Commissioning mental health services for vulnerable adult migrants

Launched in August 2014, ‘Commissioning mental health services for vulnerable adult migrants’ is a guide for commissioners which aims to support them address the complex needs of vulnerable and diverse migrant populations.

New migrants may face adversity before, during and after arrival in the UK, with resultant complex needs. If psychological problems are not addressed early on, they may develop severe and enduring mental health problems.

Refugees and asylum seekers have an overall increase in psychological ill-health, which is not an inevitable consequence of conflict and trauma but which also reflects the socio-political conditions faced in host countries. Improving these conditions could improve mental health outcomes. Migrants are at a higher risk of homelessness and destitution, which impact detrimentally on mental health. Immigration detainees have high levels of post-traumatic stress which leads to anxiety, depression, self-harm and suicidal ideation.

NHS commissioning should be informed by better understanding of health needs of the local population, including those unregistered, partnership working with patients, purchasing services that offer choice, and monitoring quality and outcomes.

Read the guidance

Vulnerable Migrants

Vulnerable migrants (including refugees and asylum seekers as well as economic migrants, spouses and students) often experience considerable mental distress owing to extreme and often lengthy disruption to their lives.

Many will have faced oppression, war and torture in their country of origin and may be experiencing various mental health problems such as anxiety, stress and depression.

Not only are their mental health needs greater than most, but migrants often face a number of obstacles accessing mental health services, including the language barrier, cultural differences, stigma, racism and confusion.

The situation is even worse for many irregular migrants, including refused asylum seekers and visa overstayers, who may be unable or unwilling to return to their country of origin and consequently might remain in the UK for many years.

They are not allowed to work, are not entitled to any welfare benefits and will be charged for most secondary healthcare treatment. NHS staff are confused by the complex policy concerning access to free healthcare for foreign nationals and, as a consequence, many migrants are wrongly denied primary and secondary mental health services, and their mental health deteriorates to the point of crisis.

What we're fighting for

We want:

  • Appropriate and accessible mental health services for all migrants
  • Policy-makers, commissioners and service providers to be aware of the key issues affecting migrants and the difficulties they experience in getting treatment for their mental health issues.
  • Commissioners to engage more effectively with voluntary and community sector service providers and refugee communities in order to build sustainable relationships to inform needs assessments and service design and delivery.
  • NHS managers and service providers to develop the skills and awareness of their staff by providing training courses on migrant mental health.
  • Full entitlement to free secondary healthcare for all refused asylum seekers until the point at which they return to their country of origin.

Mind is a member of Still Human Still Here - coalition of more than 40 organisations that are campaigning to end the destitution of thousands of refused asylum seekers in the UK. The campaign calls for the UK government to provide free access to healthcare for all asylum seekers while they are in the UK.

What are we doing?

The Equality Improvement Team at Mind are working with migrant communities, local Mind associations and mental healthcare commissioners and providers across England and Wales, in order to improve access to appropriate mental health support for all migrant communities.

We have produced reports and researches on the challenges faced by vulnerable migrants. All resources are freely downloadable from our Resources page

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 want to know more about the project, contact Marcel Vige, Equality Improvement Manager: [email protected]

Ensure that mental health service providers are able to design and deliver accessible and responsive services to migrants

Support & advice organisations for migrants

Medical Foundation for the Care of Victims of Torture
The Medical Foundation for the Care of Victims of Torture (MF) is a registered charity which is dedicated solely to the treatment of torture survivors.

Refugee Council
The Refugee Council is the largest organisation in the UK working with asylum seekers and refugees. They give direct help and support, but also work with asylum seekers and refugees to ensure their needs and concerns are addressed.

Refugee Action
Refugee Action is an independent national charity that works with refugees to build new lives in the UK. They have more than 27 years of experience in reception, resettlement, development and integration, and they provide advice and support to asylum seekers and refugees in 11 regions across England.

Welsh Refugee Council
Welsh Refugee Council is an independent charity that empowers refugees and asylum seekers to rebuild their lives in Wales. They provide advice, information and support for asylum seekers and refugees in four offices in Cardiff, Newport, Swansea and Wrexham. They offer specialist services in areas such as housing, health and employment. They are also actively involved in policy development and campaign for refugee rights.

Researches and Reports can be found in our Resources section

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