Diversity as discourse and diversity as practice: critical reflections on migrant women’s experiences of accessing mental health support in London (original) (raw)

Exploring the provision of mental health services to migrants during austerity: Perspectives of third sector organisations

2020

Due to austerity policies that started in the United Kingdom in 2010, third sector organisations have experienced an increasingly competitive funding environment. Migrants are at a higher risk of developing mental health problems because of a variety of factors including trauma in their countries of origin, isolation, discrimination and more. Furthermore, many migrants prefer to access mental health services outside the formal public system because such organisations tend to take a more holistic approach, are trusted more and offer culturally appropriate care. This report takes a Grounded Theory approach to investigate how third sector organisations providing mental health services to migrants experience austerity policies in London. Four phases of data collection, comprising of interviews, participant observations and a public conference on the topic, have been used to study the experiences of 15 organisations. A thematic analysis reveals the ground impact of austerity, including, ...

Mental health in a migration crisis. Designing front-line services for refugees, asylum seekers and local populations at-risk in the United Kingdom

2023

Details of the Research for Health in Conflict (R4HC) project can be found here along with interviews with our research leads. 1) What were the challenges in R4HC-MENA research? 2) What are the key research findings of R4HC-MENA? 3) Why is research important for academia and policy? 4) What were the key lessons from the research and project? 3 Foreword With public and political attention fixated on numbers of refugees arriving from Europe, giving proper thought and weight to their experiences as individual human beings is long overdue. There are many voices calling for this, but few have had an effect so far on policy-making by governments. Britain has a mixed record: the genuine compassion for refugees shown in much of society is set against the chilling "hostile environment" policy put in place by the government. Subsequent hardening of the policy, in the face of its failure to achieve its deterrent purpose, has compounded its harmful effects on human lives. The harm inflicted on individuals goes on to damage the social cohesion of communities and families, for lifetimes. The work done by the participants in this workshop springs from both a humanitarian approach to refugee needs, and clear-headed understanding that the psychological harm being inflicted by current policies is creating a greater problem for Britain as a society, with serious consequences long into the future. This report explains how these unintended and highly undesirable consequences of policy choices can be mitigated, and if possible reversed, without creating pressure on public services that is not more than offset by long-lasting and beneficial outcomes. The report is centred on mental health services. These will never be sufficient to meet the needs of the population if, elsewhere in the picture, government policies are not helping to enhance the existing capacity of frontline services for both local populations at risk and newly arrived refugees. Coping with trauma and mental health issues, as the great majority of refugees arriving in Britain are, requires a supportive environment of trust, hope and recognition. Not its exact opposite. I hope all those involved in wrestling with the difficult questions of refugee and asylum policy will take time to read and think about the important conclusions reached in this report. And act in the way proposed. James Watt is a former British Ambassador to Lebanon, Jordan and Egypt and Chairman, International Advisory Board, Research for Health in Conflict in the Middle East and North Africa, Conflict and Research Group, King's College London. 4 Table of contents Foreword Abbreviations and acronyms Policy brief: Options and recommendations Policy and operational recommendations Research recommendations Next steps for the community of practice will be to: 1. Introduction, workshop aims and objectives 1.1 Research for Health in Conflict 2. Situation and policy context: demand and access to mental health care in the Middle East region and the United Kingdom 2.1 Mental health services in the Middle East 2.2 Mental health services in the United Kingdom 3.Workshop methodology 4. Workshop insights 4.1 Experiences of frontline workers from Syria and Lebanon: Challenges in accessing mental health care, inspiring stories and policy opportunities 4.2 Experiences of frontline workers in the United Kingdom: Challenges accessing mental health care and good practices 4.3 The experiences of Alnarjes and Hanan: What does it mean to be a refugee in the UK today? 4.4 Afternoon sessions-Group work 4.5 Right-to-work: employment is good for mental health and the economy 5. Recommendations for future research and policy actions. 5.1 Policy and operational recommendations 5.2 Research recommendations 5.3 Next steps for the community of practice will be to: 6. Appendices 6.1 Workshop programme 6.2 List of participants 6.3 Attendees feedback

