

The article notes that NHS England allocates no specific funding for asylum seekers and refugees, nor are there any specific guidelines for their mental health.

Interviewees working with asylum seekers and refugees said they felt discriminatory and negative views about migrants led to the deprioritisation of funding for migrant services.

Language is identified in the study as another barrier to treatment, with sources noting that expressing complex emotions in an unfamiliar language is difficult, as is talking about trauma and psychological illness, particularly given the stigma surrounding mental health.

One interviewee said: "It's quite a big challenge to be able to express complex emotional feelings in another language, I think that requires some fluency and, in our experience, even when people have got a proficiency in English, they prefer to speak in their mother tongue."

The article also highlights inconsistencies of mental healthcare for asylum seekers and refugees across the UK, particularly outside London and other large cities.

"It is often said that their mental health issues are circumstantial because they are going through the asylum process and that it's because they haven't got a visa… and if they've got specific issues say PTSD, caused by torture or something like that, then there's really no support…There's a real lack of support in our region," one NGO support coordinator and advisor said.

With gaps in the literature, the authors find that further rigorous research on the topic of mental healthcare for asylum seekers and refugees is clearly needed.

The article concludes: "Mental health problems are common among ASR, particularly because the reason for seeking asylum usually involves one or more traumatic life episode. Additionally, the asylum-seeking process causes additional anxieties because of: (i) uncertainty about immigration status and finding a new home; (ii) minimal or no access to funding support, particularly for refused asylum- seekers; (iii) lack of clarity about rights to work or inability to work until immigration status is received; (iv) uncertainty about access or costs of healthcare, making mental healthcare access even more difficult; (v) language barriers and overstretched healthcare professionals; and (vi) adapting to a society which may be hostile to their needs. UK government policy could do more to address these issues. This would help ASR begin healing from the traumas they suffered so they can contribute fully in their new society without the added burdens of unresolved and ongoing traumas. A less hostile environment towards ASR would allow for their easier integration and contributions to British society."