Mental health, trauma and wellbeing of forced and other migrants: effective responses at times of crisis

It is widely recognised that the main impact of forced migrant experience involves serious distress and suffering which may escalate to psychosocial dysfunctioning, trauma and chronic mental health problems. These challenges are often affecting not only migrants’ and refugees’ own lives but also the wellbeing of their families and whole communities. In their majority, these are normal reactions to
abnormal situations. To address the mental health needs of such populations, specific skills and approaches are required. The task becomes even more complex as health and mental health infrastructure in host countries are at best unprepared, or at worst non-existent, to respond to these needs. Assumptions, however, are repeatedly made that entire refugee populations become mentally disturbed and are in need of psychiatric care. In fact, psychiatric morbidity and psychosocial dysfunctioning depends on the nature and time span of the conflict, on level and rapidity with which resilience will emerge, based on socio-cultural factors and environmental parameters. Approaches to migrant and refugee mental health care are heavily influenced by Western models of care and not always culturally sensitive or responsive to the needs of these groups. Lack of appropriate care in the mainstream services means that often humanitarian organisations are becoming the main providers of care and support for these populations, posing challenges
of dependency on this humanitarian aid and sustainability of support without dedicated funding and resources.
In this chapter, I will present a brief critical analysis of access to healthcare, social protection and welfare of forced and other migrants. I will then consider how the concept of refugee trauma and the diagnosis of Post-Traumatic Stress Disorder dominate discussion on the mental health needs of forced and other migrants. I will present some key challenges in assessing needs of these populations and designing appropriate responses by mental health service providers at a time that most European healthcare systems are under
pressure to curtail existing resources while being made accountable for compromising quality of care standards. Also, I will discuss innovative and integrated psychosocial models of care in the refugee mental health field, which still remain outside of the mainstream provision rather than embedded responses to the current refugee crisis. Finally, I will argue the necessity of identifying and eliminating existing systemic barriers to recognising the resilience and
determination of forced and other immigrants as a key factor in coping with refugee mental health care needs in reception countries. To exemplify the issues addressed, I will draw on studies in relation to the situation of vulnerable refugee and migrant groups, such as women, older people and unaccompanied asylum seeking children
in the United Kingdom and Europe.