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By Ciara Regan, Refugees, Health and Humanitarian Action course student, SPS 2021-2022 academic year

With the eyes of the world on Ukraine at this time of crisis, the managing of masses of refugees fleeing across Europe is one of the many great challenges that are arising from the conflict.

World leaders have gathered to discuss concerns over the influx of refugees, the UK is no different as debates continue over the number of refugees the Home Office is willing to accept. But the discussion must not be limited only to the volume of refugees accepted; it is also crucial to address how these refugees will be received and in what ways they will be supported.

The Problem

In the UK, regarding mental health, refugees fair worse than the general population after resettlement (Li et al., 2016). Studies show a higher incidence of PTSD, anxiety, depression, and panic disorder than local populations with vulnerabilities linked not only pre-migration stressors, but additionally post-migration conditions (Mental Health Foundation, 2016). The mental health impact of such a crisis began well before these people left their homes, and continued throughout their journey. Yet arriving in a new country is unfortunately not the end of their stress, as post-migration experience further negatively impacts individuals' mental health (Bogic et al., 2015). Often signs of worsened mental health are reported by refugees and asylum seekers after arriving in the UK (Mental Health Foundation, 2016).

When breaking down migration into three stages where stress occurs, we have pre-migration, migration, and post-migration. Each stage of the process contains stress factors such as fear of prosecution, physical danger, separation, detention, and prolonged uncertainty (Giacco and Priebe, 2018). Reflections on past experiences are fundamental to begin planning for early interventions that can minimize post-migration distress. Preventing trauma experienced prior to arrival is beyond the scope of the host nations - but host nations can influence long-term mental health outcomes relating to post-migration stressors (Bogic et al., 2015). Preventing further distress through early intervention and integration into society must be top of the priority list.

Post-migration Stressors

Post-migration stress comes from issues relating to racism, hostility, inadequate housing, economic struggles, and uncertainty over status (Carta et al., 2005). Thus, requiring recognition for the social determinants affecting one's mental health as the process of migration disrupts multiple determinants of health. Lack of control and loss of power over one’s life has massive implications for one’s mental health. Disempowerment and deprivation of choice during the asylum process with feelings of life being on hold further exacerbates or creates negative mental health (Refugee Council, 2006).

A study of refugees after the Balkan warfound that integration in the host nation was key to reducing the development of mental health disorders (Bogic et al, 2012). Keeping this in mind in the current crisis is essential to protecting and promoting the mental health of refugees. Host nations such as the UK must recognize their role in promoting good mental health and wellbeing, and how it extends beyond the provision of services to include processes of acceptance and integration.  Good health for refugees must be recognized as ‘a state of complete physical, mental and social well-being, and not merely the absence of disease’ (1: IOM, 2020)

New Scots

In the Scottish context, decisions on entry status are left to the UK Home Office. Provision of service and appropriate integration is up to the Scottish Government (Scottish Government, 2018). Through the ‘New Scots: Refugee Integration Strategy 2018-2022', Scotland has recognized the importance of prioritizing refugee and asylum-seeker mental health, with a strong focus on early intervention and impactful integration (Scottish Government, 2018). The approach takes a step in the right direction for recognizing social determinants of mental health and the long-term effects of resettlement. This comes at a time when it is acknowledged that refugees’ and asylum seekers’ mental health has been found to be one of the biggest issues facing ‘New Scots’ (Roshan, 2005). 

The approach “recognizes the whole person and the impact which interdependent factors can have on how a person feels, their health and wellbeing” (11: Scottish Government, 2018). One of the objectives to achieve this is to focus on policy and planning that incorporate social and structural factors impacting refugees’ and asylum-seekers overall wellbeing. Another objective focuses on housing as a social determinant, aiming to provide coordinated services when accessing housing and ensuring long-term integration into the community (Scottish Government, 2018). Initial reports remain positive and contain hope for the future (Scottish Government, 2019). Yet considering the relative infancy of the strategy, the long-term outcomes are unknown. Within the context of the current crisis and beyond, efforts to uphold and expanded this approach must be prioritized.

