Mental health issues in asylum seekers and refugees
There is growing concern about the lack of support for asylum seekers and refugees with mental health problems. Such problems are not always short-lived; some can last a lifetime and some may even have an influence on the children of those affected. Refugees are often people with strong determination to survive, which is why they became refugees. Accessing services early and getting appropriate support is therefore crucial.
When making a mental health assessment it is important to:
- Maintain an open mind over a longer period of assessment
- Check how the asylum seeker or refugee defines a mental health problem from their culture; also find out what the culturally appropriate responses might be to what they have experienced
- Include an assessment of the risk of suicide and any issues of child protection
- Recognise there may be cultural and religious taboos regarding talking about self-harm
- Consider that cultural differences and difficulties with language and communication may increase the possibility of a misdiagnosis of mental illness
- Realise that the questions used to diagnose mental illness may not be reliable when used in translation or cross culturally
- Note that black and minority ethnic (BME) people in the UK have been shown to be disproportionately diagnosed with schizophrenia, sectioned under the Mental Health Act and given high doses of anti-psychotic drugs rather than talking therapy
It is important to consider beliefs about the causes of mental illness. People believe many different things cause mental illness including biological, psychological, social, migration, cultural and religious factors. They may be important cultural points to consider when assessing people from cultural backgrounds different from your own. The World Health Organisation (2003) suggests five rules to assist health professionals to understand how to identify and manage mental illness in refugees. The U.S. Department of Health and Human Services has developed some guidelines for mental health screening during the domestic medical examination for newly arrived refugees, and these can be adapted by local services to develop their own assessment tools.
NHS Mental Health Services
Mersey care provides specialist inpatient and community mental health, learning disabilities, addiction management and acquired brain injury services for the people of Liverpool, Sefton and Kirkby, Merseyside. Patients can be referred by a GP, self-referral or crisis team.
5 Boroughs Partnership
5 Boroughs Partnership provide specialist inpatient and community mental health, learning disability and addiction management:
Halton Borough Council
St Helens Metropolitan Borough Council
Warrington Borough Council
Family Refugee Support Project
Family Refugee Support Project
Tel: 0151 728 9340
They work with refugee and asylum-seeking families who are struggling to deal with their experiences of persecution and exile. The project offers psychotherapy to parents and children alongside working on the land at their allotment site. Each family is offered a piece of land, tools, horticultural and psychotherapeutic support, practical support, signposting to other services and individual, family and group support meetings at the Toxteth base.
Referrals can be made by contacting them by telephone or by email. Any individual in the family can be referred. Referrals may be from health visitors, GPs, teachers, social workers, other support workers, voluntary agencies, refugee organisations or others.
Office Opening Hours: Monday to Friday 9.30am – 4.30pm.
PSS - Asylum Seekers and Refugee Counselling Services
Tel: 0151 702 5527
They provide counselling and psychotherapy to asylum seekers and refugees experiencing trauma and psychological problems. They also run a 30-hour course accredited with the Open College Network specifically for interpreters who wish to work in this field, called ‘Interpreting in Therapeutic Settings’. They also train counsellors and associated professionals to work with interpreters.
They accept referrals from any source: the health service, social services, voluntary agencies, clients themselves or interpreters. Contact via telephone service, appointment system.
Office Opening Hours: Monday to Friday 9am – 5pm
Tel: 0151 708 6688
At Compass the aim is to provide the adult residents of Merseyside who suffer from emotional and mental health problems the opportunity to access free one-to-one, long-term counselling. Contact using telephone service, appointment system.
Office Opening Hours: Monday to Friday 9.15am – 5pm
Freedom from Torture
Tel: 0161 236 5744
A counselling and therapy service to survivors of torture and organised violence aged 18+ in the North West. When the service is full, they also offer assessment-only to help survivors access appropriate support in the region.
Refer using their referral form – contact them for copies. Referral forms accepted by post or by fax. Clients may self-refer. Informal discussions regarding possible referrals are available by telephone.
Office Opening Hours: Monday to Friday 10am – 5pm
Refugee Mental Health and Wellbeing Portal
Refugee Mental Health and Wellbeing Portal for Refugees, Asylum Seekers and Health and Social Care Professionals.
