Mental Illness in Refugees and Asylum Seekers - Essay Example

 Introduction: The Home office defines a refugee as a person who “owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion…is outside the country of his nationality (and)….is unwilling to avail himself of the protection of that country.” (www.ind.home-office.gov.uk). For a variety of reasons, some individuals may leave the country of their birth and move to another country without being able to secure the necessary legal permissions or formal documentation required to survive adequately in that country. Derived of legal documentation and valid entry papers, these refugees are often ineligible to work and their plight has been recognized in the 1951 Geneva Convention that defined their status in legal terms and highlighted their need for care and a safe haven. A refugee or asylum seeker is a vulnerable adult defined by the Department of health as someone “who is or may be in need of community care services by reason of mental or other disability, age or illness and who is or may be unable to take care of himself or herself or unable to protect himself or herself against significant harm or serious exploitation.” (DOH 2000). There is a high incidence of mental illness reported among refugees and asylum seekers, which may arise due to a variety of causes and there is an urgent need to address the health needs of these individuals. Plight of refugees and asylum seekers in London: Refugees and asylum seekers tend to settle down in cities that are close to the ports or entry points through which they came into the country.(Home Office, 2003; GLA). As per the requirements of the Home Office, all refugees in the UK, including asylum seekers are entitled to receive treatment from General Practitioners at NHS Hospitals, however those asylum seekers whose applications have been rejected cannot avail of in-patient services. The prevalence of mental health problems among immigrants, especially asylum seekers has been found in several earlier studies in other countries (Vega, Collody and Valle, 1987; Williams and Berry , 1991). Similar results showing high levels of depression, anxiety and panic attacks among asylum seekers in Britian have also been shown in other studies (Burnett and Peel, 2001; Misra et al 2005,2006). Misra et al (2005) undertook a needs assessment of asylum seekers and refugees in the Hariney area of London Borough, in order to estimate the accurate number of such seekers and the availability of such services. They point to estimates that about 350,000 asylum seekers have come to the UK from 35 countries. A GLA report estimates that there are between 350,000 to 420,000 asylum seekers and refugees in the London area. (Fassil, 2000; www.london.gov.uk). These authors have not included in their study, those refugees who have already been admitted into the country or who have been able to find long term employment. Misra et al (2005) conducted interviews with adults refugees and asylum seekers of working age and participants expressed the view that access to medical services was a problem due to the time interval of five to eight weeks required for registration with a GP. Anxiety about their uncertain legal status and a lack of knowledge about their rights in the host country, coupled with social isolation and language difficulties further heightened the problems for mental health patients, who find it difficult to communicate their problems and receive the help they need. The study conducted by these authors (Misra et al, 2005) revealed high levels of mental illnesses for refugees and asylum seekers, in the form of various kinds of psychiatric morbidities. They estimate that one third to one half of asylum seekers are in need of medical help for mental and psychiatric conditions. Adding to the problem is the fact that these people may not view themselves as being mentally sick but rather suffering from other problems such as political or economic problems. This false belief, coupled with the difficulties in communication due to the barriers in language function as a further impediment for these individuals seeking the services of mental health care providers. Some of the reasons Misra et al (2005) put forth for the high incidence of mental health problems are the heavy burden of persecution and trauma they may have experienced in conflict ridden situations with the prevalence of torture and the stress sand strain of traveling across national borders. They are away from their own culture and have to make a fast adjustment to an entirely different culture and environment. Some of the stressful elements they cite in their study, as unearthed by other researchers include social isolation, linguistic problems and the resultant difficulties in communication, poverty and constant anxiety about safety and security. Bereavement for family members who may have been lost or be missing during the flight from their home countries may be yet another stress generator among these groups of individuals, and psychological pain may be more difficult for these individuals to cope with as opposed to physical pain which they may have experienced in an environment riddled with conflict and torture in their home countries (Lipson, 1993; Tribe 2002). In further examination undertaken recently from a health care provider perspective, they highlight the prevalence of mental health problems among these groups. (Misra et al, 2006). In a series of interviews conducted with providers, these authors have pointed some of the problems highlighted by them (a) the increased demands placed upon time and resources which are already under strain (b) language barriers and the difficulties in administering treatment through interpreters (c) cultural barriers which resulted in asylum seekers consulting providers about problems outside their ambit and the question of whether western methods of treating mental illness were appropriate for refugees and asylum seekers. Assimilation: One of the significant reasons for the high incidence of mental problems among refugees is the difficulties they face in assimilation. The ability to adapt to conditions in the host country after having experienced different conditions in one’s native country is an integral part of maintaining health and well being of an immigrant.