Examining the impact of mental illness stigma on asylum seekers in the UK: an informed advocacy approach for social workers

Nassir Hassan- July 2015

Abstract

This secondary research argues that asylum seekers with mental health problems are some of the most ‘socially excluded’ groups in the UK and mental health social work with these groups necessitates urgent attention, this is because the current social work practice in relation to asylum seekers, failed asylum seekers in particular is inadequate. six key themes are discussed in this study, these are; stigma, media depiction and heathcare, poverty and the effects of UK’s immigration policies such as detention and dispersal policies and how they impact and contribute to asylum seeker’s mental distress. A significant finding of the literature review is that a different type of social exclusion of asylum seekers exists, for example, social and structural stigma. Overall, only a small number of social work literatures I identified have addressed the impact of stigma on the mental health of asylum seekers. Psychology and psychiatric literature addressed the subject in more detail and this is an issue that will be critically discussed in this paper.

Chapter 1 – Introduction

Rationale

Asylum seekers with mental health problems are some of the most ‘socially excluded’ groups in the UK (Liewellyn et al., 2008, p.9) and mental illness stigma among other problems are in many ways ‘the most important challenges they and service providers face’ (Crisp, 2004, p.13) This secondary research study will explore the stigma perception and experiences of asylum seekers who have a mental health problem. The research will also attempt to spell out the implications for asylum seekers if they need medical, social work or other support. It will do so by reviewing current literature regarding the mental health of these groups. Factors exacerbating the vulnerability of these groups to mental illness, and ‘compounding social and legal factors will also be discussed’ (Craig et al., 2010)

Personal experience of working with asylum seekers, and witnessing the impact stigma and social exclusion can have on their lives, is the reason why stigma related to mental health, was chosen as the topic of research. I have worked with asylum seekers for a number of years, at a community centre, which provides temporary accommodation and hot meals for failed asylum seekers. I have built great rapport with them and developed a deep understanding of the day to day problems they face. As a result of these experiences, I decided to write about social and legal issues faced by asylum seekers living in the UK, particularly, social factors that may be contributing factor to their mental health problems as well as those arising from their experiences of government’s immigration policies. The topic is also relevant to social work practice as actions to address social exclusion, promote social justice and reduce stigma are integral to social work values, because social justice is a key social work values. (Thompson, 2000) In addition, this study will examine whether the impact of immigration policies is enabling or disabling them. This dissertation will also consider how social work (both statutory and non-statutory) should respond to the needs of asylum seekers.

This study consists of seven main chapters, the first chapter introduces (as discussed already) the topic. The second chapter is a literature review; this section explores the main dominant themes of the research, it is further divided into two parts, the first part discusses the social factors that contribute the mental health problems of asylum seekers. These are; stigma, media depiction, and healthcare. The second part looks at poverty and the effects of UK’s immigration policies such as detention and dispersal policies and how they impact and contribute to asylum seeker’s mental distress. The third chapter outlines the research methodology of the dissertation, the purpose of this chapter is to describe how I undertook the research and the procedure I used to analyse the data I collected including definitions of key terms and inclusion and exclusion criteria. The fourth chapter presents the analysis and findings of the literature review. The fifth chapter looks at the implications and lessons for social work. Learning I gained from undertaking this study will be presented in chapter six. And finally, the final chapter will summarise and conclude the study.

Chapter 2 – Literature Review

The aims and objectives of this literature review is to provide some understanding of the stigma felt by asylum seekers with mental health problems and to find out the factors that contribute to their mental health problems. Review of the literature carried out showed that ‘the evidence base for good practice in social care for refugee and asylum seekers is not robust’ (SCIE, 2010, p.1) limited work has also looked specifically at the issue of accessing appropriate mental health support for failed asylum seekers’. There is a particular ‘dearth of empirical’ research in social literature that focuses on this issue (McKenzie et al., 2007) There is a significant gap in the social work literature in relation to addressing the needs and the impact of immigration policies on the mental health of asylum seekers, failed asylum seekers in particular. Similarly, as Masocha and Simpson spelled out, there is a growing evidence of the ‘differential treatment’ received by asylum seekers ‘within mainstream welfare services’ (Masocha & Simpson, 2011, p.432, Chantler, 2012, p.322). Therefore, through examination and analysis of current relevant literature, this literature review intends to establish factors that contribute to the poor mental state of asylum seekers. It does so by discussing research themes identified when I was collecting relevant data for my chosen topic.

It was a difficult decision for me to decide which issues (themes) are important for asylum seekers, due to the criteria for this project (which is secondary research) which meant I would not be personally meeting asylum seekers. However, my personal experience of working with these groups, which I have briefly mentioned in the introduction chapter have naturally highlighted some of the main issues and problems that affect them. Although I will give a broad overview of all the themes that came up during the data collection in my methodology chapter, I intend to discuss the following themes specifically; first I will discuss the social factors that contribute to the mental distress of asylum seekers, these are; stigma/labelling and media depiction. Then, I will discuss four key themes that came up during the early stages of the research, and I then will explore the mental health implications of each: these are; poverty, access to health care, detention and dispersal policies. I will also consider different responses from both statutory and voluntary sector providers of social services. And finally, I will explore how social workers can empower asylum seekers through positive campaigning and advocacy. All these issues will be discussed in the order they are mentioned.

Social factors that contribute mental health illness:

Stigma

There is debate about the definition of stigma and none of the theoretical frameworks to be discussed should be seen as definitive. It is necessary here to illuminate exactly what is meant by stigma. There is a degree of uncertainty around the definition of ‘stigma’. Scholars provide no clear definition and seem to refer stigma as “being marked or branded” a term frequently used in the literature (Corrigan & Watson, 2012). Although there is a clear difference of opinion in the literature, there appears to be some agreement that the term “stigma” refers to ‘invisible traits that result in a person being discriminated against by society’ (Bates et al., 2013, pp.569–75) from a psychological viewpoint, stigma refers to negative and discriminatory attitudes towards those who have a mental health condition (ibid)

Modern concept of stigma is linked to sociological and psychological theoretical traditions; it is commonly attributed to Erving Goffman (1963) who is widely credited for his explanation of the concept of stigma. Goffman, proposed that an individual associated with a stigmatized condition such as mental illness, progresses from “normal” to “deeply discredited” in the community (Goffman, 1963, pp.3-4). While a number of different definitions exist in the literature, ‘a very common one is that of an attribute that is deeply discrediting and reduces the bearer from a whole and usual person to a tainted, discounted one’ (Goffman, 1963, p.3)

From a Social Work perspective, building from Goffman’s initial idea, Dudley (2000) defines stigma as ‘stereotypes or negative views attributed to a person or groups of people when their characteristics or behaviours are viewed as different from or inferior to societal norms’. Therefore, Dudley’s definition provides an ‘excellent stance from which to develop an understanding of mental health stigma’ (Dudley, 2000, p.449) A number of different schools of thought has contributed to the understanding of how social stigma operates in society; however, Social Work has offered ‘limited contributions’ to this area. (Ahmedani, 2011, p.414). This is an area where Social workers need to develop a ‘broad social view of mental health problems, especially in respect to concerns about stigma, labelling and other discriminatory practices’, that could affect not only asylum seekers with mental health problems, but also other service users they intend to empower (Davies, 2012)