Feelings of belonging and security are key for refugees’ mental health and for the promotion of their rights. If the entirety of the UK is to uphold its commitments to the 1951 UN Convention and the 1967 Protocol, a rights-based approach, such as the New Scots strategy, must be implemented to improve the wellbeing of refugees. Thus, acknowledging the long-term impact of the resettlement process on mental health is crucial.

The Ukrainian crisis brings refugees to the media’s attention, but it must be noted that concepts of integration and mental health among refugees are not novel issues. With no intention of disregarding the extent of the current crisis, this is highlighted rather to acknowledge that the discourse recently is extremely Eurocentric. This hostility of the asylum policies in the so-called ‘Fortress of Europe’, is being lessened as the refugee crisis moves to closer territory. Countries open their borders welcomingly to specifically Ukrainian refugees, leaving those fleeing other crises stranded at the borders (Tondo, 2022). Uncertainty and rejection experienced by other refugees will have detrimental impacts on their health. Support for refugees and asylum seekers must overcome race, gender, religion and identity. Efforts to ensure that ancient structures of prejudice and racism cannot be carried into mental health provisions are essential now more than ever.

References

Bhardwa, S (2018) 'New Resources for Student Mental Health Launched'. Times higher education. June 12th. Available at: New resources for student mental health launched | Student (timeshighereducation.com)

Bogic M, et al. (2012). ‘Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK.’ Br J Psychiatry. 200. Pp. 216-23.

Bogic M, Njoku A, Priebe S. (2015) ‘Long-term mental health of war-refugees: a systematic literature review’. BMC International Health and Human Rights, 29, pp. 3-6, 35-38. Available at: https://bmcinthealthhumrights.biomedcentral.com/track/pdf/10.1186/s12914-015-0064-9 (Accessed: 01/03/22)

Carta, M.G., et al., (2005). ‘Review Open Access Migration and mental health in Europe’. Clinical Practice and Epidemiology in Mental Health, 1(13), pp. 3.

Giacco, D., and Priebe, S., (2018). ‘WHO Europe Policy Brief on Migration and Health: Mental health care for Refugees’. World Health Organisation. Available at: Available at: http://www.euro.who.int/__data/assets/pdf_file/0006/293271/Policy-Brief-Migration-Health-Mental-Health-Care-Refugees.pdf  

IOM (2020). ‘World Migration Report’. World Health Organisation, 06(2019), pp. 34.

IRB. (2020). Refugee Claims. Immigration and Refugee Board of Canada Available at:. https://www.irb-cisr.gc.ca/en/refugee-claims/Pages/index.aspx (Accessed: 27/02/22)

Li, S. S. Y., Liddell, B. J., & Nickerson, A. (2016). ‘The relationship between post‐migration stress and psychological disorders in refugees and asylum seekers’. Current Psychiatry Reports, 18, pp. 1–9. Available at: https://doi.org/10.1007/s11920-016-0723-0 (Accessed: 01/03/22)

Mental Health Foundation (2016). 'Policy Briefing: Refugee, mental health and stigma in Scotland'. Mental Health Foundation, August 2016. Available at: Anti-stigma briefing.pdf (mentalhealth.org.uk) (Accessed: 27/02/22)

Refugee Council (2006), Destitution trap. Refugee Council. Available at: http://www.amnesty.org.uk/uploads/documents/doc_17360.pdf

Roshan N. (2005) ‘Supporting New Communities: A qualitative study of health needs among asylum seekers and refugee communities in North Glasgow’, NHS Greater Glasgow. Available at: supporting new communities summary report 2005.pdf (Accessed: 02/03/22)

Scottish Government (2018) ‘New Scots: refugee integration strategy 2018 to 2022’. Available at: New Scots: refugee integration strategy 2018 to 2022 - gov.scot (www.gov.scot) (Accessed: 02/03/22)

Scottish Government (2019). ‘New Scots refugee integration strategy 2018-2022: first year progress report’. Available at: Supporting documents - New Scots refugee integration strategy 2018-2022: first year progress report - gov.scot (www.gov.scot)

Tondo, L (2022) 'Embraced or pushed back: on the Polish border, sadly, not all refugees are welcome'. The Guardian. 4th March. Available at: Embraced or pushed back: on the Polish border, sadly, not all refugees are welcome | Lorenzo Tondo | The Guardian (Accessed: 05/03/22)