Refugee and Asylum Seeker Communities and Access to Mental Health Support: A Local Case Study

Journal of Immigrant and Minority Health, 2022

The complex mental health needs of refugee and asylum seeker (RAS) communities, often resulting from past trauma, are not met by overburdened and inadequate service provision. Pre-displacement, in-transit, and post-settlement traumas create a specific set of mental health needs which underfunded mental health services often cannot meet, despite the illusion of access to a range of services. This paper aims to explore how a range of stakeholders responded to inadequate provision at the local level. Interviews and focus groups with regional stakeholders, charities and RAS community groups, which were conducted as part of wider mixed-methods project on international migration in Northern England, revealed several gaps in provision. Findings indicate that charities and community groups are often left to fill the gap and provide signposting and liaison with local authorities. However, these groups are often ill-equipped to provide sufficient support but the absence of commissioned services leaves limited options. We conclude by suggesting that further research is necessary on trauma, RAS communities, and the pathways to mental health support.

Invoking vulnerability: practitioner attitudes to supporting refugee and migrant women in London-based third sector organisations

Journal of Ethnic and Migration Studies, 2019

The paper explores London-based third sector practitioners’ engagement with vulnerability in their work with refugee and migrant women during pregnancy and in the post-natal period. Practitioners draw on notions of vulnerability that signal weakness and passivity as a strategy, which enables them to secure resources for the women they support as well as to sustain their own organisational existence in a third sector landscape that has been transformed by a range of neoliberal measures. Despite this invoking of essentialised vulnerability practitioners possess an awareness of how the broader context of women’s lives, including government policies and structural disadvantage, acts to shape their vulnerability. The paper argues practitioners’ contextual understanding of refuge and migrant women’s vulnerability resonates with theoretical approaches that conceptualise vulnerability as an ontological characteristic of human existence. Strategic use of essentialised vulnerability is central to accessing resources, while an ontological understanding of vulnerability as a universal potential activated by socially mediated unequal power relations enables practitioners to address the specific factors that are producing women’s vulnerability to harm. Crucially, this includes challenging the effects of the UK government’s antiimmigrant ‘hostile environment’ policy and neoliberal austerity measures.

(Super)diversity and the migration–social work nexus: a new lens on the field of access and inclusion?

Ethnic and Racial Studies 38(4): 608-20, 2015

The notions of diversity and superdiversity are of promising relevance to social work with immigrant clients. They enable a nuanced appreciation of the complex and varied sources of inequality to which such clients are exposed. However, these categories are sometimes employed in overly principled or prescriptive tones, and their distinctive contribution is relatively under-debated. How can diversity and superdiversity be used to make sense of migrants’ disadvantages as welfare clients, and what do they add to the pre-existing social work perspectives? This paper revisits three major issues from within the literature on social work with immigrants: (1) the shifting ways of framing these clients; (2) the relevance of diversity and superdiversity in the self-representations and organizational arrangements of service providers; (3) the methodological underpinnings, and ensuing dilemmas, of helping relationships with immigrant clients. Overall, social work emerges as an exemplary field to assess the conceptual transition from diversity towards superdiversity.

Humanising the migration crisis: designing front-line mental health services for refugees, asylum seekers and local populations at risk in the United Kingdom

Global Challenges Research Fund, 2023

The current asylum and refugee crisis being played out in Portland off the Dorset coast is damaging brand Global Britain. It threatens to relegate us from the Premiership of nations. Survival migration and population displacement are challenges that will worsen in coming years due to climate change, conflict, and economic crises. The United Nations state that one in 8 of all people across the world are on the move – an estimated 1 billion people. Of this population, one in 10 (100 million people by end of May 2022) have been displaced due to armed conflict and climate change. [iii] Practical policy ideas based on evidence, and which treat people humanely are now needed to tackle these systemic challenges. A new report from the Research for Health in Conflict Group led by academics from the Centre for Business Research at the University of Cambridge and colleagues from King’s College London and the American University of Beirut presents stark insights into the treatment of refugees and asylum seekers in the UK, especially their mental health.

