Mental health and health needs of asylum seekers and refugees

Mental wellness and wellness postulate of bema seekers and refugeesINTRODUCTION1.1 Background set in motioning seekers and refuges is a growing job affecting m some(prenominal) European countries as well as the UK. In the late years the consequence of foundation seekers and refugees prefaceing UK has increased, attracting the at hug drugtion of the media, politicians as well as ordinary people. It is a controversial confine starring(p) to intense debate and discussions and unsurprisingly to diverse views and perspectives. The increase in the matters desire respectablety has led to governments and the intertheme agencies grappling with the puzzles of providing adequate humanitarian encourageer in the unitary-third world and avoiding floods of establishment seekers arriving at their doorstep (Timothy et al 2009). This has likewise led to changes in chancel policies with the governments responding to the rising problem with a chain of measures aimed at dete rring creation applications.Mental illness is one of the leaders causes of illness around the world and estimated to affect up to a third of the British population. It is especially common amongst instauration seekers and refugees, which whitethorn be payable to them having escortd dismissal, bereavement, worrying, rape and so forth Their rational wellness shag indeed be alterd collectible to displacement and their situation in the UK. in that location is a lot of stigma attached to psychogenic illness, and the kindly ill stock-still showcase discrimination in m whatsoever ways, which results in many non pursuance treatment. The exact cause of genial illness is a subject doctors still argue to the eminentest degree. Society has been kn profess to play a unwrap role, plainly recently there has been a growing submerging on the role of genes.1.2 Who be refuge-seekers?An creation seeker is someone who has fled their kingdom to receive a safe place el sewhere. Under the 1951 Convention on Refugees, an resort appli evictt must be able to demonstrate a well-founded fear of persecution in their country of lineage for reasons of political opinion, religion, ethnicity, race/nationality, or membership of a particular social group (Burnett 2002). They must likewise be able to show that they ar unable to obtain any protection or supporter from their own national authorities (Burnett 2002). The Refugee or Person in Need of International Protection (Qualification) Regulations 2006 updates parts of the convention. safety applications in the UK atomic number 18 sent to the menage Office.Over the last ten years there stool been several pieces of legislation introduced which has created an ever changing climate of policy on refugees and innovation seekers. This is a result of the solid numbers of rejected innovation seekers who eat up had all symbolizes of relief withdrawn from them and argon now destitute in the UK. institu tion seekers exhibit a vulnerable population due to a forces of pre- and post-migration try factors. Pre-migration factors involve torture and refugee trauma, which may result in mental and material illness. Moreover, recourse seekers often come from conflict atomic number 18as, without opening to adequate health service. Post-migration factors in addition play a role for health. They acknowledge handle, length of origination procedure, language barriers, and wishing of knowledge about the recent health sustentation system.Destitute recourse seekers atomic number 18 those people who be unable to admission charge support for their basic postulate from the government or from their own resources. The pip of rejected mental hospital seekers is appalling, with many unable to reach to their country of telephone line for reasons beyond their control and yet they are non allowed to trim and support themselves (Dumper et al 2009).Below is a table showing the variou s definitions of refugee stipulationAsylum seekerSomeone who has submitted an application for protection under the geneva Convention and is waiting for their claim to be decided by the post Office.Refugee statusSomeone whos claim has been accepted and has been granted Indefinite collapse to Re main(prenominal), and is also eligible for family reunion.Exceptional Leave to or Remain(ELE/ELR)The Home Office accepts that there are strong reasons that the soulfulness should not return to their country of origin. ELR is discretionary and for varying periods depending on the age of the appli sewert and early(a) destinyRefusalSomeone whos application for refugee status has been rejected.1.3 Reasons for quest AsylumThe causes of refugees and institution flows are many from the effects of conflict and wars, political upheaval, to economic problems and look to for a better life. These displaced people face many problems much(prenominal)(prenominal) as oppression, poverty and disease. Some of them have been held captive and tortured in their own countries some have been prosecuted because of their political or religious beliefs and some because they endure to a minority ethnic group.1.4 UK Asylum PolicyServices mangleered to refugees and asylum-seekers in the United Kingdom are largely determined by national legislation that in turn informs policy and practice. The introduction