(Portes and Rumbault, 1990). While mental problems in immigrants were initially attributed to be caused by their own shortcomings or psychological makeup, further research has revealed that the main reasons are linked instead to stressors within the environmental context. (Vega et al, 1987). There is a vast difference between the conditions that an individual may have been exposed to and grown up with in his/her home country as opposed to the country of immigration. Compressing the “profound historical changes of a revolutionizing century into a few adult years of an individual life cycle may extract a high price in psychological well being.” (Stole et al, 1962:354) This process of assimilation is further complicated through linguistic difficulties and problems in communication. As a result, these individuals experience social isolation, coupled with bereavement for family members who have been lost, killed or left behind at home, thereby leading to severe depression and mental health problems.(Burnett and Peel, 2001). Stress: Bach et al (1982) point out that the conditions refugees may have experienced in their native countries may have been traumatic, and the manner in which they may left their country, the modes they may have used to arrive in another country and the squalid conditions which may continue in the country of their arrival may serve to generate considerable stress in immigrants. Lawrence (2004) documents the fate of refugees in Australia, who are placed in mandatory detention. She points out that these refugees flee their home shores seeking protection but often face an unfriendly environment in the host countries, resulting in a high incidence of depression, anxiety, post traumatic stress disorder and attempted suicides. This is replicated in London as well, as pointed out Misra et al (2005), where immigrants are not allowed to work and this creates the greatest hardship for men because it affects their pride and sends them into depression, stress and loneliness. The uncertainty about the state of residence may itself serve to fuel anxiety and depression, leading to mental illness. For instance, refugees who are granted temporary visas may in fact face higher levels of stress and anxiety, rather than those who receive permanent visas.(Annonymous, 2006). A recent report states that about 92% of refugees on temporary visas are stressed out as compared to 10% who were given permanent visas. The refugees may worry a great deal about their families and their safety, being forced to return to the home country where they have faced torture or being unable to return to the country of their birth. The refugee experience has been referred to by some researchers as being equivalent to one which is akin to dislocation from familiar surroundings and a loss of trust in new and strange surroundings.(Turner 1995; Summerfield 1998). These individuals are placed in a position where they have experienced the loss of safety and order in their home territories through civil war and conflicts in those areas and now find themselves in strange surroundings where they are also linguistically bereft and unable to judge the trustworthiness of the people around them. In most instances these refugees may have survived by lying their way out of their home countries and may have learnt to be distrustful of authority and of the people around them; as a result they are unable to talk freely about the pain they have experienced or the lost and disoriented feelings they are feeling for fear that someone may exploit them if they reveal their vulnerabilities.(Meucke, 1992). This places a further strain on the mental state of these individuals, since they are unable to vent their feelings or anxieties and receive help and medication. They may also be unsure about the legal implications of seeking help in a foreign country and whether such help will be accorded; in those rare instances where they may seek help the difficulty in access to services proves to be a further barrier to receiving treatment and worsens the mental condition.(Misra et al, 2005) Discrimination and neglect: As Misra et al (2005) have pointed out, difficulties in communication through language barriers may bar refugees and asylum seekers in approaching health care providers. This could result in neglect of their problems which may not be intentional, but may simply be a question of logistics, since it not be possible for the Governmental bodies such as the NHS to specifically hunt out and treat these individuals, unless they approach health care personnel on their own. Moreover, in many cases, there may be legal and paper formalities that must be completed before an individual can access to health services, as Misra et al (2005) point out, access to GP services could typically take from six to eight weeks which results in unintentional neglect and exacerbation of the mental illness these individuals suffer from. Furthermore, since these refugees are from other countries and are poor and helpless, they may unwittingly become the subjects of discrimination by others in the host country. Due to the loss of right of free movement and the right to work, refugees and asylum seekers are in a helpless position, especially since their legal status in the country is still indeterminate and in some cases can also be unfair, in granting residence rights to some refugees while denying it to others (Amnesty International, 2004). This only adds to the uncertainty and anxiety that these individuals are already feeling and increases their depression, leading to other kinds of psychiatric disorders. Another important aspect that arises is the question of funding health care for these refugees and asylum seekers out of public resources that are already strained. Hargreaves et al (2005) have discussed how new proposals by Government are targeting asylum seekers in their bid to reduce what is viewed as an abuse of the UK’s health related services. Regulations are being introduced into the NHS to regulate in a much tighter fashion, the funds that are being dispersed to individuals for health services and the nature of the services that are being