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Improving Mental Health Support for Asylum Seekers and Refugees

News and presentations from today's conference held in partnership with The Tavistock and Portman NHS Foundation Trust and chaired by Guglielmo Schinina Head of Mental Health The International Organisation of Migration, looking at how to better understand and meet the needs of asylum seekers and refugees. 

Improving Mental Health Support for Asylum Seekers and Refugee Communities
Maurice Wren
Chief Executive The Refugee Council

Developing local services and responses
Paul Farmer
Chief Executive MIND

Paul discussed Mind's role in providing mental health support for asylum seekers and refugees. Paul emphasised the importance of prevention and discussed local MIND project including Harrow Mind who have developed a project to improve dialogue between local commissioners and vulnerable migrants. Paul also highlighted the MIND Guide  to commissioning in this area which is available on the MIND website.  Paul also dicussed an influencer manual which is in development, cultural competency training available from MIND and the early development of a project in Wales.  Further information is available in the slides below.

Full presentation

Adapting service and treatment models to provide psychological first aid to refugees
Dr Hannah Murray
Clinical Psychologist Traumatic Stress Service, South West London and St George’s Mental Health NHS Trust
Full presentation
Pre-conference Abstract
Asylum-seekers and refugees have multiple needs when they arrive in a new country, and often require help and support. A significant proportion of asylum-seekers and refugees will develop psychological problems which will require treatment. In this talk, Dr Murray will discuss psychological recovery after trauma, including how services can monitor, screen and assist individuals who need treatment. In particular, she will outline existing evidence-based treatments for Post-Traumatic Stress Disorder (PTSD), and explain how these can be adapted to provide optimal treatment for asylum-seekers and refugees.

Counter transference experiences in working with traumatised refugees
Joanne Stubley
Consultant Psychiatrist in Psychotherapy, Team Leader Trauma Service and Belsize Unit Adult Services, and Chair Tavistock Society of Psychotherapists
Full presentation
Pre-conference Abstract: â€‹Counter-transference Experiences in Working with Refugees.
Psychoanalytic understanding of the impact of trauma may allow those working with traumatised refugees and asylum seekers to not only have a sense of what their client / patient is struggling with but may also better inform the worker of the potential impact on themselves.  The overwhelming nature of traumatic experiences and the helplessness they engender may result in a disturbance in the capacity to use words to communicate, to have a coherent narrative of the traumatic experiences and to be able to think about what has occurred. When words are not possible, then action is more likely to ensue. This may take many forms but one such action is through what Freud described as the Repetition Compulsion – that which cannot be thought about is instead endlessly repeated. Often this repetition takes the form of an unconscious pull to repeat some aspect of the traumatic scenario – Victim, perpetrator, witness, rescuer. Through monitoring of one’s own feelings and thoughts in the encounters with traumatised individuals (the counter-transference), it may be possible to see the potential for repetition through enactments in the therapeutic setting.

I hope to use case examples to outline this further, focusing on the experience of the worker as a means to better understand the traumatic experiences of the refugee. I hope it will also highlight some of the inherent difficulties facing the worker in whatever role they have.

Working with asylum seekers and refugees who have experienced trauma
David Amias
Consultant Systemic Psychotherapist, Refugee Service The Tavistock and Portman NHS Foundation Trust
Full presentation
Pre-conference Abstract 
This presentation will consider what factors should be taken onto account in working with asylum seekers and refugees who have had traumatising experiences. It will consider the multiple losses, dislocation and other traumatic separations that impact on their capacity to make sense of life in the host community. The importance of not pathologising the experience of all refugees will be stressed with a discussion of Papadopoulos’ Trauma Grid mapping the range of refugee responses to adversity and his notion of Adversity Affected Development. Case material from the work of the Refugee Service of the Child & Adolescent Mental Health Service at the Tavistock Centre will illustrate the complexity of working with the tensions between past and present issues. When to focus on past traumatic events? When is such a focus contra-indicated?

Our choices as therapists to ascribe significance to certain utterances and ignore others depend on a multitude of factors: our own predilections and personal histories and the extent to which we can develop a safe relationship of trust with the people seeking our help.  Finally there will be a consideration of the emotional impact of the work and what can be done to enable practitioners to cope with the exposure to highly traumatising material. 

Therapeutic care of unaccompanied young people seeking asylum
Gillian Hughes
Consultant Clinical Psychologist and Systemic Psychotherapist & Team Leader, Child and Family Refugee Service, The Tavistock and Portman NHS Foundation Trust
Full presentation
Pre-conference Abstract 
Separated children face a unique set of challenges. Their particular circumstances of being away from family and dealing with traumatic memories alone, as well as having to navigate a foreign and often hostile country, mean that they face layer upon layer of intolerable stresses. Most have experienced trauma in their homelands and have had to embark on extraordinarily dangerous journeys overland at the mercy of traffickers, leaving their families behind in uncertain and dangerous circumstances. Those that make it to the UK can access education and social support, but once they approach 18, this support dwindles and at the same time, they must face the prospect of returning to court again to argue their case to remain in the UK. For so many who have survived the enormous task of settling in the UK and have created new networks around them to occupy the void left by their missing families, the prospect of facing this loss a second time is unbearable. A return to court means going back to traumatic memories that they have spent months and years trying to bury, and raises the issue again of not being believed.

These circumstances make young people extremely vulnerable and represent an assault on their identities. Often, they see themselves as failures because they cannot concentrate in school, and because as refugees, they are viewed as the bottom of the pile, facing racism and negative assumptions from both peers and wider society.

However, many of these young people also develop extraordinary resources and resilience through the process of learning to survive. As practitioners, I believe that it is vitally important we tap into these in order counter the many negative identity definitions that these young people accumulate. Before we attempt to address the effects of trauma which can dominate so much of their lives, we must create a ‘safe place’ where these young people can stand if we are to avoid re-traumatising them during our attempts to help. This safe place is both in their view of themselves, and in their relationship with the networks around them including how they are perceived.

I will describe how we, in the Refugee Team at the Tavistock Centre, have developed narrative and liberation approaches  to help young people access their personal and community resources, grounded in their cultural and social histories. Also, how we have connected young people with each other to create communities of support. We have used film and documents to communicate the positive stories of survival, and in ways that re-position young people as having something to contribute. This builds on the positive identities that we have helped them to re-connect with, and enables them to deal with the effects of trauma from a position of far greater strength. I will outline the core principles which underlie this practice.

Throughout my presentation, I will share examples from the young people I have worked with to show how they have shaped the development of this practice.

Resources supplied by Dr Sarah Davidson Head of Psychosocial British Red Cross, Chair The International Federation of Red Cross and Red Crescent’s European Network of Psychosocial Support​.




Future events of interest:

 Improving Mental Health Services for Young Adults: Supporting the Transition to Adulthood
 Tuesday 21 June 
 Hallam Conference Centre, London

Mental Health, Ill Health & Personality Disorder
Thursday 23 June 
Asia House, London

Sexual Abuse & Mental Health - Reducing the impact of abuse on mental health
Tuesday 20 September 
Hallam Conference Centre, London

Medically Unexplained Symptoms/Somatic Symptom Disorder
Friday 21 October 
De Vere West One, London


8 June 2016

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