From a sociological perspective, Link and Phelan (2001) developed a conceptual theory which suggests that ‘stigma exists when the following interrelated components converge’. First, they argue that society ‘distinguish and label human differences’. In the second component, they argue that ‘dominant cultural norms, link labelled individual with negative stereotypes’ – i.e. labelling a Muslim person as a terrorist, or labelling depressed individuals as ‘mad’ person. (Link, 2001, p.25) The third components states that, ‘labelled individuals are placed in distinct categories so as to accomplish some degree of separation of ‘us’ from ‘them’. And finally, the labelled individual experiences ‘status loss and discrimination that leads to unequal outcomes’. (Link, 2001, p.363). Therefore, in most societies, many human differences may be ignored and therefore may be socially irrelevant, for example, one’s hair colour, or food preferences, but other differences such as, one’s racial background, health condition such as mental illness and HIV AIDS are socially noticeable. Therefore, there is a ‘social selection’ of human differences when it comes to identifying differences that will matter socially’ (Link & Phelan, 2005). Link and Phelan’s model indicate that it is easier to discriminate against vulnerable groups such as asylum seekers, and that ‘stigma can exist at a number of levels in society’ such as public, and structural levels (ibid).

The impact of social stigma is profound, asylum seekers with mental health problems often delay seeking support for fear of social consequences. For example, refused asylum seekers and those with children, in particular, may be unwilling to pursue the support they and their children may be entitled to under section 17 of the Children Act 1989 ‘for fear of being separated from their children.’ (Nottingham Citizens, 2012) But, most importantly, structural stigma (i.e. the stigma that is part of government policy) ‘presents additional large-scale barriers to mental care of asylum seekers by undermining opportunities for them to seek help.’ (Chantler, 2012, p.429) For example, Section 9 of the Nationality, Immigration and Asylum Act 2004 clearly states that the Government can withdraw support from failed asylum seekers, even those with dependent children ‘if they cannot explain why they have not taken any reasonable steps to leave the UK voluntarily’ (legislation.gov.uk, 2004) This clearly indicates that the UK’s asylum policy prioritises immigration control over its humanitarian obligations.

Addressing social stigma is compatible with social work values; therefore, social workers need to actively address social stigma, and stereotyping faced by asylum seekers. Studies have shown that asylum seekers seem to be more vulnerable to poor mental health problems than the general population, stigma, discrimination and labelling are thought to be a major contributing factor (Aspinall & Watters, 2010, p.16). Therefore, addressing stigma and stereotyping are central to understanding their mental health problems. When I searched the term “mental health stigma on asylum seekers” on Google the results shown were mainly psychiatric and psychological literature. There was very little social work literature on these issues. ‘Social workers have historically had a major role to play in delivering services to people with mental health problems’ but, they also need to lead the field in mental health literature on asylum seekers.

Asylum seekers often demonstrate a lack of understanding of the UK healthcare system and thus ‘face distinctive barriers’ to accessing healthcare. Therefore, asylum seekers would benefit from the provision of information about mental health care service. (ibid). While the importance of social worker’s role in managing risk, addressing oppression and working with people with health and social needs is widely acknowledged, (Dalrymple & Burke, 2006) social workers do not yet have a visible presence in the area of mental health literature that addresses mental health stigma, and many of the ‘developing interventions and research literature is evolving out of other fields’ i.e. psychology and psychiatry (Corrigan et al., 2014)

The principal perspective for understanding mental health illness is the bio-medical model and this means that social factors such as stigma, and labeling ‘may not be given the weight they deserve in understanding’ how the mental health of asylum seekers affected by these factors. (Masocha & Simpson, 2011, p.429, Chantler, 2012) The bio-medical model attributes, mental health problems to ‘physiological, biochemical or genetic causes and attempts to treat these disorders by way of medically grounded procedure such as drug and other medical treatments’ (Bates et al., 2013).

In contrast, Scheff (1966) proposes a sociological model for understanding mental illness, which is a complete opposite of the medical model. Sociological model views mental illness as ‘a label attached to persons who engage in certain types of deviant behaviour’ (Shaw & Tablin, 2007) this seems to create problems, when mental health professionals approach mental illness from this perspective. Because many asylum seekers tend to view their mental illness differently (Mind, A civilised society, 2009), and as discussed earlier in this paper, most of the literature that informs social work practice regarding asylum seekers with mental health problems comes from other fields, and the Social Work literature seems to ‘lack coherent theoretical and policy frameworks to inform effective social work models of service delivery’ (Masocha & Simpson, 2011a, p.429). Therefore, a critical opportunity exists for the Social work profession to catch up if it is to achieve one of its key values, which is ‘upholding and promoting human dignity and well-being’ (BASW, 2015, p.8)

The role of media

The media coverage of asylum seekers is mostly negative (with the exception of the independent and the guardian). The Tabloid press in particular, often fails to correctly differentiate between economic immigrants and asylum seekers. They tend to portray asylum seekers as bogus and illegal and employ ‘inaccuracy statistics and groundless claims’ such as asylum seekers are here to get handouts from the state (Smart et al., 2007, p.144). Similarly, the mass media are also a very significant source of public attitude towards asylum seekers. For example, the British public seemed to have contradictory views about the asylum seekers. A research carried out in 2008 found while 89% believed giving refuge to asylum seekers is an ‘important British values’, 90% were concerned about ‘abuses in the system’ and 71% thought that Britain is taking in too many asylum seekers. (Asylum and Destitution Working Group, 2008, p.95). Another study investigating print media coverage of asylum seekers, over ‘ten week period’ found that overall a ‘small number of articles described asylum seekers in terms that are unsympathetic, inflammatory and contained ‘inaccuracies, including misuse of statistics, and groundless claims’ (Smart et al., 2007, p.144). The study further suggests that while the articles that demonises asylum seekers are small in number, their impact on asylum seekers is far reaching, because these small articles are ‘likely to be having an impact on sections of public opinion’(ibid)

Access to health care

Asylum seekers are eligible to register with a GP, and GP surgeries have discretion to accept failed asylum seekers. However, unlike refugees, asylum seekers have limited access to secondary healthcare services due to their immigration status. Primary care is free to both asylum seekers and failed asylum seekers, however an HC2 (Health Costs 2) document is needed for exemption from prescription charges. To get an HC2 document, one needs to fill a complex form and provide proof of address and identification. Failed Asylum Seekers are unable to provide such documents, and therefore are unable to access the health services. (Allsopp et al., 2014). (Project London, 2010)

With regards to secondary healthcare, asylum seekers are exempt from paying charges; while failed asylum seekers are not, unless they are suffering from certain ‘infectious diseases and treatment in the accident and emergency department’ (Department of health, 2007, p.27). A research carried out by Aspinall (2006) found that there were difficulties for asylum seekers accessing healthcare due to lack of documentation, language barriers, but most importantly, ‘lack of awareness of entitlements by both GPs, other professionals and asylum seekers themselves’. (Aspinall, 2006, p.88). O’Donnel et all (2007) has carried out a small study in Glasgow which consisted of 36 asylum seekers. He found that, navigating through the healthcare system was a major barrier for those asylum seekers, however, once asylum seekers ‘saw a GP or other health professionals, their experiences were mostly positive’. (O’Donnell et al., 2007, p.1-11).