provided. All free secondary care services to asylum seekers who have failed in their bid to be legalized, have been withdrawn by the NHS as of April 2004. Moreover, while contagious diseases may be treated free of charge, this does not include HIV/AIDS for which payment has to be made. Since most refugees and asylum seekers, especially those who have failed to be legalized, are not authorized to work, they may be unable to afford health care services. Since many of the failed asylum seekers cannot be sent back to their countries immediately and may be forced to remain in the UK, stateless and unemployed, this worsens their situation. It also worsens the rancor and ill will that they face from others in the host country. The process of seeking asylum is in itself a grueling one, since the individuals may experience high levels pf anxiety about whether or not they will be legalized, however once the process has failed they may experience higher levels of anxiety as they await deportation. Conclusions: On the basis of the above, it may be concluded that there are multiple reasons for the incidence of mental illness among asylum seekers and refugees. One of the most important reasons that may be attributed to be a causal factor is that of stress. These individuals face stress in their home countries, where they may be subjected to oppression or torture, as a result of which they may flee those countries in order to escape the persecution they face. Moreover, the conditions under which they may leave their country, the conditions under which they may be transported to the host countries, and the uncertainties they face once they arrive in the host country all serve to reinforce the anxiety these individuals feel. While escaping from the oppression in their home countries, immigrants may also lose their loved ones and this could further exacerbate the stress and strain of the overall traumatic experience of leaving their home country and traveling to a strange land. Apart from the stress that refugees may face on leaving the countries of their birth, there is the question of the unfriendly response in the host countries, where these individuals are often detained or not permitted to work, since they do not have the necessary legal documentation or work permits and therefore are unable to access many basic level services that are available to others living in these lands. There are often differences in language and immigrants are unable to communicate their needs to those around them, which results in a feeling of isolation and loneliness through a loss of verbal contact with others. This inability to communicate further enhances the feelings of anxiety and depression these immigrants may already be feeling. The legal process of actually going through the application to receive asylum may also be a harrowing and anxiety generating one for these individuals. The outcome is uncertain and there is no set procedure that can guarantee that the application for asylum will be accepted, as the report from Amnesty International shows. As a result, the plight of the refugees becomes one fraught with despair and helplessness, especially for the males who are unable to work and whose pride and self esteem is adversely affected by the in-limbo status. All of these aspects contribute towards raising stress levels for these individuals, which are further worsened by poverty, isolation and the unfriendly atmosphere they often face. Over and above all these problems, the unwillingness of these individuals to face up to the fact that they may have mental problems may itself be an almost insurmountable obstacle. There is a tendency for refugees to attribute the health problems they face to other causes, such as economic or political ones, so that they are unable to realize that they may need help and continue to suffer in silence. Even in those rare instances where they approach Government hospitals for help, they may find it difficult to gain access to care, due to the time factor required in registering to see a GP. Moreover, since many of the health services have now become paid for services, the unemployed status of the refugee or asylum seeker often means that he/she is unable to afford these services and is forced to endure his or her mental health deterioration in silence. Therefore, these individuals are often the victims of the system in a sense, because they unintentionally bear the brunt of neglect of the system about their health needs. Since health care providers are already burdened with a level of sick patients they are unable to cope with effectively within the constraints of time, there is less priority accorded to asylum seekers, particularly those whose applications for asylum may have been rejected. There is also a paucity of funds and Government initiatives are geared towards battling for preservation of resources and their efficient utilization to take care of its own citizens first. The prevailing belief that refugees and asylum seekers abuse the services of the NHS and use it at the expense of other needy individuals who are legal inhabitants of the country, has resulted in further elimination of the avenues that were once open to refugees to obtain services and they now have to pay for most secondary services unless they are life threatening emergencies. Mental health disorders are not characterized as life threatening unless the patient is severely disturbed, therefore most individuals suffering from this condition do not much other recourse than to endure it, with no legal course available to them to fight for relief. Bibliography: * Amnesty International, 2004. “Get it Right: How Home Office Decision Making Fails Refugees”. 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IN EV Daniel & JC Knudsen “Mistrusting Refugees” California: University of California Press. * Vega, William A, Kolody, Bohdan and Valle, Juan R, 1987. “Migration and mental health: An empirical test of depression risk factors among Mexican women.” International Migration Review, 21:512-29. * Williams, Carolyn N and Berry, J.W., 1991. “Primary Prevention of Acculturative stress among refugees: Application of psychological theory and practice.” American Psychologist, 46, 631-42. Read More