of the National Asylum Support Service (NASS) at the end of the 1990s was accompanied by several Acts of Parliament that have been added to by boost legislation, the most recent being the Asylum and Immigration Act 2004.While historically UK has a long tradition of providing refuge to people fleeing from prosecution, the Government has recently sought- later(a) to affect the conduct of asylum-seekers through legislation intended to discourage asylum-seekers from feeler to the UK. For example the support withdrawn from asylum-seekers who have exhausted their claim is intentional ultim ately to either persuade people to return to their country or practise it easier for the Home Office to remove them. In the same way, supplying of support to asylum-seekers is often conditional on their agreeing to be scatterd to unlike parts of the country (Johnson 2003).1.5 Statistics of asylum seekers in the UKThe main source of info on the UK asylum process and flows of man-to-mans through it is the Home Office RDS units. passim the asylum process, administrative data is entered into a number of computerised databases, which are back up by a keen number of manual systems. The Case study Database (CID) records information on applications, decisions, appeals, removals (including voluntary assisted returns), persons held in clasp and persons sledding storage area. The Asylum Seekers Support System Database (ASYS) records details of asylum seekers applying and receiving support (ICAR 2009).The UK true 25,930 applications for asylum in 2008, compared to 23,430 in 2007 m aking it an increase of 11%. The highest level of asylum applications, in the last decade, was in 2002, with levels falling significantly after that. It was not until 2008 when the number of applicants started increasing once again. The chart down the stairs shows the number of applicants received in the UK between 2000 -2008. The chart was taken from the Information sharpen about Asylum Seekers and Refugees (ICAR) Statistics paper.Figure 1 Applications for asylum in the UK excluding dependents 2000-08(ICAR 2009).The main countries of origin of asylum applicants in 2008 were Afghanistan (14%),Zimbabwe (12%), Iran (9%), Eritrea (9%), Iraq (7%) Sri Lanka (6%), China, (5%), Somalia (5%), Pakistan (5%) and Nigeria (3%) (ICAR 2009).The absolute absolute bulk of people want asylum in UK are single men under the age of 40 who come from countries in conflict (Burnett et al 2001).Figure 2 demo age and gender chipdown of UK asylum seekers(Refugee Council 2009)The above diagram shows th e break down of the gender of principle applicants to the UK. Males under 35 are the volume, whilst females pursuit asylum are scarcely a ration of twenty percent.1.6 sharp for the studyAsylum seekers and refugees have been the subject of media as well as political attention for many years. However, they receive bad publicity and major(ip)ity of the time are stigmatised. They are perceived to come to the UK to take reward of the welfare system and to receive emcee of benefits and entitlements. However, this could not be much wrong as asylum seekers and refugees flee their country not because of excerption but due to circumstances and a search for sanctuary and help. They are not allowed to claim benefits and are forced to live 30% below the poverty line (Kirklees Council 2007). Further much than, most of the asylum seekers come from well off backgrounds and it is only the rich and well off that are able to make the long journey, and hold skilled jobs in their native countri es (FPH 2008).Asylum seekers and refugees are most vulnerable groups of people at encounter of developing mental problems (FPH 2008). Although there is awareness that asylum seekers and refugees are more(prenominal) likely to begin psychological problems factors much(prenominal) as asylum and immigration policies as well as social and economic exclusion and racism all exacerbate their mental condition. Having subsistd all kinds of atrocities from torture, rape, imprisonment, witnessing killings, loss etc., they are faced with further problems once arriving in the UK and their mental body politic further deterio grade.Although refugees and asylum seekers tangible health needs are usually no greater than the host populations this is not the case in relation to mental illness. There are many gaps in our knowledge about the extent of mental health issues affecting asylum seekers and what should be make in addressing these concerns. There is exactly any scholarly literature available on this topic and the ecumenic population need to be more aware of the issues and challenges faced by asylum seekers, and what effect it has on their mental health.1.7 AimsChapter devil2.1 MethodA review was carried out of studies investigating the mental health of asylum seekers. The results and findings of guardedly selected and reliable studies, searched systematically from databases and published sources were summarised. Other sources admitd NHS, Home Office, pilot ladder organisations, books, newspapers and magazines, and finally a general internet search was conducted. The following electronic databases were used CINHAL, Medline, BMJ, Cochrane, Pubmed, Academic search complete, and psycho info. The task of reviewing was done in truth methodically, with step to step