Under section 47 of NHS and Community care act 1990, asylum seekers who appear to be in need of community care services, are eligible for a community care assessment. (legislation.gov.uk, 1990) However, their needs cannot be simply due to hardship, ‘they must be destitute plus’ that is having a serious need for care ‘that is over and above the mere lack of accommodation and subsistence’ (NRPF, 2006, p.4) those who meet section 47 criteria, may be entitled to support under section 21 of National Assistance Act 1948. (legislation.gov.uk, 1948) If an asylum seeker with mental health problems is detained under the Mental Health Act 1983, he or she is ‘eligible for treatment’ under section 117 of the said Act. However, under Schedule 3 of the Immigration and Asylum Act 2002, failed asylum seekers ‘are not entitled’ to such support, unless they apply for asylum ‘as soon as reasonably practicable’ after the person’s arrival in the UK (legislation.gov.uk, 2002, icar.org.uk, 2006, p.4). It is claimed that providing community care services to asylum seekers is ‘complex, confusing and inconsistent’ this is because, there appears to be ‘a conflict of responsibility between the local authority and other organisations’ that provide assistance to asylum seekers (icar.org.uk, 2007). It is clear in the literature that support is available to both asylum seekers and failed asylum seekers, however, they are having difficulty accessing such support and as a result of this, their health needs are not met. (ibid) In summary, ‘it is clear that asylum seekers more likely to have complex mental health needs that are less likely to be met appropriately’ (SCIE, 2010, p.35)

Poverty

Having examined how social and structural stigma contributes the mental health problems of asylum seekers, the paper will now address poverty as another social factor that contribute to asylum seeker’s mental health problems and will link it to UK government’s immigration policy. According to the ‘social model of disability, which recognises the role of disabling environments ascontributory factors, poverty has been widely recognised as a risk factor for mental illness’ (Chantler, 2012, p.322) the possibility that ‘mental health problems may stem from social injustice, poverty and oppression is not widely recognized’ (SCIE, 2010). However, there is ‘reasonable agreement that, whilst links between poverty and mental illness cannot be determined, poverty is a risk factor in the onset of mental health problems’ (Chantler, 2012, p.322) This study found that poverty amongst asylum seekers have ‘multiple causes, one of which is the asylum policy itself, and that poverty impacts negatively on health, personal and family relations and access to vital support networks’ (Allsopp et al., 2014, p.6)

Social work has been slow to respond to the needs of asylum seekers, particularly those with mental health issues. Morag Gillespie’s research on asylum seekers in Scotland has shown that the 811 respondents she studied between 2009- 12 ‘only two received any social work support’. (Gillespie, 2012, p.15) The studies further revealed that ‘that every stage of the asylum processes’, asylum seekers experienced delays in getting ‘entitlement to benefits and as a result were ‘living in various stages of destitution’. Therefore, in addition to social and structural stigma, poverty should also be given ‘due consideration in any plausible explanation of the high incidence’ of mental illness within the asylum seekers (Masocha & Simpson, 2011a, p.426)

With regard to the link between poverty and immigration policies, Chantler (2012) argues that ‘enforced poverty is a central feature of the UK’s asylum policy’ because it ‘replicates known risk factors in the onset of mental distress’ (Chantler, 2012, Shaw & Tablin, 2007, p.360). Therefore, poverty should also be seen as a ‘structural problems’. There is no doubt that social work is facing challenging times, however, as Stepney (2006) points out, there are ‘good reasons why social workers should be willing and able to tackle poverty and its effects’ on service users including both asylum seekers and refused asylum seekers. One way of achieving this is by ‘demonstrating the ability to interpret and use current legislation and guidance to protect and/or advance asylum seekers rights and entitlements’ (TCSW, 2015, p.28).

Immigration policy:

Detention

At any given time in the UK, an estimated ‘3000 individuals’ are held in detention centres for immigration purposes (Association of Visitors to Immigration Detainees, AVID, 2011), these figures call into question whether the use of ‘detention is in compliance with international human rights law’ (Masocha & Simpson, 2011a, p.433) The government claims that it is necessary to ‘detained’ asylum seekers as ‘it cuts the risk of them absconding’ (ibid). However, research by ICAR (Information Centre about Asylum and Refugees) found that rather than absconding, the majority of asylum seekers released complied with the bail conditions. (icar.org.uk, 2007) However, the situations of those who abscond are even more alarming; this is because many of them tend to hide from the authorities and therefore are unlikely to seek social work support. Humphries (2004) argues that ‘social workers have unquestioningly accepted the role of gatekeeper to services, and function as an arm of immigration services, reporting failed asylum seekers to authorities rather than providing them with support.’ (Humphries, 2004) such roles are contrary to the values, ethics, and principles of Social Work.

It is difficult to determine the impact detention has on the mental health of asylum seekers due to the difficulties of obtaining access to detainees (Robjant et al., 2009). Although this area is under research, due to researcher’s inability to get access, existing research shows that detention has a ‘negative impact’ on asylum seekers and detained asylum seekers tend to be more vulnerable to mental distress, particularly depression, anxiety and PTSD, in comparison to ‘non-detained asylum seekers’. (Chantler, 2012, p.330). Cohen (2008) found that rates of ‘self-harm and suicide’ amongst detained asylum seekers are ‘significantly higher amongst immigration detainees than amongst the prison population in the UK’ (Cohen, 2008, p.235) and this clearly shows the impact detention policy has on the mental health of asylum seekers. Masocha & Simpson, (2011) argue that, although cases of violence protests by asylum seekers in detention are well ‘discussed’ in the media, other issues associated with mental illness are never ‘reported and discussed in public’. (Masocha & Simpson, 2011a, p.433). For example, ‘attempted suicide, self-harm, depression and paranoia’ to mention but a few, are all contributing factors of mental illness, however, there is no clear-cut ‘information available as to their prevalence’ amongst detained asylum seekers. (ibid) Therefore, the mental health implications of detention of asylum seekers are ‘certainly of special interest’ to mental health social work. (ibid)

The coalition Government implemented a new immigration bill in 2014. This new Bill is so restrictive; it will likely have far reaching consequence on asylum seekers, particularly failed asylum seekers. The Immigration Act 2014 appears to restrict ‘most grounds of appeal for immigration decisions, turn landlords into immigration police and extend charges for NHS care’ (Roberts & Lister, 20147). From a social justice and a Human Rights perspective, this new law could be problematic, particularly with regards to access to health care for asylum seekers, because as Masocha (2014) argues ‘charging healthcare services means that failed asylum seekers, without the means to pay for GP services will not be seen, resulting in negative health outcomes which may have serious implications for public health. (Masocha, 2015, p.347)

Dispersal policy

Much has been written about the negative effects of dispersal policy on Asylum seekers, and whether this policy contributes to the mental health problems of these groups is widely contested in the literature (Phillimore, 2011). Some studies carried out soon after the dispersal policy was implemented, claimed that it ‘exacerbated poverty and dependency by cutting asylum seekers off from existing support networks’ studies also suggested that it violates human rights (Allsopp et al., 2014), although few have explored its impact on mental illness, there is a body of evidence which indicate that it ‘generates stress’ which in turn contributes to the causes of mental illness amongst these groups (Phillimore, 2011, p.28). Hayes and Humphries (2006) argue that “it is often the most vulnerable that this policy affects most” for example, separating asylum seekers from existing support networks Humphries (2006, p: 44).

