Securing better mental health services for vulnerable migrants

Mind’s research into the mental health needs of refugees and asylum seekers showed that they experience significant obstacles to accessing mainstream mental health services.This includes

• the lack of specialist or culturally appropriate services
• the language barrier
• the influence of shame and stigma, and
• the practical problems of starting a new life in a strange country.

In addition, migrants face racism and discrimination as a result of the prejudice and confusion felt by some people within mainstream mental health services.

Our work with local Minds and refugee community organisations (RCOs) aimed to address some of these obstacles by building their capacity to influence local service providers to ensure that refugees and asylum seekers are able access responsive services.

Since August 2010, we have been working with Primary Care Trusts (PCTs) in the south east of England, to enable them to be better at identifying and addressing the mental health needs of migrants within the service commissioning process.

Commissioning mental health services for vulnerable migrants

This project aims to improve the way in which PCTs commission (purchase) mental health services so that those services are more appropriate for and accessible to vulnerable migrants, including refugees and asylum seekers.

Key to this is ensuring that commissioners have a thorough knowledge of their local migrant population, and a good understanding both of their mental health needs and of their experience of using mental health services.

The project will also provide evidence to inform the debate about entitlement to free healthcare for refused asylum seekers and irregular migrants.

The project will:

• Raise awareness amongst commissioners and service providers of the mental health needs of vulnerable migrants, including those in detention, as well as the gaps in service delivery and the obstacles to accessing services.
• Ensure that mental health service providers are able to design and deliver accessible and responsive services to migrants, and are monitoring uptake and outcomes among their migrant service users.
• Enable migrant service users and communities to have better knowledge of available services, entitlements and pathways to care, and a good understanding of their role in influencing the design and delivery of mental health services.
• Improve cooperation between commissioners, voluntary and statutory service providers, and the local community, to ensure that services are accessible for and responsive to the needs of vulnerable migrants.

Progress so far:

The project has succeeded in bringing together commissioners, equality and diversity leads, and community development workers from six PCTs and local authorities in the South East, with migrant community organisations and local Minds.

The key findings and recommendations so far include:

1. There is still considerable unmet mental health need within migrant communities, and the obstacles to accessing services remain.

2. There is a real need for holistic services that can address the range of environmental and social factors that impact on the mental wellbeing of migrants.

3. Commissioners have difficulty identifying the size and mental health needs of their local migrant population. Improved cooperation with migrant organisations, communities and service providers would ensure that data is collated and analysed effectively.

4. Commissioners need to reach into marginalised populations through their community engagement and development programmes to ensure that their needs are being fed into the commissioning process.

5. The move towards greater mainstreaming in service delivery means that commissioners need to ensure that providers are meeting their equalities obligations and delivering inclusive and responsive services.

Over the next couple of months, we will continue to work with the six PCT commissioners and, where possible, engage with emerging clinical commissioning groups, Health and Wellbeing Boards and local HealthWatch to implement these recommendations. We are also drafting a set of guidelines for commissioners on behalf of the Department of Health.

Take action

• If you provide mental health services to migrants, let us know about your work. We are always looking for good practice in mental health service design and delivery.
• If you are a commissioner and you have some good practice to share, get in touch. We might feature you in our upcoming guidelines.
• If you want to know more about the project, contact Sile Reynolds, Senior Policy and Campaigns Officer at Mind on s.reynolds@mind.org.uk.