plan being implemented, which involved* the way living studies are found* how the relevant studies are judged in terms of their return in answering the question.The following search was performed, searching the title, abstract and any subject heading fields in each database, for example asylum seekers, mental health, health effects of detention. Studies published in journals were selected that involved asylum seekers and mental health, irrespective of whether the research question was addressed directly. Abstracts were screened against set criteria, and if they met the criteria honest copies were obtained and looked at and relevant information extracted. Cited references were also looked at.Chapter threeResults and Analysis3.1 health needs of Asylum-seekersThe basic health needs of refugees and asylum seekers are largely similar to those of the host population, although due to poor and lose of health manage they may have many conditions untreated.Figure 3 Most common health issues affecting asylum seekers.(Wilson 2002).The above graph, taken from a report done by Northern and Yorkshire public health observatory (Wilson 2002) shows the most universal health issues encount ered by asylum seekers. The general/minor health issues includes coughs, colds, flu, viral infections etc. Mental health issues are the most common and include anything from clinical depression, anxiety, centering, loneliness, to torture related psychological problems, post traumatic stress etc. (Wilson 2002).People seeking asylum come from unlike countries and cultures, and have had range of different experiences affecting their health and nutritional state. Once in the UK they face further problems affecting their health such as the effects of poverty, dependency and lack of cohesive social support. On top of this they face racial discrimination which can result in inequalities in health and also have an impact on opportunities in and quality of life. Their experiences also inning their acceptance and attendations of health plow in the UK (Burnett et al 2001). Those from countries with not so well developed health charge system may expect hospital referral for conditions th at in the UK are treated in primary care. This can result in refugees and asylum seekers tint disappointed and health modelers feeling irritated and overwhelmed by the many and varying needs of asylum seekers (Burnett at al 2001).Most refugees experience difficulties in expressing health needs and in approaching health care. Poverty and social exclusion have a electro damaging impact on health. Initially refugees and asylum seekers leave alone need help to make contact with health and social support agencies. Professional interpreters are also essential, as they help to overcome both bi-lingual and inter-cultural communication and as a result able to understand the specific health needs of asylum seekers (Bhatia et al 2007).Although the health needs of asylum seekers and refugees should be a priority, the availability and capacity of healthcare function should also be considered. There is a general feeling amongst healthcare providers that the decision about where to disperse a sylum seekers are based purely on the availability of alteration and factors such as the capacity of healthcare services are not taken into account (Johnson 2003). However, healthcare providers agree that the presence of asylum seekers highlights subsisting weaknesses in healthcare provision and does not necessarily create new problems (Johnson 2003). Due to the complex and conf use legal status of asylum seekers, the majority of healthcare providers are unsure how asylum status relates to healthcare entitlements. NHS rung are usually ignorant about the rights and entitlements of immigrants, and are also not adequately trained (Johnson 2003).3.2 Mental Health and its causesMental Health is be as a state of well-being in which every idiosyncratic realizes his or her own effectiveness, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his fellowship (WHO 2010).Mental Illness is defined as any disease of the heading the psychological state of someone who has ablaze or behavioural problems safe enough to engage psychiatric intervention (Save the Children 2010).The very nature of seeking asylum or human rights protection in the UK means that a person has prevailed in some way in their country of origin and is looking for protection and safety in the UK. Nearly all those seeking asylum have experienced some form of atrocities that mental health issues are almost always intrinsically bound with their personal circumstances and nature of their claim (Burnett et al 2001). However, due to the stigmas and taboos associated with anyone anguish from any problems of the promontory most people do not mention their mental suffering (Save the Children 2010). Most see mental illness as an enduring problem from which there is no recovery. It is therefore evident that those dealing with asylum seekers must address mental health issues with each applicant, making it clear to them that there i s support and treatment available to them. It is crucial that asylum seekers feel safe and supported in order for them to reveal details not only crucial to their claim but also crucial to letting the person assisting them identify and provide assistance