Over the past nine years, the UK’s immigration policy has undergone a number of reviews and reforms and has focused on greater control of migration to the country. Some of these policy changes have affected health care services, particularly within mental health. (Bacon et al., 2010) a research carried out by mental health charity MIND has argued that Government’s restrictive immigration policies such as dispersal policy…..are ‘functioning to socially exclude and marginalize asylum-seekers and this is a contributing factor in exacerbating existing mental health problems and causing further mental distress’. (Mind, A civilised society, 2009 , p.2) The government claims that this policy is designed to support asylum seekers through the UK border Agency (UKBA) and to move them to suitable accommodation away from the Southeast of England. The home office argues that dispersal policy is actually voluntary and asylum seekers can opt out of obtaining accommodation by staying with friends and families. However, if an asylum seeker is destitute, dispersal is the only means of obtaining accommodation. (Hynes, 2011, p.2).

Chantler (2012) argues that the establishment of UKBA ‘seemed to have wrongly reinforced the view that asylum seekers are being supported and therefore do not require social work intervention’ (Chantler, 2012, p.321), Humphries (2004) argues that social workers seemed to have accepted this idea. (Humphries, 2004) Therefore, Enforced poverty, social isolation and compulsory dispersal policy alongside uncertainty about the future, are serious ‘post-migratory stressors that do not appear to be well articulated in the social work literature on mental health’ (Chantler, 2012, p.331)

Social work response

Being and asylum seeker does not necessarily cause an ‘automatic response from local authority statutory services’. Therefore, anyone undertaking an investigation to social work’s response to asylum seekers has to be aware of the context in which social work provision is provided (Fell & Fell, 2014, p.1325). Masocha (2011) has carried out a study in which its objective was to explore how social workers defend their practice. Although on a small scale, the study found that social workers employ different tactics to defend their practice. The study is concerned about the way social workers justify their practice with regard to ‘areas where expectations are perceived as not having been met by practice’ (Masocha, 2011b, p.1624) for example, discharging their duty with regards to assisting asylum seekers with no recourse to public funds. Most of the participants the researcher interviewed recognised that ‘in terms of service provision, a lot more could and should be done for asylum seekers.’ Furthermore, resource constraints, eligibility criteria were identified as limiting what statutory social workers could do for asylum seekers (Masocha, 2011b).

One of the responses, respondents, has given about supporting asylum seekers is that the law restricts their ability to discharge their obligation. ‘The existing legislation is blamed for making it difficult for social workers to work effectively’ with asylum seeking service users. (Masocha, 2013, p.246). The responses were given by social work respondents portrayed as though the system is ‘forcing them to engage with asylum seekers at a superficial level.'(ibid). Therefore, respondent’s recognition of ‘such gaps in service provision in the social work profession, implies a level of blameworthiness’ (ibid).

The ethical duty to assist asylum seekers is enshrined in the profession’s ethics and values. (BASW, 2015) Therefore, it is the social worker’s onus to ensure that asylum seekers, are empowered, and enabled and provided services that they are entitled to. Masocha (2011b) argues the fact that respondents admitted that asylum seekers are not getting service provision, ‘creates moral and ethical dilemmas for social workers’. (Masocha, 2011b, p.1626). Kohli (2008) argues that social work is being ‘excluded or is excluding itself from effective political and professional engagement with asylum seekers’ (Kohli, 2008, p.165). However, it is worth noting that statutory social work possesses the necessary skills to respond to asylum seekers needs, but they can only discharge their duty up to the point the current government legislation permits.

There are many other positive ways that Social work can respond to support asylum seekers. Rather than be seen as government gate keepers, statutory social workers should focus on challenging social as well as structural stigma, social exclusion, and challenging unjust legislation such as section 9 of the Nationality, Immigration and Asylum Act 2002. This can be done through ‘campaigning, contributing to the debate on social rights, and to influence social policy’ (Dalrymple & Burke, 2006, p.95). The profession’s concepts of anti-oppressive and anti-discriminatory practice ‘on their own are not enough as a basis for understanding and countering prevailing racist policy frameworks for asylum seekers’ (Masocha, 2013) instead, social workers should campaign for better treatment for asylum seekers, they should also speak out against human rights violations and forced detention. In addition, social workers need to be mindful of discriminatory policy frameworks that are ‘constructed to oppress and exclude’ asylum seekers. (Dalrymple & Burke, 2006, p.23). The social work code of ethics is clear about human rights. The code of ethics of British Association of Social workers requires social workers ‘to seek to change social structure which perpetuates inequalities and injustice’ (BASW, 2002, Section 3.2.2d, cited in Dalrymple & Burke, 2006). One way of achieving this could be utilising the new College of Social Work’s Task Force recommendation, which demands the profession to have ‘clear independent voice that will be heard in policy development’ (Social Work Task Force, 2009).

On the other hand, non statutory social work response to the need of asylum seekers is generally positive, although what they can provide for asylum seekers is very limited compared to what statutory social work could provide. For example, the Refugee Council and other agencies responded well to the need of asylum seekers by providing them with free advice and information. They also provide therapeutic service and hardship support for destitute asylum seekers. But most importantly, they are always campaigning, and challenging government legislation and pushing for changes to improve the lives of asylum seekers. (Refugee Council, 2014) Indeed, the third sector agencies, many of whom employ qualified social workers provide vital support of a different kind to asylum seekers (Fell, 2013) similarly, faith-based organisations have also responded well by offering ‘drop-ins, advice, and refreshments’ for asylum seekers. (Fell & Fell, 2014, p.1326). Voluntary agencies do not only respond and provide what they can to asylum seekers, but unlike statutory social work, they do not collude with immigration controls. (ibdi)

Advocacy

Advocacy simply means, ‘speaking up for oneself or others’ (Atkinson, 1999, p.2). Advocacy has been described as being ‘at the heart of social work (Dalrymple & Boylan, 2013, p.1) It is also a good method of speaking up on behalf of individuals and vulnerable groups within ‘legal power and political structure’ (ibdi). ‘It involves either an individual or group, pressing their case with influential others’ (Forbat & Atkinson, 2005, p.322). In this context, social work advocacy, is not only to represent the views of asylum seekers, but also to empower and enable them to speak for themselves. This can be done in two ways, an individual level and a policy (system) level. An individual advocacy level, might involve ‘representation in crisis situations’ (Masocha & Simpson, 2011a, p.437) for example, assisting destitute failed asylum seekers access the healthcare system, or making a case on their behalf and encourage them to express their views. This approach should be integral part of every social worker’s role and they should not feel ‘discouraged from using advocacy skills within their work’ (ibd). However, it is worth noting that advocating for asylum seekers whose asylum claim has been rejected ‘places social work advocates in a position in which they may not be able to assist their clients entirely through their own efforts’ (Fell & Fell, 2014, p.1334). Because statutory social workers are constrained by government policies and legislation, their role as an advocate may not empowering service users, In this case, an independent advocate would be preferred option. ‘An independent advocate only promotes the view of the service user, irrespective of other consideration’ (Dalrymple & Burke, 2006, p.252).

