PROVIDING SERVICES: OVERCOMING DIFFICULTIES

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PROVIDING SERVICESOVERCOMING DIFFICULTIES

• DR ANGELA BURNETT - GP
• and
• DR TAIWO AFUAPE - CLINICAL PSYCHOLOGIST

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Providing mental health services

• Outline of the difficulties which face refugees,
  asylum seekers and healthworkers around mental
  health
• The Access Project - Newham Psychology service
  for people in transition

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Refugees and asylum seekers as people of BME
heritage

• Evidence suggests that services are not
  adequately meeting mental health needs, and that
  black and minority ethnic communities lack
  confidence in mental health services
  
• (NSF Framework for Mental Health)
• S. Fernando

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BME GROUPS EXPERIENCES OF MENTAL HEALTH
CAREInside Outside - Sashidharan 2003

• over-emphasis on institutional and coercive
  models of care
• professional and organisational requirements
  prioritised over individual needs and rights
• poorer outcome
• more likely to disengage from services
• triple discrimination
• institutional racism within mental health services

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CULTURAL BEREAVEMENT(Eisenbruch 1990)

• Multiple loss
• loss of things that give meaning to life
• social structures
• cultural values and community rituals
• relationships
• material losses

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Lets talk about psychology when the war is
over. When the war is over I am going to dream
all the dreams that I cannot afford now.If I
would sit down and start to think of my feelings,
I could break down You, the Europeans can enjoy
the luxury of analyzing your feelings. We simply
have to endureA Palestinian mother (quoted in
Punamaki 1992)
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FACTORS CONTRIBUTING TO EFFECTIVE HEALTH CARE
PROVISION

• easy access
• welcome
• time
• effective communication
• trust
• continuity
• cultural understanding
• teamwork and liaison
• cultural appropriateness

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COMMUNICATION

• importance of interpreters
• gender
• effects of having a third person in the
  consultation
• limitations of using family/friends/children to
  interpret
• face-to-face/telephone interpreting
• briefing and debriefing
• written information and welcome packs
• access to English classes

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IS THE MEDICAL MODEL APPROPRIATE?

• It is normal to react severely to extreme events
• symptoms may be learned adaptive reactions
  rather than pathology
• e.g withdrawal from others, lack of trust
• reactions may need to be unlearned
• do not necessarily represent mental illness

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• BE AWARE OF POSSIBILITY OF PATHOLOGISING NATURAL
  REACTIONS TO HIGHLY ABNORMAL SITUATIONS
• Symptoms may have different meanings in different
  settings
• BE CAUTIOUS IN THE USE OF DIAGNOSTIC LABELS

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The most effective promoter of well-being for
many people can be reclaiming the right and
ability to rebuild their life
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Grappling with the chaos

• .. I do not feel that Ms X can benefit from our
  service until these other issues related to her
  asylum claim have been resolved.

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MASLOWS HIERARCHY OF NEEDS

• self actualisation
• self esteem
• social needs
• safety needs
• physiological needs

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IMPORTANCE OF VOLUNTARY SECTOR

• Significant work done by Refugee Community
  Organisations (RCOs) and voluntary organisations
  e.g. MIND
• statutory sector need to recognise voluntary
  organisations as equal partners
• how to involve users effectively

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DETENTION

• Increasing numbers
• length of detention unknown
• effects on mental health
• previous detention and torture
• detention of children

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REFUGEE HEALTHWORKERS

• The workforce should reflect the community it
  serves
• language skills and revalidation of
  qualifications
• acculturisation to NHS
• BME healthworkers and service users may not
  necessarily share culture and understanding

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LOOKING AFTER OURSELVES

• rewarding and challenging work
• avoid unrealistic expectations and rescuing - be
  aware of limits
• engage with but dont be taken over by the chaos
• dealing with deadlines
• encourage independence and power
• wide team
• training
• exposure to distress - have support and time out
• build networks - www.medact.org

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SUPPORTING RESILIENCEYou (the torturer) can
break my body but you will not break my
willSangul, a Turkish Kurdish woman seen at the
Medical Foundation Help me to stand up and I
will go on fightingTheresa, a Latin American
woman seen at the Medical Foundation

• (Patel and Mahtani 2004)

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