Refugee Mental Health

There have always been people who have had to flee from wars, or natural disasters or severe persecution because of their ethnic origin or their political, religious or social activities.
 
If we all had our DNA tested, few of us would not reveal traces of ancestors who have landed in these islands due to such circumstances; cold, wet, tired, with nothing but the clothes they wore – and traumatised by both the horrors that forced them to flee and the terrible travails that they had along the way.
 
The incredible will power, vigour and drive needed to make those journeys perhaps explains why refugees and their descendants have then often contributed so significantly to the cultures to which they have fled, all around the world.
 

Safe but not settled

Sadly, arrival in this country does not, in itself, bring peace of mind. Though someone who has arrived in the UK may be physically safe, the intricacies of the asylum system and attending to their basic welfare needs then require immediate attention. At the same time, they live in a country with a different culture, language and structure and wait in a state of limbo, anxious to hear if they will be forced to leave again.
 
In addition, they must now come to terms with the losses associated with their flight and, perhaps just as importantly, with a loss of a belief in an imagined future. Even if accepted as refugees, this country will, very likely, not be what they imagined and dreamed it to be.
 
Of course the terms asylum seeker, refugee or migrant are all too frequently used in a negative and derogatory way. Our media and many politicians tend to focus on issues of economic migrancy rather than refugee issues. This has the effect of marginalising all asylum seekers and refugees.
 
Thus the reality of being a refugee, with the sometimes terrible mental traumas that have led someone to flee everything they know to seek sanctuary abroad, is too easily ignored or minimised.

Being elderly or an adolescent can increase this trauma, as does a lack of knowledge of the host language and, for some, a loss of their previous socio-economic status. Many of us will have met refugees who were qualified chemists or doctors in their own countries but who are now working as taxi drivers or cleaning floors.
 

Psychological distress

However, this is not only a problem that should be seen in terms of us just not wanting to hear their stories. It is also a problem because it can be very difficult for those who have suffered to tell us of their experiences. Cultural interpretations about psychological distress, trauma and mental health are seen differently around the world, and these cultural nuances may not be picked up easily by those who have not shared the experiences that have created them.
 
Furthermore, though we all know that there is still plenty of stigma about mental ill-health in this country, in many other cultures that stigma is still much more pronounced. It is just not a subject that can be openly discussed. Somatisation among refugees is frequently high as physical pain is so much more acceptable than psychological pain.
 
For many survivors of severe psychological trauma it may be especially unacceptable to discuss such things with a professional of a different gender or a different religion, and we have to remember what that other religion or gender might symbolise for that person.
 

What can churches do to help?

Becoming an asylum seeker is a major event in someone’s life, though it is not their whole story. Therefore, how and why individuals are forced to become asylum seekers, refugees or displaced people and to flee to this foreign country, is perhaps not that important. They are here.
 
Most professional treatment – which may involve complex and specialist talking therapy and in some cases use of prescribed medication – ultimately aims to re-integrate those deemed to have a diagnosable condition into society.
 
Not all asylum seekers will be deemed to have psychological problems of this nature, but the need for identity, a sense of belonging and love, as well as the meeting of more basic needs (warmth, shelter and financial security) should be areas for church communities to consider supporting.   
 
The important thing is to think about how to help them to come to terms with their experiences, to settle into their new lives and to become the same sort of significant contributors to our futures as all those other refugees that this island has assimilated in its rich and varied history of providing refuge to those who most need it.
 
In some instances, this necessitates a level of discernment that will indentify those felt to be significantly distressed, with a view to signposting them to the appropriate professional support services.  In other instances, the simple extension of a warm welcome, the offer of a cup tea or the invitation to conversation may have a profound impact in kickstarting this re-connection to society.
 
Dr Chi-Chi Obuaya is an NHS Consultant Psychiatrist

This is a revised version of an article published online at https://www.psychiatry-uk.com/refugees-mental-health/