On the other hand, at the policy level, social work as a professional body can and should advocate ‘for policy change and social justice for asylum seekers’ (Refugee Council, 2014). This can be achieved by effectively challenging the oppressive and discriminatory immigration policies, and working with other none statutory agencies in campaigns to influence decisions affecting asylum seekers. Practitioners working with asylum seekers should embrace anti-oppressive advocacy, as a means of addressing the unmet needs of asylum seekers. Anti-oppressive practice ‘is based on a belief that social work should make a difference’ to oppressed and vulnerable service user’ lives… to do this, ‘social workers have to be political, reflective, reflexive’ and committed to challenge the status quo and to promote change’ (Dalrymple & Burke, 2006, p.48).

In conclusion, the reviewed literature has highlighted how social factors such as stigma, labelling and stereotyping as well as media depiction impact the mental health and the wellbeing of asylum seekers. The literature review also pointed out that Social worker’s role in managing risk, addressing oppression and working with people with health and social needs is widely acknowledged, (Dalrymple & Burke, 2006) However, social work do not yet have a visible presence in the area of mental health literature that addresses stigma, and many of the ‘developing interventions and research literature is evolving out of other fields’ i.e. psychology and psychiatry. The review also highlighted how government’s immigration polices not only oppress asylum seekers but also restrict statutory social worker’s ability to discharge their duty in assisting asylum seekers. And finally, the paper discussed statutorily and none statutory social work’s response with regard to meeting the unmet needs of asylum seekers and the role they could play in advocating on their behalf.

Chapter 3 – Methodology

This chapter will describe my methodological approach to the literature review. I will also include the definition of key terms, themes I have selected for my study and those I have excluded. The chapter will also describe data collection procedures and theoretical perspectives.

To start with, I defined the key terms stated in my research topic: Examining the impact of mental illness stigma on asylum seekers in the UK: an informed advocacy approach for social workers. TheWorld Health Organization (WHO) defines mental health ‘a state of well-being in which every individual realises his or her own potential’ (WHO, 2014). Dudley (2000) defines stigma as ‘stereotypes or negative views attributed to a person or groups of people when their characteristics or behaviours are viewed as different from or inferior to societal norms’ (Dudley, 2000, p.449)with regard to asylum seekers, an asylum seeker is someone who has ‘applied for asylum and is waiting for a decision as to whether or not they are a refugee’. (WHO, 2014)

The research design for this dissertation is secondary rather than primary research, as this would limit potential ethical concerns that may have resulted from exploring mental illness through a primary research method. It is also the least intrusive way of collecting the necessary information needed for this research. The method chosen to explore the topic is by literature review, ‘which allows the necessary freedom of exploration,’ (Cross & MacGregor, 2010, pp.593-1600) In addition, doing secondary research has many benefits; It allows the opportunity to access good quality data from the comfort of your home. This type of research method is also cost effective compared to undertaking research through a primary method. Having said that, one needs to be aware of the limitations the secondary data may have and the problems that could arise if these limitations are ignored. For example, the data collected may not be accurate, some of the data may be bias therefore objectivity and the potential influence of researchers must be noted and the source of the data must always be checked. (Brayman, 2008)

Data Collection

The method of data collection was based on qualitative accounts gathered from various sources. Data was obtained from the University library and other online sources. An extensive search was conducted during 2014/15 academic year using different sources. The sources of the material I have used for my study are the following: Academic Search Complete, Jstor, PsycInfo, Wesley Online Library, NHS reports, Local authority reports, and British journal of social work. I have also used books and journals obtained from my local libraries, topics relating mental health in general and mental health stigma in particular were explored in detail. Search terms used include; mental illness stigma, mental disorder, mental health of seekers, and the impact of immigration policies on asylum seekers. Other sources such websites were examined for relevant data, for example, data collected from mental health charity (MIND) and The Social Care Institute for Excellence (scie) was used for this study. Special consideration was given to reliability of the materials collected as well as the objectivity of the researchers. Conflict of interests is said to ‘obscure more than enlighten a research area’ (Brayman, 2008, p.526) therefore, the material collected was rigorously scrutinised, in order to obtain a diverse data and views about mental health illness. As suggested by Avyard, (2007) I used inclusion and exclusion criteria for my research, many terms and materials were included others were excluded from the search results. For example, the inclusion criteria were

  • Literature published within the last ten years ( this was study dissertation criteria)
  • Research carried out in the UK (so as to be relevant to the research topic)
  • Literature on mental health stigma (in order to link stigma with mental health problems of asylum seekers)
  • Literature on asylum seekers (so as not to deviate the aims of the topic)
  • Both published and grey literature (so as to check and compare the integrity of all data)

Exclusion list

  • Research carried out outside UK ( I am only interested asylum seekers in the UK)
  • Literature on refugees (as they have the same right as a UK citizen)
  • Research carried out before 2005 ( this is one of the criteria for conducting secondary research)

Themes included

  • Stigma/labelling, media depiction, poverty, healthcare, detention and dispersal policies.

I chose these themes as these are the areas I was most interested in during my voluntary work with asylum seekers.

Themes excluded

  • Racial discrimination, this is a very important issue, however, this is something all immigrants face and therefore, not specific to asylum seekers.
  • Immigrants from Europe ( as they do not face the restriction as asylum seekers)

Ethical consideration

There are many ethical challenges that have implications for conducting secondary research, such as the issue of confidentiality, and ‘informed consent’ these issues arose during the early stages of my research. Heaton (1998) notes that ‘informed consent cannot be presumed in secondary analysis, and that the researcher cannot rely on any vagueness of the initial consent….’ (Heaton, 1998, p.25) Therefor, as both Heaton (1998) and Thorne (1998) suggest, ‘a professional judgement may have to be made about whether the re-use of data violates the contract made between participants and the primary researchers’ (Thorne, 1998, p.547). Obtaining consent from the authors and participants of the secondary literature I have collected became a daunting task; this is due to the fact that I was unlikely to meet the authors and the participants’ concern. Therefore, I came to the conclusions that, as there is no people involved in my research, no ethical approval is required from the University; however, I am aware that there is still an ethical consideration that needs to be addressed in any research. For example, acknowledging other people’s written work, making my research as subjective as possible, and avoiding bias and dishonesty. In addition, the

Data Analysis

Heaton (1998) describes secondary data analysis as ‘the use of existing data collected for the purposes of a prior study, in order to pursue a research interest which is distinct from that of the original work (Heaton, 1998, p.1) Thus, It is important that once data has been collected a process must be in place to examine each component of the data collected. Therefore, thematic analysis (TA) was used as a tool to examine selected data, in order to identify and analyse patterns in the literature. The thematic process is essentially a method for categorizing and examining patterns in qualitative data (Clarke & and Braun, 2013, p.122) in order to identify themes which are considered to be of interest. For example, the number of times a certain term has been appeared in the literature, i.e. mental illness, or stigma, or discrimination. Any method of analysis should be driven by relevant theory, TA is said to be theoretically flexible approach and does not require ‘adherence to any particular theory’ (ibid) as it can ‘bridge ideas between theory and social construction’ and allows researchers to employ a mixture of varied data sources (Boyatzis, 1998, p.40) therefore, TA analysis corresponds with the topic I set out to investigate.