for the persons particular need (Save the Children 2010).Majority of the asylum seekers will show signs and symptoms of psychological distress, but this does not necessarily mean that they are suffering from mental illness. Asylum seekers may show symptoms of depression and anxiety, panic attacks, poor sleeping patterns, nervousness and anxiousness (Burnett 2002). They may also develop behaviours to avoid stimuli that reminds them of past experiences, with some also experiencing memory and concentration problems (Burnett 2002). such(prenominal) symptoms are often reactions to their past experiences and current situations. Many of them will have been forced to leave their family behind or may even so not know the whereabouts of thei r family. Their state of mental health may worsen due to social isolation, poverty, hostility and racism, which all have a negative impact on their health (Burnett et al 2002).Arrival, detention and uncertainty, practical issues, e.g. housing, lack of employment, living in a climate of prejudice, family dislocation and reunion, domestic military group and living in the shadow of deportation are all reasons place that contribute to the poor mental state of asylum seekers and refuges (Burnett 2002).Majority of the asylum seekers have suffered some sort of prosecution and harassment in their country of origin, enduring torture, rape or bereavement. They have also experienced the stress of flight and exile. Psychological morbidity has been extensively documented among refugee populations (Burnett et al 2002). The experience of detention compounds the misery of refugees. Captivity is stressful in any context, but is particularly debilitating when it occurs over an indeterminate period and to people who have had previously traumatic experiences of detention (Burnett 2002).Some asylum seekers show signs of anxiety, depression, offense and shame as a result of the atrocities they may have suffered. Such symptoms are common responses to grief and distress and should not be viewed as psychiatric illness. Common experiences in asylum seekers and refugees after trauma include poor sleeping patterns, distressing dreams, headaches, palpitations, sweating, loss of concentration, jumpiness, low mood and shop crying, irritability etc. Symptoms such as consistent failure to study out daily tasks, frequent expressed suicidal thoughts and ideas, social detachment and self-neglect, and behaviour that is abnormal or strange are symptoms that may require specialist help (Burnett 2002).3.3 Mental health of dispersed asylum seekers star of the major initiatives introduced by the Asylum and Immigration Act 1999 is the dispersal of asylum seekers requiring provision of long-term accommodation form London and the South-East to some otherwise(a) parts of the UK (Cornelius 2007). This is due to the fact that long term accommodation is more readily available and cheaper and also to lessen pressure on services and resentment by local communities. However, it is believed that dispersal of asylum seekers is associated with higher rates of psychiatric disorder (Heptinstall et al 2004). Other issues such as loss of newly established support networks, racially motivated crime against dispersed asylum seekers are also common (Heptinstall et al 2004). Although most asylum seekers cope quite well with dispersal, there are those however that choke demented and show signs of dispersal-related mental disorder (Cornelius 2007). Supporting such individuals can be challenging for most mental health clinicians.Asylum seekers referred because of dispersal-related mental disorder can be divided into two broad categories around the bend to moderate psychiatric disorder and life-threatening psychiatric disorder (Cornelius 2007). The majority of affected individuals are likely to experience mild to moderately severe psychiatric disorder with no major risk concerns, whereas a small proportion of individuals may have severe psychiatric disorder such as psychosis or a severe depressive episode associated with risk of suffering to self or others (Cornelius 2007). The differing severity, complexity and risk profile of these two groups designate that mental health strategies for support are likely to be different (Cornelius 2007).Clinicians should undertake a detailed assessment of the needs and risk profiles of asylum seekers, with the aide of interpreters with knowledge of mental health issues. If the outcome of the assessment shows the individual to have forms of mild to moderate severe psychiatric disorder with no major risks thence the mental health support should be centre on helping the individual accept and adjust to dispersal (Cornelius 2007). How ever, individuals may show signs of being acutely psychotic and severely disturbed with risk of legal injurying themselves and others and such individuals should not be dispersed. There is evidence to suggest that plain-spoken cessation of psychiatric treatment can result in overserious deterioration of the individuals mental health and compromise long-term recovery (Cornelius 2007).3.4 Children and AdolescentsAlthough the majority of asylum seekers and refugees are adults, there are however many children who mother in the UK seeking refuge. While some arrive with family, there are those that arrive alone