General issues in children and young asylum seekers and refugees
Refugee children and young people will have experienced a wide range of stressors and traumatic events prior to their arrival in UK. They include:
- coming under combat fire and bombing
- destruction of homes and schools
- perilous journeys
- sudden disappearances of family members or friends
- loss of family members in violent circumstances
- threat of harm to family members and friends
- refugee camps
- witnessing violence and death
- forced conscription
- physical injury
- arrest, detention or torture
- sexual assault.
This may manifest itself in children in a number of ways, including:
- withdrawal, lack of interest and lethargy
- aggression, anger and poor temper control
- tension and irritability, poor concentration
- repetitive thoughts about traumatic events
- poor appetite, overeating, breathing difficulties, pains and dizziness
- regressions (e.g. return to bedwetting), nightmares and disturbed sleep
- crying, nervousness, fearfulness and proneness to startle
- poor relationships with other children and adults, lack of trust in adults
- clinging, school refusal
- hyperactivity and hyper-alertness.
Under the Children Act 1989, support for separated young people is the responsibility of local authority social services departments, regardless of the child’s immigration status. In Liverpool, a specialist team are responsible for the care and support of these young people. For children and young people who are being looked after by parents or adult carers in asylum seeking or refugee families, any need for services or safeguarding issues should be referred via the City Council Careline service in the normal way.
Services for children and young people
Place2b is the leading children's mental health charity providing in-school therapeutic and counselling support to improve the emotional well-being of pupils, families, teachers and school staff.
Bullybusters provide a responsive and effective service for those who are affected by, or concerned about, bullying in schools and the wider community. Their priority is to raise awareness of bullying, to highlight the effects that bullying has on individuals and wider society and to reduce bullying through a holistic package of training, engagement and interventions whilst working in collaboration with various agencies including the voluntary and community sector in delivering positive anti-bullying strategies.
Free phone advice line: 0800 169 6928
Office line: 0151 330 2012
ADDvanced Solutions Community Network
ADDvanced Solutions Community Network provides community-based, open access, pre-, during and post-diagnosis learning, coaching, mentoring, health and well-being activities and groups for children and young people living with a neurodevelopmental condition.
Telephone: 0151 486 1788
Barnardos Action with Young Carers
Barnardo's Action with Young Carers is a city-wide, community-based service that ensures young carers and young adult carers in Liverpool (up to and including 25 years) are identified and can receive a carer’s assessment, support plan and review to meet their needs and reduce the negative impact of caring for an adult.
Telephone: 0151 228 4455
Alder Hey Children's Charity provides mental health and physical health professionals to assess and treat young people when eating has become difficult. Either a young person has lost a lot of weight and is wanting to continue to lose weight but is becoming physically unwell due to this, or a young person is using other ways, such as over exercising or vomiting to try to control their weight.
Telephone: 0151 2933662
Early Intervention in Psychosis Service
Early Intervention in Psychosis Service
Early Intervention in Psychosis Service supports young people aged 14–35 who have had a psychotic experience and raises community awareness, in order to improve access, engagement and treatment, whilst promoting recovery and ordinary lives.
Telephone: 0151 250 6272
Liverpool FRESH CAMHS
Liverpool FRESH CAMHS is a service for children/young people (aged 0–18) and their families/carers who are struggling with how they are feeling, thinking or the way they are doing things. They especially help those whose difficulties are getting in the way of being able to manage everyday life and relationships. All referrals to this service come through the Single Point of Access.
Office line: 0151 293 3662 / 0151 293 3659
Mersey Care offer a range of assessment and intervention services for young people in Liverpool aged 14 and above who are dealing with a range of emotional and mental health difficulties
Free phone advice line: 0800 328 2941
Office line: 0151 471 2377
Spinning World PSS
Spinning World (PSS) is a specialist psychological therapy service working with trauma and recovery. The aim of the service is to improve the mental and emotional well-being of migrant and refugee children and young people. They also work with any child where English is a second language and where there are issues of culture, race or religion.
Telephone: 0151 702 5527