TA is also a useful tool in analysing secondary data. As Clarke & and Braun (2013) suggest, my preliminary analysis involved familiarising myself with the materials collected, reading and re-reading and ‘noting any initial analytic observations’ (Clarke & and Braun, 2013, p.122) following this, the data collected was sorted and categorized to summarise and synthesize data. Data analysis was based on an ‘inductive approach’ in order to identify themes and patterns in the data ‘by means of thematic analysis’ (Bowen, 2005) therefore, a bottom-up approach was employed whereby analysis was ‘data driven’ instead of ‘theoretical thematic analysis’ which tend to be driven by the researcher’s analytic preconceptions. (Clarke & and Braun, 2013). Coding was utilised to identify any patterns and themes that require further investigation. This involves ‘generating pithy labels for important features of the data of relevance to the research question guiding the analysis’ (Clarke & and Braun, 2013, p.12). This procedure was applied across all of the data collected.

Chapter 4 –Findings and discussion

Through analysis of the literature, two main themes (social and structural factors) were identified in relation to factors that contribute the mental health problems of asylum seekers and barriers they face when accessing social care support. From the two main themes, some sub-themes were also derived. In this chapter, I will discuss these themes, but first I will present a summary of key findings.

Key findings

  • A significant finding of the literature review is that a different type of social exclusion of asylum seekers exists, for example, social and structural stigma. Overall, only a small number of social work literatures I identified have addressed the impact of stigma on the mental health of asylum seekers. Psychology and psychiatric literature addressed the subject in more detail (Corrigan et al., 2014). Social work has offered a limited contribution to this area. The findings from the literature review revealed that asylum seekers have complex and interlinked needs, and face social and structural barriers that contribute to their mental health problems, and this prevents them from seeking their social care needs.
  • Failed asylum seekers avoid or delay to seek support for fear of being detained or fear of being separated from their families. The study confirms that media plays major role in perpetuating stigma in mental health, and its coverage of asylum seekers is also often negative.
  • There are major problems for failed asylum seekers accessing healthcare. Limited understanding of the healthcare system by asylum seekers, confusion of entitlement by healthcare professionals and legislation that restricts asylum seekers accessing the NHS, are identified to be major barriers. In addition, poverty and destitution seem to contribute to the mental health problems of asylum seekers.
  • Immigration policies such as detention and dispersal are major contributing factors of mental health problems of asylum seekers. Many asylum seekers with Post-traumatic stress disorder (PSTD) and mental health problems are being detained. Staturoy social work seemed to be silent on this issue, literature that raised awareness of this issues are mostly non statutory social work. (Mind, A civilised society, 2009 ) the study als found that poverty, social isolation, detention and compulsory dispersal policy alongside uncertainty about the future, ‘are serious post-migratory stressors that do not appear to be well articulated in the social work literature on mental health’ (Chantler, 2012, p.331)
  • The literature review also found that social worker’s role in responding asylum seekers needs, addressing oppression and working with people with mental health disorders is widely acknowledged. However, their ability to discharge their duty is restricted by government legislation, and as a result, they deploy linguistic strategies to defend their practice. And finally

The literature review revealed important themes that I believed contributed to the mental health problems of asylum seekers. The following section addresses each of these themes.

Stigma

This research has discussed the factors that contribute to asylum seeker’s mental health problems by reviewing the current and past literature. Findings echo those of other research carried out on this issue, showing that many of the concerns raised about social and structural stigma, immigration policies, and access to effective health care and advocacy for asylum seekers are yet to be fully addressed. During analysis of the literature, particularly non-social work literature, stigma emerged as a strong theme. I believe non-social work literature appropriately addressed the impact of stigma on asylum seekers, an area I was expecting statutory social work to take the lead. Indeed, mental health stigma can ‘pervade’ the lives of asylum seekers in many different ways. According to Corrigan (2009) stigma “diminishes self-esteem and robs people of social opportunities Corrigan (2009, p.14)”. This can affect their ability to seek or get healthcare, employment or accommodation because of their illness. (ibid). Asylum seekers, particularly failed asylum seekers do not qualify statutory services from local authorities. This is because they do not meet the eligibility criteria for intervention that is, no severe and permanent mental illness, even though they clearly display pre and post migration stressors (Masocha, 2011b) the literature review revealed that the mental healthcare system is regularly failing asylum-seekers; in particular failed asylum seekers. There is a major barrier which makes it difficult for this group to access mental health.

Media

The role of the media in spreading fear and hate against asylum seekers is another theme that came up during my research. The findings of the literature review suggest that media coverage and the public opinion they influence to reinforce the stereotypical perception of asylum seekers as economically motivated and dangerous (Smart et al., 2007). However, it is worth to note that while there is a consensus that some section of the media does stigmatise asylum seekers, the research by Smart et al., (2007) is limited in scope as the time scale of the study was only 11 weeks. It could, therefore, be argued that the result gained from such a small sample in a short period, cannot be generalised to all media. It is also worth to note that not all media is negative, the Guardian and the Independent, for example, seemed to be sympathetic for asylum seekers in comparison to the tabloid press.

Health

Access to health care was another theme that I felt was important for the asylum seekers. The majority of the studies I reviewed indicated that there are barriers for asylum seekers accessing health care. For example, the research by Aspinall (2006) found, although asylum seekers are permitted to register with GP, it is lack of documentation that prevents them registering with GP. Studies by O’Donnel et all (2007) have also shown that access to healthcare is difficult for asylum seekers, failed asylum seekers in particular, they pointed out that ‘varying attitudes’ towards asylum seeker’s health problems amongst healthcare professionals has been shown to significantly contribute to the problems experienced by asylum seekers in gaining access to primary and secondary healthcare. These studies seem to be very reasonable, because other studies also confirmed thier findings. (British Medical Association, 2012, p.5) However, this is not the case anymore; as the Home office started issuing Application Registration Card (ARC) it is used ‘as evidence of identity, immigration status and entitlements in the UK’ these include registering with a GP. However, this card is no use to failed asylum seekers, because once it is expired, they can no longer access entitlement in the UK. The review also found some evidence that suggest poverty, and destitution was major factors which impacted on asylums seeker’s mental health Chantler (2012). No doubt that asylum seeker cherish the ability to be employed and to contribute to the society and to their well-being, but the UK government has since the introduction of nationality and immigration Act 2002, ‘denied them this opportunity, hence aggravating their poverty and possibly exacerbating mental distress’. (Chantler, 2012, p.321)

Immigration policies

Immigration policies such as detention and dispersal policy were key research themes discussed in my literature review. Findings from studies such Masocha (2011b, Chantler, 2012, Corrigan et al., 2014 and Aspinall & Watters, 2010) has consistently linked the experience of immigration detention practices, the impact of dispersal policy and poor mental health of asylum seekers. This link has been demonstrated using a ‘variety of research methods with asylum seekers detained in varying contexts in the UK’ (Chantler, 2012, p.423). Research in this area was challenging for a number of practical and procedural reasons. Researchers reported facing problems in getting access to asylum seekers in detention centres and this has impacted the quality of the studies (Masocha 2011b). The literature I have reviewed suggested that overall the UK immigration policy and the asylum system in particular, has negative impact on the mental health of asylum seekers, Masocha, 2011b, Chantler, 2012. In summary, the literaute has highlighted that the UK asylum system is de-personalising asylum seekers as it does not take into account asylum seekers pre immigration as well as post immigration mental health problems, , 2011b, Chantler, 2012, a veiw also reinforced by the findings of this study.

