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Advocacy for refugee mental health
Posted Wednesday 22 June 2011
Guest post from Abdi Gure from the Somali Mental Health Advocacy Project at Mind in Harrow.
We know that there are a lot of factors that effect refugees’ mental wellbeing, and that they face enormous challenges in accessing appropriate services based on their needs.
Refugees suffer many problems in the country in which they live and consequently the lack of mental wellbeing should not be simplified; I myself have experience of being a refugee, and I have also been working with the Somali refugee community in Harrow.
Mind in Harrow developed the Somali Mental Health Advocacy Project, with three years' funding from The Kings Fund. The project focuses on ‘cultural brokerage’ and ‘bilingual advocacy’; we have been exploring how effective these approaches prove to be for refugees.
In the context of Somali culture, the family unit is very strong. For this reason, families of those affected have been one of the main groups benefiting from the project; we understand their role in Somali culture as primary carers, and huge benefits of having familial support for the individual in question.
There is a Somali proverb which says “if your brother is in insane, you are sane for him”. In other words, family narrative can help clinicians to understand the background of the patient and find the right diagnosis. The project has worked with clinicians by holding workshops in which we explained how the Somali community perceives mental illness and what are some of the barriers they experience to accessing mental health services.
We took a holistic approach to advocating on behalf of clients since refugees have many problems in addition to mental distress, such as immigration, benefit and housing difficulties. Unfortunately, many clinicians do not understand the immigration problems experienced by the refugees they are treating. With the help of the bilingual advocate, the immigration issues were taken seriously and we even succeeded in resolving the immigration problem in six cases, one of whom was facing deportation.
One of the findings of our project is that many of our clients were neglected by their families. We had a client who has not seen his family for the last four years and he felt abandoned because of his mental illness. The reconnection of the family has ignited a kind of healing process that made our clients feel that they are still alive and their dignity is restored.
We also addressed some of the preconceptions held by the Somali community, many of whom feel that if you become mentally unwell you can never recover. We explained to them that with medication and support, people can lead active lives and achieve positive change.
From my experience when I started in 2007 this bilingual advocacy project was a daunting challenge, particularly being accepted as a professional advocate in the mental health setting because of a lack of understanding of many clinicians about my role. Every time I was asked the same question: “are you the interpreter?” and my simple answer was “no”. Later, after some struggle, I could assert my voice on behalf of voiceless people who can’t express their feelings because of the lack of language.
Abdi Gure, Coordinator of the Somali Mental Health Advocacy Project at Mind in Harrow
2 Comments
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Whilst I applaud the work of Abdi Gure I beleive many problems faced by refugees (like many of us) is the result of the system. I have met people from Zimbabwe who have spent years trying to have assylum granted in this country. All they want is a chance to get on with their lives in a safe country. Their 'refugee' status barres them from working and also claiming benefits. They rely on sponsors until sponsors can no longer support them. Yes, language is a big problem also so why can't they be given the opportunity to learn English? Most immigrants I speak to want to do just that, to be able to communicate could counteract the isolation that often compounds any mental health problem. I am also a little sceptical of treating refugees as a 'special case' as if they were somehow separate from the rest of us with their own unique problems. In my work with CAB the problems faced by immigrants mirror the problems faced by many working class indigenous people ie unemployment, poverty and housing. Basically they have come here for a better life and the state and the system too often acts as a barrier to this-thats where the problems lies.
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Thanks Linda. I think you’ve hit the nail on the head. Mind’s research, as well as earlier work by Freedom From Torture, demonstrates that the social and environmental pressures on refugees can have a devastating impact on their mental health. Many of the refugee community organisations we interviewed told us that the stress and uncertainty of the asylum process, the prohibition on work, homelessness and destitution, had all contributed to depression and anxiety among asylum seekers and refused asylum seekers. Even after refugee status is granted, the pressures do not abate; under- or un-employment, poor housing, poverty, physical ill health, the language barrier and racial abuse all lead to poor mental health. These are all symptoms of an asylum process that forces prolonged inactivity, financial dependency and social isolation.
You are correct to say that refugees should not be considered as separate from the rest of UK society. In most cases, they are experiencing the same mental health and social problems as the resident population, and can benefit from the same holistic treatment models. However, it is important to remember that between five and 30% of asylum seekers have been tortured and will require specialist help. Refugees have gone through a process that many will find traumatising: loss of home, family and friends, detention, constant fear of return to persecution. In addition, they face barriers to accessing mainstream care, not least of which is the need for language support, in the form of English language classes and interpreters. You are right to highlight the vital role that communication plays in overcoming social isolation, and ensuring that refugees can access the same mental health services that we all benefit from.
Mind’s work in this area is focused on supporting commissioners to ensure that the services they procure – whether mainstream or specialist – overcome those barriers. For more information, feel free to get in touch with me: s.reynolds@mind.org.uk
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