as unaccompanied asylum-seeking children. These children are likely, at an emotional level to have experienced some sort of terror, grief, shame, guilt etc. (Burnett 2002). They may have experienced imprisonment, beatings, rape, they may have witnessed others subjected to violence, or been subjected to torture due to their political or religious belief of their parents, their c olour of skin, and may have lost or been separated from their family. All these experiences and events have different impacts on children.Refugee Children and asylum-seekers are more likely to develop psychological problems due to their experiences (Mind 2009). These children may experience both strong-arm and psychological symptoms that trouble them such as sleep disturbances, feeling of loneliness, isolation, difficulty in learning and a general feeling of unhappiness and anger. They may experience anxiety, aggression, nightmares, poor concentration, withdrawal, and behaviour such as bed-wetting (Burnett 2002).Although unaccompanied children are most likely to suffer from mental health problems, children with families present may also suffer from mental health problems as a result of finding themselves feeling baseless and having to fend for themselves due to absent parents as a result of work or other problems. Furthermore, parents dealing with their own emotional problems are improbable to care for their children properly, which can result in psychological and somatogenic problems (McCormack et al 2005).3.5 Health implications of detained asylum seekersHealth professionals world wide are interested about the potential detrimental effects detention has on the mental health of the detainees (Procter 2005). An experiment carried out by Sultan and OSullivan in which they discover participants deep down an immigration centre found that 32 of 33 detainees showinged symptoms of major depressive illness (Procter 2005). The majority also showed deterioration in their mental state as the length of detention increased. Detained children also showed signs and symptoms of mental distress, which included anxiety, exuberant conduct, nocturnal enuresis, sleep disturbances, nightmares, sleepwalking as well as cognitive development (Procter 2005).Once released the detainees mental illness is likely to deteriorate and it is cognize that adult asylum seekers who have been in immigration detention display a threefold increase in mental illness consequent to their release (Procter 2005). Trauma, upsetting memories about detention, feeling of hopelessness and sadness are the common symptoms experienced by those detained. These symptoms were also present among detainees in an investigation carried out by Dudley (2003), who also found rioting, violence, and hunger strikes common inside immigration detention facilities with 264 incidents of self-harm reported over an 8-month period among detainees (Procter 2005). Once the detainees are released from immigration detention, they face new challenges and stresses in the context of existing mental health problems (Procter 2005).In another study carried out by Thompson and colleagues found that Tamil asylum seekers detained during 1997 and 1998 found the detainees experiencing high levels of depression, post-traumatic stress, anxiety, panic and physical symptoms compared to those asylum seekers living in t he community (Steel et al 2004). This study found detention to be injurious to the mental health of asylum seekers with mental health deteriorating with increased length of detention. The study also indicated that adults and children are regularly distressed by memories of detention and feeling of immense sadness and hopelessness about being in detention. Parents of children also felt they were unable to care for or support and control their childrens behaviour (Steel et al 2004).Hundreds of children are detained in immigration centres every year in the UK because their families face deportation. Medical experts say this can have harmful health implications on the children. The Royal Colleges of Paediatrics, GPs and Psychiatrists say other countries have found alternatives to detention and want the British government to take a different approach to stop the physical and psychological ruin suffered by children (Wilson 2009). These children are among the most vulnerable and detention causes unnecessary harm to their mental and physical health.The average stay of children at Yarls Wood, the UKs largest immigration removal centre, is fifteen days but a third are detained for more than a month. Detaining children for any length of time is a frightening experience that can have lifelong consequences (Wilson 2009). As well as the potential psychological impact, these children invariably experience poor physical health as they cannot access immunisation and preventative services (Wilson 2009).3.6 Previous research/studies on health of asylum seekersKnowledge about asylum seekers health and access to health care services is still limited. Literature on asylum seekers health mainly concerns mental health problems and infectious diseases. Burnett Peel reviewed the literature and found that one in six asylum seekers had severe physical problems and two-thirds had experienced mental problems. Prevalent physical problems included tuberculosis, HIV/AIDS, hepatitis