Research limitations

While this study was carefully prepared, I am still mindful of its limitations and shortcomings. The sample of participants or materials used is some of the limitations. As this was a secondary research, I was not personally able to witness the views of asylum seekers, as I was relying on what other researchers wrote about my topic. Another limitation is a practitioner’s perspective was taken, obtaining the perspective of asylum seekers/service users and would improve the quality of the study, this shortcoming can be attributed to the method of study (secondary review) and finally, another limitation would be, as this is an area that I am interested in, I probably interpreted the materials I collected in a way which supports or suits my research objectives.

Chapter 5 – Implications for social work

Social workers ‘promote a philosophy of self-determination and empowerment to reduce the effects of social inequality’ (Trevithick, 2012, p.12). This secondary review suggests that asylum seekers with mental health problems are some of the most stigmatised, marginalised and vulnerable groups in the UK (Mind, 2009). The review acknowledges both statutory and none statutory social work engagement with asylum seekers but argues that current practice is inadequate. This chapter will discuss the implications for the social work profession and suggest recommendations accordingly.

Ethics and values

By and large, the social work response has been slow to address the needs of asylum seekers and to spell out the relationship between living in destitution and mental distress. This lack of support for asylum seekers by social workers is evidenced in Gillespie’s research which has shown that out of 811 ‘respondents she studied between 2009-12; only two received any social work support’ (Lester, 2014, p.12). Social workers have a ‘responsibility to promote social justice, in relation to society generally, and in relation to asylum seekers inparticular’ (BASW, 2015, p.17). Therefore, asylum seekers must be seen as individuals with the same rights as UK citizens they must be listened to and their needs acknowledged and appropriately met (Lester, 2014) This means ‘working within an equality and diversity framework and putting measures in place to ensure that asylum seekers receive a fair and just response’ (SCIE, 2010, p.11)

Mistreatment of asylum seekers raises important issues of human rights. Practitioners need to employ a strong human rights approach to their practice The Social Care Institute for Excellence (scie 2015) has introduced guidance on ‘how social workers should assist asylum seekers’ (SCIE, 2010, p.11). The approach is right-based, in which social workers are expected to uphold the basic human rights of asylum seekers (ibid). Therefore, I suggest that social workers or anyone working with asylum seekers to adopt a human rights based approach in order to insure that the profession’s principles of equality and respect stated in the code of ethics of the profession are met. The principle states that ‘social workers should uphold and promote human dignity and well-being of service users’ (BASW, 2015, p.17).

Policy and practice

Many UK government policies and legislation concerning asylum seekers may be violating the basic human rights of asylum seekers, for example, detention and dispersal policies of asylum seekers, thus, statutory social work needs to be aware of this. There may be occasions where professional’s values will conflict with the government’s policy; for example when professionals find themselves in a position where they are requested to do something which they strongly feel will be risky to their own service users. For example, under Immigration and Asylum Act 2002, local authorities are required to inform the Home Office when they consider someone to be an ‘ineligible’ person (Lester, 2014, p.40). As a result, many refused asylum seekers with mental health problems ‘might fear their removal and so do not access any help from the local authority’ (ibid).

Therefore, rather than acting as an arm of immigration services, professional should practice an ethical way and uphold the human rights of individuals who use their services. They can manage this ethical dilemma ‘by making sure that asylum seekers are aware of the risk, so they can make an informed choice about what is best for them’ (Aspinall & Watters, 2010, p.20). Social workers also need to challenge oppressive legislation such as Immigration and Asylum Act, even though this will result in a direct conflict with their employer. The manner in which asylum policies have been shaped characterises significant ethical dilemmas for social workers. The manner in which asylum policies have been shaped characterises significant ethical dilemmas for social workers (Masocha, 2015, p.37). This is because social workers find themselves having to follow their employer’s instructions by excluding failed asylum seekers solely by their immigration status (ibid) Therefore, there is a need for social workers to have a critical understanding of the impact immigration and asylum polices have on asylum seekers.

Chapter 6 – Learning gained from undertaking the project

Undertaking a research project provides the researcher a potential method for learning and exploring a topic of interest. In my case, the topic I chose is about asylum seekers and the social problems they face in the host country. Thus, a qualitative method of social work research was considered appropriate for answering my research topic. I have never undertaken similar research before, so everything was new to me, for example, the literature review, research methods, methodology and other research terminologies. I had some basic secondary research skills before starting on this project; however, those skills were significantly improved as a result of conducting this study. I can look back now and say that my research skills were not as good as I would have liked in the initial stage of my research project, as I was so confused and did not know where to start with. But, after reading relevant books such Alan Bryman’s social research methods, I began to get a basic understanding of how to conduct a qualitative research topic. There are a number knowledge and experience I have gained from undertaking this study; the following section summarises such gains.

During the early stages of my research, I came across a huge amount of materials regarding asylum seekers in various secondary data sources, such as journals, books, government reports, newspapers, the internet, etc. The current study experience has taught me that it is not possible to analyse all the available data related to my research topic. Therefore, during the mini literature review phase of the study, I had learned to prioritise secondary as well as any primary data related to my research topic, according to a set of key criteria such as the reliability of the data, the integrity of the authors and their political and ideological affiliations. One of the benefits of secondary data review is that researchers with limited research experiences can conduct this type of study (Bryaman, 2008). However, I had learned that the key to effective research, is the ability to judge the quality of the data or information that has been gathered (Brayman, 2008, p.161) this is a skill I had lacked before I began my research.

Undertaking this project required a lot of planning and preparations, as each phase of the research had to be conducted in an organised and timely manner. Therefore, time management skills are one of the important skills I learned while undertaking the research project. Initially, I encountered challenges with regard to ensuring the progress of the research according to my schedule. These challenges mostly arose at the initial phase of the research. Because I had miscalculated the length of time required for the project and was constantly behind schedule. I have overcome this issue by taking control of my time, setting up a time plan and following that time plan.

During my research, I have learned that there are two types of research methods, primary and secondary research. I also learned that researchers who opt for primary research would primarily investigate topics relating to ‘current status and correlation factors’ (Brayman, 2008, p.294). However, the difficulty with this kind of research is that ‘its generalisability is often hampered by small sample sizes and time limitations’(ibid). On the other hand, researchers who opt for systematic review (secondary research) of data, will have the benefit of accessing existing primary data. They will also be able to easily access large amounts of materials from the comfort of their homes, ‘without necessarily needing to worry about the issues commonly faced by researchers carrying out large-scale primary research’ ibid) for example, gaining ethical approval before one begins his or her research. With regards to ethics and values, I have learned that social workers (as well as student social workers) are regularly confronted with ethical dilemmas when doing research has well as engaging with clients in practice. For example, the ‘values of self-determination can conflict with a duty of care, competing interests of the different organizations that a social worker is working with, and conflict between welfare for the service user and loyalty to their (social worker’s) employer’ can affect the social worker’s ability to provide an effective social work practice (Oliver & Sapey, 2006, p.25).

