Mental health needs of young refugees

1
Mental health needs of young refugees

• Dr Irene Sclare
• Clinical Psychologist
• South London and Maudsley
• NHS Trust

2
Refugee and asylum seeker mental health service
work

• Individual, family and parent-focussed treatment
• Groupwork
• Training and teaching
• Joint assessment and planning
• Research and evaluation

3
Nature of mental health problems

• Primarily depression, anxiety and PTSD
• Around 40 of young refugees are at risk
• Increased risk of developing problems if exposed
  to death, war and torture
• Stress associated with UK living adds risks
• Problems can be chronic, impacting on schoolwork
  and social integration
• Social support, post-trauma and on resettlement
  is protective

4
Rohan

• Fled from Kosovo aged 3 years with parents after
  army attack on village
• Father reunited with family in UK after 1 year
• Referred by GP at age 8, because of anxiety,
  irritability and concentration problems
• Separation anxiety, loss fears about lost
  family
• Mothers mood and fathers adjustment
• Trauma-focussed CBT to address fear and loss
• Family communication work re Kosovo events

5
Common clinical issues

• Effect of rape and torture on self esteem
• Within-family problems on settlement in UK,
  including generation and gender
• Inability to communicate about losses
• Parenting difficulties due to adult stress
• Hidden depression, grief and PTSD
• Headaches, pain, sleep problems
• Teenage parents following rape

6
Unaccompanied young asylum seekers

• Younger children are usually in fostercare
• 16 and 17 yr olds are semi independent.
• High incidence of depression, suicidality
• Socially isolated, poor support systems
• Fear of being deported
• Unidentified traumatic memories
• Traumatic grief and anxiety about family
• Language and culture barriers
• Vulnerability and exploitation

7
Hannan

• 17 year old unaccompanied Ethiopian
• Depressed and suicidal, terror of future
• Traumatic memories of dead mother
• Culture and language barriers
• CBT for grief and depression
• Prayer and ritual
• Narrative therapy to provide coherence
• Management of fear of deportation
• Risk management and support

8
Barriers in help seeking

• Lack of knowledge about services
• Shame
• Trust issues
• Stigma of mental health care
• College and study priorities
• Desire to avoid distressing thoughts and memories
• Cultural frameworks for counselling

9
Barriers in services

• Hidden nature of emotional disorders
• Lack of mental health screening
• Lack of inter-agency planning frameworks
• Formality of MH service provision
• Lack of suitable interpreters in surgeries
• Transitions at age 18 to adult services
• Lack of knowledge of asylum law
• Separate children and adult services

10
Coping and adjustment

• Many young refugees are very resilient
• PTSD may resolve when settled/secure
• Talking treatment may not suit all
• English language skills
• School as aid to integration
• Religion and prayer
• Educational motivation and success
• Stabilisation and asylum status

11
Marcus

• Unaccompanied minor from Africa
• Raped by 2 men, abandoned by mother
• Strong Christian faith
• Relationship problems in fostercare
• Heard voices.God is bad
• HIV fears, shame and fear of ostracisation
• Spiritual counselling and CBT for voices
• Fostercarer advice

12
Key messages

• Screen for hidden emotional disorders
• Identify past, present, future concerns
• Consider both parent and child needs
• Facilitate preventive social, religious and
  cultural support
• Inter-agency working advocacy
• Screen for sexual abuse and sexual health
• Headaches and pain as psychosomatic?
• Accessible NHS Clinical Psychology