Forced Migration and Mental Health and Recovery

– Face 2 Face Workshop

The workshop was facilitated by David Palmer

David opened the workshop by explaining the complex and multi-faceted nature of migration and mental health due to the factors surrounding forced migration such as the experiences of loss, separation from family/friends, exile, war, torture, trauma and imprisonment. The issue of recovery can be contentious in this field as there is a current debate about whether people who experience forced migration can actually ever ‘recover’ unless they successfully return to their home country.

Recovery in migrants with mental distress would have to encompass a cluster of factors which are practical, social, emotional and cultural. The immigration process itself can be very stressful and along with separation and loss, it can lead to great pressures for people in their everyday lives. David quoted studies that have linked suicides to Home Office decisions and procedures in immigration cases. The existence of wider social factors impacting upon new migrants’ mental health means that a more holistic approach to looking at people’s needs is required. There must to be consideration of the experience of encountering different cultural traditions in a new country along with destitution, detention and denial of access to basic health care in many instances. Issues such as ‘trauma’ and ‘torture’ cannot be treated in isolation but must be considered within this wider social context.

Every culture has its own knowledge of human psychology and has stigma attached to mental health problems and such stigma has to be tackled both within and outside of different ethnic communities. In Face 2 Face, recovery takes the form of one-to-one work focused around self-help, developing one’s own activities and interests, first language advocacy and mentoring. The model of mentoring employed by the Project is a broad and flexible one which incorporates befriending, general support and language help. The mentors are usually doctors who are themselves newly-arrived migrants and many share similar experiences to those they are working with. The doctors involved often have to wait a period of time to re-train or have their qualifications ratified before they can practice here and this can take some years. So the project provides a useful opportunity for doctors to be undertaking something that is educational and developmental for them on a personal level as well as helping other forced migrants. They often feel challenged by the holistic approach adopted by the Project which may go against their traditional professional medical training.

Referrals to the Project come mainly from the Community Mental health Team and the Refugee Support Service with the main criterion being that the person must be motivated to join the scheme and ‘want to do it’. There is an ongoing evaluation study taking a ‘longitudinal’ approach, looking at the ‘beginning’, ‘middle’ and ‘end’ experiences of service users. Methods of data collection include the use of questionnaires, one-to-one interviews and focus groups. The outcomes identified so far have been increases in self-confidence, self-respect and self-worth. In fact there have been some remarkable gains for ‘mentees’ from the scheme highlighting the importance of cultural understanding and first language approaches. One clear finding so far is that further work needs to be undertaken in reducing stigma in the refugees’ own communities.

We then viewed a short video about the Project containing statements from the service users of the scheme as well as the doctors providing mentorship to the service users. There was a heart-rending account from one woman ‘mentee’ who described how she witnessed the killing of her sister by a policeman in her country and the subsequent distress she experienced. She felt that she was not understood and looked down upon until she joined the Project and gained her self-confidence back. There were also several doctors who described the profound impact their work as mentors had had on them and the learning they had gained from operating in more ways than purely medical roles. The importance of cultural understanding, working in first language and above all listening actively to people was highlighted.

Following the video there was a lively and wide-ranging discussion about the implications of the Project for work with forced migrants, refugees and asylum seekers; the mutual benefits for mentors and ‘mentees’ and the under-usage of the skills and capabilities of this group of migrants in the UK. David emphasised the importance of training for the project volunteers around a social model approach to mental health to counteract other forms of professional and medical training mentors may have received previously. The issue of mentors being doctors was raised and it was agreed that the same approach could be used for any group of migrants who wished to volunteer in providing support to their peers who may be experiencing mental distress. Several of the doctors who have been through the scheme had expressed a new interest in working in the mental health field as well, which was another beneficial spin-off for the project. The issue of how effective such doctors could be in the mental health field and how they could be assisted in spreading their expertise in culturally appropriate practices was discussed. In the current climate of attitudes to migrants and doctors from abroad it was agreed that there would be many barriers to overcome.

The project is funded for a further six months and has attracted much praise and attention, even on an international basis with queries from America and Australia. It is hoped that the video being produced will attract further funding for the project. There is more work to be done in challenging stigma in the various migrant communities and to question some of the simplistic diagnoses being given to migrants in mental distress such as ‘Post Traumatic Stress Disorder’. Examples of how stigma operates were given such as in the work of interpreters who may be prejudiced against migrants who are seen as ‘mentally ill’ or ‘mad’. Other wider social and cultural factors must be tackled such as shock, stress, isolation, poverty, lack of support, and misinterpretation and misdiagnosis of culturally appropriate forms of expression of emotions. The overall message was that there needs to be more positive engagement of migrant communities to foster self-help and tap into the enormous potential and skills in those communities. This would not only be empowering for the communities concerned but would also be economically more efficient.

Report by Peter Ferns - October 2007