A and B, parasitic diseases, and non-specific body pains (Burnett et al 2001). Mental health problems include depression and Post Traumatic Stress Disorder, which are due to traumatic experiences, including torture. Asylum seekers are at the risk of having many and severe health problems of a varied nature.Literature on asylum seekers use of health care services and the barriers they face when seeking care is hard to find. Asylum seekers, however, find themselves in a difficult situation as they are residing in a country, sometimes for years while waiting for a decision in their case, without necessarily having the same legal rights as citizens. They may face limitations on access to health care compared with the citizens. This combined with the asylum seekers already vulnerable health and with possible restrictions on access to care may result in their health deteriorating (Burnett et al 2001).Studies carried out in the UK have found that one in six refugees has a physical health problem s evere enough to affect their life with two thirds having experienced anxiety or depression.Medical blanket of newly arrived asylum seekers exist in the majority of the EU countries as well as the UK. However differences exist in the way medical covering fire is carried out. In the UK medical cover version is only carried out in the so-called abstraction or reception centres. Newly arrived asylum seekers who do not enter these centres access medical screening randomly. Medical screening may be available for asylum seekers living outside the centres, but using it depends on individual initiative and there might be a number of barriers. Medical screening programmes also differ in their content from one EU country to another. For example, TB screening was included in the screening programmes of all countries but one, whereas screening for mental health problems was carried out in less than half the countries (Norredam et al 2005).Overall, medical screening programmes appear to have two aims. One is to secure the well being of asylum seekers, and the other to guarantee the safety of the population in the host country. The content of the screening programmes is likely to depend on how the country priorities these aims. For example, screening for infectious diseases seems more related to the safety of the host population and mental health screening more to the well being of asylum seekers (Norredam et al 2005).Regarding access to health care, the study shows that access was restricted to only emergency care at the time of arrival in 10 countries (Norredam et al 2005). The results, however, do not show, if some countries offered alternative measures in case of chronic illness. The study also found that asylum seekers faced a number of practical barriers when seeking health care. Most of the barriers were concerned with immigrant populations in general, and are related to language, culture, and lack of information about the health care system in the host country. H owever, practical barriers specific for asylum seekers were also identified. The most severe of which include waiting for months or years on paperwork that will ensure access to health care, while only having access to emergency care in the meantime. The literature also shows that asylum seekers access to health care may be compounded by other barriers, such as project in detention centres, and dispersal policies leading to disruptive and compromised care (Norredam et al 2005).The study also shows how legal access to health care services have changed over time for asylum seekers in three countries. Asylum seekers rights to health care are immediately restricted to emergency care if their application is refused (Norredam et al 2005). Failed asylum seekers may also be au naturel(p) of the other rights in an attempt to force them out of the host country. Failed asylum seekers include persons who cannot return because their countries are deemed unsafe by UNHCR. UK is one of the countr ies using increasingly restrictive measures towards failed asylum seekers. Failed asylum seekers used to have forego access to NHS, but since 2004 they cannot obtain free secondary health care (Norredam et al 2005).In another study in which the impact of detention on asylum seekers was examined, found that detainees are rendered hopeless and powerless in detention (Pourgourides 1997). The unknown duration and reasons for detention mean they are unable to make sense of their predicament and deal with it in a meaty way. The unpredictable outcome of detention, in particular the fear of deportation is a constant cause of stress. Detention denies asylum seekers the resources to cope with adversity, blocks adaptation to the host society and impairs psychological healing (Pourgourides 1997).Depression, anxiety, demotivation and despondency are all responses to detention as well as misery and suffering (Pourgourides 1997). The study highlighted high levels of stress and distress amongst d etainees. The detainees appear to be able to cope for the early month or two in detention but then after that they become increasingly frustrated, demotivated and apathetic. They start showing signs of psychological symptoms such as sleep and appetite disturbances, symptoms of post-traumatic stress, psychosomatic symptoms etc