It’s the survivors who thrive

One in four of us is expected to suffer from a mental health
problem at some point in our lives. For asylum seekers, absence of
family and friends, and language and cultural differences can make
existing problems worse.

Nearly all of the 3,000 new clients attending the Medical
Foundation for the Care of Victims of Torture each year have a
mental health problem. And although it is unusual for asylum
seekers and refugees to develop psychoses, serious depression and
post-traumatic stress disorder symptoms are prevalent.

Their ability to cope with what happened to them in their home
countries depends on how they see themselves, says the Medical
Foundation’s director of clinical services Alex Sklan: “It’s about
being a victim and a survivor. There is a long journey between the
two and people go up and down.”

Sklan says the Medical Foundation aims to move people away from
feeling victims to being survivors. “Some people are deeply
affected by what appears to be relatively small amounts of torture
and cope badly. Other people experience a great deal of torture and
can seem to cope with it.”

When they arrive in the UK, the fear that their asylum claim will
be rejected and they will be sent home to face further persecution
adds to their mental distress.

“Although they are adults they become like babies,” says Aida
Alayarian, clinical director of the Refugee Therapy Centre, herself
an Iranian refugee. “They cannot communicate with anyone and lack
knowledge about how the system here works and what the culture
is.”

Since it was established in 1999 the centre has dealt with 400
clients from more than 20 countries, 350 of whom have been in the
past two years. Clients either self-refer or are referred to the
centre by social services, GPs and psychiatric services and receive
weekly counselling.

Refugee Action’s well-being project in Manchester tries to help
asylum seekers and refugees cope with their trauma. It was set up
in October 2002 to promote well-being and prevent mental health
problems through a range of activities. These include a football
club (see panel, left), samba classes, tennis and
photography.

The project’s development worker, Tim Hilton, does not talk to
refugees and asylum seekers about possible poor mental health
because the condition is not seen as a separate issue from other
social issues in some cultures. He says:”They see it as something
that happens because they don’t have any friends to visit or don’t
live in good housing.” In some cultures mental health problems are
seen as taboo and asylum seekers do not want to be labelled with a
condition that would exclude them further.

The Nationality, Immigration and Asylum Act 2002 has not helped
their plight. Under section 55, the government can refuse to
support people who do not make their asylum claim “as soon as
reasonably practicable”.

Beba Parker, a training adviser at the Refugee Council, says
denying asylum seekers basic support can lead to a deterioration in
their mental health.

Hilton agrees that the system is a problem: “Asylum seekers are not
allowed to work, spend a lot of time alone and feel isolated, which
leads to mental health problems.”

Sklan says the asylum system’s fundamental problem is that it is
designed to disbelieve asylum seekers and so leaves them feeling
humiliated. Many clients tell the Medical Foundation about the
“horrors of the asylum process”, he says.

Asylum seekers and refugees seeking help for their mental health
problems face the difficulty of finding appropriate services, says
Mental Health Foundation chief executive Andrew McCulloch. “They do
not know how to access services and they don’t see them even being
open to them.”

Alayarian says there is not enough training and supervision of
clinicians who want to work with asylum seekers and refugees with
mental health problems. “This work is not as straightforward as
work with the indigenous population and can be more
challenging.”

Working with asylum seekers and refugees can put off some
professionals, says Parker. “Some practitioners can baulk at it
because they do not understand much about it. They assume that all
asylum seekers are deeply traumatised and they won’t know how to
help them.”

But it doesn’t have to be complicated. “If you simply listen, smile
and show empathy it can help a lot,” says Alayarian, who calls for
staff to use appropriately trained and experienced interpreters to
enable clients to express themselves in a comfortable way.

McCulloch advocates recruiting therapists from the same communities
as asylum seekers and refugees so they understand the culture as
well as language. He also wants to see an audit of their mental
health needs to ensure no one is slipping through the gap. Without
this we may fail to provide asylum seekers and refugees with the
most basic mental health services. CC

– For more on the mental health of asylum seekers and refugees go
to the Mental Health Foundation’s website www.mentalhealth.org.uk/page.cfm?pagecode=PERF

It’s all about confidence

Refugee Action’s Manchester-based well-being project started a
football club last January in an attempt to work positively with
asylum seekers and refugees. Initially, a qualified coach ran open
sessions and in March it was extended to two sessions a week. A
Sunday league football team was set up called International
Manchester Football Club and in September it started playing
matches. So far the team has won four of the five matches it has
played this season. About 80 asylum seekers and refugees have used
the project and 30 regular members make up the team squad. Mohamed
al Din, a Kurdish Iraqi, captains the team and is one of the three
refugees on the club’s management committee. He says joining the
team has made him “happier than before” and given him the
confidence to try new things and make friends.

Fred Diarra, 18, from the Ivory Coast, has attended the football
sessions since they began. “I started coming because I wanted to
make some friends,” he says. “I made many good friends during the
sessions. They helped me forget about all the bad things that
happened in my country.”

Edward Banya, from Uganda, has been playing football at the
scheme for eight months. The 25-year-old says he felt very isolated
before joining: “I couldn’t talk to people or express myself, I
felt very different. Now I can see that everyone is the same as
me.” (All names have been changed.)