Refugee and Immigrant Community Health Champions: a Qualitative Study of Perceived Barriers to Service Access and Utilisation of the National Health Service (NHS) in the West Midlands, UK

Journal of Immigrant and Minority Health

There has been much discussion recently that better healthcare systems lead to increased service access and utilisation. However, there are still concerns raised among the refugee and immigrant communities about barriers to access and utilisation of primary healthcare services in the UK. This study aimed to explore with refugee and immigrant community health champions (CHCs) their perceptions about such barriers based on feedback in their own discussions with fellow refugees, asylum-seekers and immigrants in the West Midlands, UK. A total of 42 refugees and immigrants were recruited. Qualitative design-focused group discussions were conducted among purposively selected participants. These discussions were conducted between May and September 2019, and data were analysed using thematic analysis. The barriers to service access and utilisation are categorised into four themes: (i) knowledge about health issues that most affected refugees and immigrants; (ii) community indications of fac...

Multicultural mental health services: projects for minority ethnic communities in England

Transcultural psychiatry, 2005

Black and minority ethnic (BME) communities form 7.8% of the total population of the UK. Many of these communities face a variety of disadvantages when they access, or are forced to access, statutory mental health services under the National Health Service. Efforts have been made to address these problems by developing projects both within statutory mental health services and in the non-governmental ('voluntary') sector. This article describes some of these projects located in England, drawing out the themes and models that underlie their approaches, and discusses the lessons that can be learned from the U.K. experience. Key words ethnic minorities • inequality • multicultural • NGOs • racism The UK, comprising England, Scotland, Wales and Northern Ireland, has seen waves of immigration over the centuries. Until recently, immigration had been largely from other parts of Europe, but many of the immigrants during the postwar period were from South Asia, Africa and the Caribbean islands of the 'West Indies.' The terminology used to describe the different racial, cultural and ethnic groups now permanently resident in the UK has varied from time to time. The concepts 'race' and 'culture' have given way to 'ethnicity' for the purpose of categorization, the standards being set by the categories used in the national census (White, 2002). Ethnicity is usually self-ascribed to reflect self-perception in a

Perspectives of mental health professionals on treating refugees and asylum seekers in the United Kingdom

Questions about providing mental health care to forcibly displaced individuals in an effective way have long challenged experts . Concerns about the suitability of providing psychological support in the context of significant instability and about the efficacy of Western-derived treatments for an overwhelmingly non-Western population are at the forefront of contemporary disagreements in the field (Miller and Rasmussen, 2010; Neuner et al., 2002). Yet little is known about the perspectives the clinicians who treat forcibly displaced individuals, namely refugees and asylum seekers, hold about their work. The following study presents the results of a qualitative investigation in which five semi-structured interviews were conducted in 2011 with clinicians treating displaced individuals in the greater London and Cambridgeshire areas. These interviews were analyzed using interpretative phenomenological analysis (IPA). The findings convey how professionals practicing with this population maintain a positive outlook on the efficacy of their treatments. While the group attributed some barriers to cultural differences, they also identified the two essential prerequisites of understanding and interest on which successful counseling was predicated. The participants offered insights into how they view the acculturation process as having a beneficial impact on their clients' ability to make gains in counseling.

Access to primary health care for asylum seekers and refugees: a qualitative study of service user experiences in the UK

British Journal of General Practice, 2019

BackgroundAsylum seekers and refugees (ASR) face difficulty accessing health care in host countries. In 2017, NHS charges for overseas visitors were extended to include some community care for refused asylum seekers. There is growing concern that this will increase access difficulties, but no recent research has documented the lived experiences of ASR accessing UK primary health care.AimTo examine ASR experiences accessing primary health care in the UK in 2018.Design and settingThis was a qualitative community-based study. ASR were recruited by criterion-based sampling through voluntary community organisations.MethodA total of 18 ASR completed face-to-face semi-structured recorded interviews discussing primary care access. Transcripts underwent thematic analysis by three researchers using Penchansky and Thomas’s modified theory of access.ResultsThe qualitative data show that participants found primary care services difficult to navigate and negotiate. Dominant themes included langua...