“It's not one single trauma, it’s hundreds of traumas”

New films highlight mental health crisis among refugees and asylum seekers

Asylum seekers on a small boat (Credit: geralt)

Asylum seekers on a small boat (Credit: geralt)

Policies aimed at addressing the migrant crisis need to take into account the serious mental health issues faced by refugees and asylum seekers, say researchers at the University of Cambridge as they launch two films highlighting the plight of migrants and possible policy options to support them.

The team, from the Research for Health in Conflict project, say that migrants need equitable access to health services, but warn that policymakers need to ensure that local populations are not disadvantaged as a consequence. However, if correctly developed and implemented, policies could provide a ‘win-win’, helping improve their health and wellbeing while allowing skilled migrants – displaced medics and nurses, for example – to reduce the shortage of frontline staff in the NHS.

According to the United Nations, one in eight people across the world – an estimated one billion people – are on the move. Of these, one in 10 (equivalent to 100 million people by the end of May 2022) has been displaced due to armed conflict and climate change. Survival migration and population displacement are only set to worsen in coming years due to climate change, conflict, and economic crises.

Earlier this year, researchers from the University of Cambridge and King’s College London convened a series of workshops aimed at exploring how to improve mental health services for refugees and local populations at risk in the UK. These brought together academics, representatives from the government, NHS and the UN’s refugee agency UNHCR, together with international non-governmental organisations (NGOs), frontline public health services in the UK, and refugees.

To illustrate the difficult and complex situation facing many refugees who arrive in the UK, the team has commissioned two films from filmmakers Edith Champagne and Warda Aljawahiry. The films show how, after months of being stuck in legal limbo and travelling across Europe, refugees are confronted with the challenges of navigating the complex health and welfare systems in the UK, which only adds to their already vulnerable state and mental health.

Dr Adam Coutts, from the Department of Psychiatry and Centre for Business Research at the University of Cambridge, said: “The ongoing global refugee crisis resulting from conflicts and natural disasters presents complex humanitarian, political and public policy challenges for countries receiving refugees and asylum seekers.

“In the media and political hubbub surrounding the crisis, the lives, personal stories and mental health and wellbeing of migrants, refugees and asylum seekers are absent. We wanted to show the reality of the situation for these people and the challenges they face.”

The first film explores the work of Solace, a charity providing mental health support for asylum seekers and refugees in Yorkshire and the Humber region, one of the partners in the collaboration.

“Asylum seekers are five times more likely to have a mental health difficulty and 60% or more have serious mental distress,” explains Anne Burghgraef, Clinical Director at Solace, in the film. “That may not always be apparent when you speak to someone, but it's always there in the background.

"Everything that held them in place, that gave them a sense of identity, has been removed."

Professor Simon Deakin, Director of the Centre for Business Research, said: “It’s clear there is an urgent need and demand among displaced populations in the UK for better access to good quality mental health services. Currently this service gap is being filled by NGOs such as Solace. This is unsustainable given the likelihood that the numbers of refugees will increase over coming months and years.”

The second film focuses on the loss of identity of displaced people, and emphasises the importance of reframing the policy and public debate around supporting refugees and asylum seekers. Among those featured in the film is Hanan, a Syrian refugee, who describes how the abuse she has received since arriving in the UK has added to her trauma.

“I used to wake up to threatening messages written on the car,” says Hanan. “I woke up hundreds of times during the night to answer phone calls where I had to listen to them threatening me and my parents and sisters in the most horrible way I can think of.

"We were always scared and afraid. We lived with fear. It's not like one single trauma, it's like hundreds of traumas."

Although Hanan got access to mental health services after around seven months, her therapist eventually told her that her case was too complex for their services. She has been referred to another service, but has been warned it might take years before she is seen.

This second film sets out policy options from the workshops and subsequent report aimed at tackling the mental health crisis facing migrants.

Among the team’s recommendations is the introduction of an ‘E-Health and Work Carnet or passport’ that contains essential health and welfare information. This is a secure digital platform that a refugee can access throughout their transit and while they are in the long asylum process. There is a dearth of reliable data on refugee and migrant health, making planning and budgeting for frontline health services challenging. The data void also makes accessing services difficult for migrants. This platform can be updated by a trusted provider in each country they pass through and accessed with the consent of the individual by frontline staff. The aim would be to reduce the burden on already overstretched NHS services by saving time in medical consultations and the need for lengthy interpretation and translators. Translators alone are estimated to cost the NHS £113 million a year. Above all, the intrusive nature of retelling often traumatic stories, events and information to multiple and anonymous service providers is lessened.

Other key policy options include

  • Ensuring equitable service access and delivery for refugees, and local vulnerable populations at risk. Policies for refugees should not function to increase the health disadvantages and inequalities suffered by local populations;
  • Developing a cross-departmental government approach to supporting refugees and asylum seekers. This would involve generating much greater cooperation between multilateral agencies in humanitarian contexts and host community departments such as the Home Office, Department for Work and Pensions, and the NHS;
  • Developing the economic and civil society case for integrating and employing refugees and asylum seekers in the UK labour market. Displaced refugee medics are a key group where quick wins are possible that can benefit the NHS and the lives of the displaced medics.

Recent research found that allowing people seeking asylum the right-to-work would increase tax revenue by £1.3 billion, reduce Government expenditure by £6.7 billion, increase GDP by £1.6 billion, and improve the mental health and wellbeing of those individuals. Critics argue that asylum seekers cost £6 million pounds per day in terms of accommodation needs, but the researchers say this misses the point that these costs could easily be offset by allowing migrants to work and contribute to the economy.

Dr Coutts added: “The immigration and asylum debate is not a zero-sum game. These populations can provide much needed workforce capacity in the UK as well as contributing to the vibrancy and social cohesion of local communities. By helping them overcome their health and mental health needs, interventions can be introduced to reduce the burden on already fragile frontline NHS services.

“Unfortunately, the situation has become so politicised that common sense analysis and practical policy options are often lacking."

"Even the rational ‘no-brainer’ economic ones, which show that asylum seekers make significant contributions to the UK economy and labour market, as well as improving their mental health, if they are allowed to work – a potential ‘win-win’ for all concerned – are absent.”

The project and films were funded by a Global Challenges Research Fund impact grant at the University of Cambridge. This enabled dissemination and major policy impacts to be created from the Research for Health in Conflict project, funded by a five-year UK Research and Innovation and GCRF project grant.

Thank you to the refugees, frontline staff and academics who took part in this research.

  • Professor Simon Deakin, Director, Centre for Business Research, University of Cambridge.
  • Diane Pochard, CSAP fellow, Centre for Science and Policy, University of Cambridge.
  • Anne Burghgraef, Clinical director, Solace.
  • Dr Alexandra Chen, Trauma Psychologist & United Nations Advisor.
  • Nick Edwards and Safaa al-Mokdad: Solace therapists
  • Dr Adam P. Coutts, Department of Psychiatry and Centre for Business Research, University of Cambridge. Dr Coutts is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration, East of England (NIHR ARC EoE). The views expressed are those of the author and not those of the NIHR.