In the framework of IARS Gender and Justice Empowerment Project (a 3-year Comic Relief funded project), today we have submitted a response to the consultation on the Mayor’s Health Inequalities Strategy in regards to the specific domain on Mental Health. Our full response can be read below:

Is there more that the Mayor should do to make sure all Londoners can have the best mental health and reduce mental health inequalities?

Although the Mayor’s Health Strategy points towards the idea that “we must address inequalities in access to treatment and services”, specific and more complex mental health requirements are largely overlooked, which are equally essential. In particular, there is a scarcity in the strategy in regards to the health inequalities which affect refugees and migrants. This is particularly concerning considering the fact that there is substantial evidence which suggests elevated rates of mental illness among refugees and asylum seekers. Some of the principal causes of distress are: the interview process, pressure of accumulating the supporting role, vouchers, reporting, fear of decision, detention, racism, housing and language. These issues remain equally unaddressed by the Mayor’s Health Strategy.

A more comprehensive approach is necessary to address for example, the availability and creation of a separate and distinct body which also acts as a safe space for mental health related treatment for refugees and asylum seekers. Although the Mayor’s health strategy begins to address inequalities in health, and points towards mental health issues including stress, depression, anxiety and more serious conditions, there is room for development to ensure the strategy truly incorporates London’s diverse population. In the case for refugees and asylum seekers, negotiating the health service can present significant challenges. In some cases, problems can be linguistic or cultural (some cultures have difficulties talking to different-sex professionals about medical issues) for example.

How can you help to reduce mental health inequalities?

The IARS International Institute is a user-led charity with a mission to give everyone a chance to forge a safer, fairer and more inclusive society. As part of our Equalities Projects area we work with groups of LGBT refugees and refugee women. IARS Women’s Advisory Board is composed of refugee and migrant women who are engaged in co-designing and co-delivering training and activities to migrant and refugee women as well as professional working with migrants. Currently, they are also part of our Gender and Justice Empowerment Project, which is an innovative, 3 year Comic Relief funded programme that empowers, gives collective voice and protects vulnerable refugee and asylum-seeking women affected by crime.

Through this group, IARS is able to reduce mental health inequalities by raising awareness about the mental health needs of refugee and migrant women and the importance of addressing them. We are able to deliver specific trainings and workshops in this area to both service providers as well as other refugee and migrant women from whom we can make referrals to services.

How can we measure the impact of what we’re doing to reduce inequalities in mental health?

We believe that in order to reduce inequalities in mental health it is crucial to address the mental health needs of the most disadvantaged and vulnerable, which amongst other groups are refugee and migrant women – many of whom our organization work with. Therefore, in order to measure the impact of the Mayor’s Strategy in reducing inequalities it is vital to measure the following:

1.       Availability of health assessment at point of arrival;

2.       Availability of cultural sensitive counselling in various languages;

3.       Provision of appropriate treatment and relevant information communicated to mental health services, particularly in regards to special needs of vulnerable groups;

4.       Availability of interpreters as well as potential alternatives for provision of services in the patients’ native language;

5.       Improved support to provide fully funded mental health awareness events for refugee communities;

6.       Support for mental health advocates from refugee communities to develop skills and become Independent Mental Health Advocates;

7.       Focused support from mental health and refugee umbrella bodies to tackle stigma around mental health in refugee communities;

8.       Cultural competence training for statutory staff at all levels, including commissioners, managers, GPs and receptionists. It is recommended that refugee advisers be involved in developing and delivering this training;

9.       Long-term funding for refugee mental health projects in recognition that short-term funding can often leave service users compromised and with worse problems when funding comes to an end.

Do you agree with the impacts of the draft Health Inequalities Strategy that have been identified in the IIA?

Although we agree with impacts identified in the Mayors’ Health Inequalities Strategy, we regret that there are pressing issues that need addressing if the strategy is to be truly inclusive of migrants and refugees and their associated mental health needs.

Do you think there are any impacts missing and if so, how these might be addressed?

We consider that more specific policies and services are needed to address the mental health needs of disadvantaged populations, in particular refugee and migrant women who fled gender based persecutions and are often highly likely to be re-victimized through the UK system.  It is concerning the lack of nuance in accounting for the particular needs of this group.

The lack of sensitiveness of the strategy could be addressed by accounting for some missing impacts, such as the prevalence of mental health issues among this population and specific barriers and challenges to access services. In addition, it crucial that the strategy account for the ways in which the UK immigration process and welfare system can significantly negatively affect and deteriorate the mental health of refugee and migrants instead of alleviating it. There are several practices and problems which have been widely reported to be extremely harmful to refugees and migrants’ mental health, for example:

·         The practice of detaining migrants and refugees;

·         No time limit for detention of migrants;

·         The policy of No Recourse to Public Funds;

·         Unreasonable extensive time for decisions to be made by the Home Office;

·         Lack of sensitivity in the asylum interview process;

·         Restrictive use of vouchers, reporting;

·         Fear of destitution, detention and deportation;

·         Impacts of everyday and institutionalized racism;

·         Homelessness;

·         Restrictive legal support;

·         Lack of cultural sensitiveness and language barriers in accessing to services.

It is regrettable that such important issues have remained unaddressed by the Mayor’s Health Strategy.