Chapter 7 – Conclusion

This study sought to review the impact of mental health on asylum seekers and to provide some understanding of the stigma felt by asylum seekers with mental health problems and to find out the factors that contribute to their mental health problems. My literature review is outlined in chapter 2. Factors that contribute or exacerbate mental health stigma on asylum seekers in the UK have been described. Of particular focus were, stigma (social and structural) the role of media, poverty and immigration policy such as detention and dispersal policy. This research has found that a combination of social stigma, structural stigma (by the state) lack of social provision, poor accommodation, oppressive legislation and racism left asylum seekers with a range of mental health problems for which they received very limited support (Phillimore, 2011)

The study also outlined how the mass media, Tabloid papers, in particular, play an important role in spreading negative stereotypes about asylum seekers. While the tabloid media often headline reports that asylum is here get handouts from the state (Refugee Council, 2014), broadsheet papers such as the Guardian ‘pay more attention to the impact of poverty among asylum seekers’(ibid). The study also highlighted barriers faced by asylum seekers with regard to accessing health services. Some of these barriers include; lack of documentation, language barriers, but most importantly, lack of awareness of entitlement by both GPs and asylum seekers themselves. Government legislation such as Scheduled 3 of the Nationality, Immigration and Asylum Act 2002 also limits access to health care for asylum seekers, particularly refused asylum seekers. The study also found that poverty and mental illness are linked, and the literature review suggests that asylum seekers are among the highest risk categories for mental health problems. (Chantler, 2012)

Ample literature which examines the experience of asylum seekers and failed asylum seekers suggest that specific government policies such as detention and dispersal, and legislation such as Nationality, Immigration and Asylum Act 2002 are designed to disincentive those remain in the UK and to deter future arrivals (Chantler, 2012, Aspinall,2010). The research found that detention and dispersal policies have a negative impact on asylum seekers and detained asylum seekers tend to be more vulnerable to mental distress, particularly depression, anxiety, and PTSD, in comparison to ‘non-detained asylum seekers’ (ibid). The study also found how immigration policies such as dispersal policy can result in isolation and the loss of existing support networks. The final sections of chapter two presented the response of statutory and none statutory social work. The study argued that the social work response to the need of asylum seekers with mental health problems is inadequate. However, the study also acknowledged statutory social work’s limitation due to financial constraints and government legislation. Similarly, the study also found that non-statutory social work response to the need of asylum seekers is generally positive, but they are also affected by financial constraints. However, unlike statutory social work, they tend to challenge government legislation and push for changes to improve the lives of asylum seekers, but more importantly, they do not collude with immigration controls.

Chapter 3 described my methodological approach to the literature review, including the definition of key terms, themes I have selected for my study and those I have excluded. The chapter also described data collection procedures, ethical consideration, data analysis and theoretical perspectives. Research findings, implications for social workers and learning gained from undertaking this study is outlined in chapter 4, 5 and six respectively. Finally, I believe that statutory social work should actively challenge government policies that disadvantage asylum seekers. Social workers are in a position to do this as the profession’s code ethics, and values require that social workers have ‘a holistic approach and creative ways of working that do not collude with existing structural inequalities’ and oppressive government legislation (Aspinall & Watters, 2010, p.23).

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2015 in review

The WordPress.com stats helper monkeys prepared a 2015 annual report for this blog.

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The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 26,000 times in 2015. If it were a concert at Sydney Opera House, it would take about 10 sold-out performances for that many people to see it.

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2014 in review

The WordPress.com stats helper monkeys prepared a 2014 annual report for this blog.

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 17,000 times in 2014. If it were a concert at Sydney Opera House, it would take about 6 sold-out performances for that many people to see it.

Click here to see the complete report.

Abdi and his Golden Ticket to the US

 By Leo Hornak: BBC World ServiceAbdi Nor Iftin

Abdi Nor Iftin fled Somalia only to land in one of Kenya’s worst slums. When he won the US green card lottery his problems seemed to be solved – but it turned out to be the start of a whole new struggle.

In Somali slang, there is a special word for the daydream of starting a new life in a far-off land: it’s known as a bofis. And for millions of refugees across Africa, there is one bofis that obsesses people above all – the idea of moving to the West, and in particular to the US.

For most, it remains an impossible dream. But there is one legal way in which even those without wealth or connections can do it – getting a lucky break in the US Diversity Visa Program, better known as the green card lottery. In 2013, nearly eight million people applied for just 50,000 winning tickets, which means that for every 1,000 applicants only six won the chance of a new life.

For the past year, I’ve followed the story of one of the winners – a young Somali refugee called Abdi Nor Iftin, living in the Eastleigh district of the Kenyan capital Nairobi. Known as Little Mogadishu, it’s one of the country’s toughest slums. And one thing I discovered is that becoming an American is not easy, even for those who do have a winning ticket.

There is no denying that there is something a little strange about the Diversity Visa Program. At a time when immigration to most Western countries is becoming ever more restricted, the US government still gives away 50,000 permanent resident visas each year to people chosen at random from across the world. Entries from most developing countries are permitted, and only a high school education, or a few years of work experience, are required. The stuff of a true bofis.

A woman selling goods in Eastleigh/ "Little Mogadishu"

When I first contacted Abdi he had been living in Little Mogadishu for some time. He and all his friends had applied for the lottery together as a group, at a local internet cafe, but Abdi was the only one to be picked by the lottery computer. “We all cheered! We picked him up!” remembers Yunus, one of Abdi’s best friends. “Everybody was holding him, we were shouting, ‘You won it, you won it! You are going to America!'”

A remarkable stroke of good fortune? No, says Abdi, it was his fate.

“This was not just luck. My whole life I have been in love with America – the best country in the world, the dreamland, the land of opportunity,” he says. “Ask anyone what they called me when I was a kid in Mogadishu and they will tell you. My nickname then was ‘Mr America’, or ‘Abdi America’. Everyone used to joke about it.”

Abdi spent most of his childhood in Mogadishu.

He dodged the bullets of Somalia’s civil war, and survived famines. He coped with the suffering around him by watching Hollywood films, and using them to teach himself fluent English. “I was crazy about movies – watching Arnold Schwarzenegger, Sylvester Stallone, Bruce Willis,” Abdi remembers. “I liked the way they sounded; the way they talked. I wasn’t learning how to speak English like that, with that American accent, from my school.”

Continue reading the main story

Find out more

You can listen to Abdi and the Golden Ticket on BBC Radio 4’s Crossing Continents on 29 December at 20:30 GMT or catch up afterwards on iPlayer. The programme ran on the BBC World Service’s Assignment programme on Christmas Day, and can be heard on the Assignment website.

At a local cinema which showed Hollywood movies without subtitles, Abdi became the unofficial translator, explaining the plot and the dialogue to the rest of the audience as each film was screened. “People would listen to me, and wait for me to tell them what was happening,” he says.

Some of the things he saw in those films fascinated him. Snow for example. And doughnuts. “In movies about the police they always talk about doughnuts!” I asked him what he thought a doughnut was. “I think it’s something like a circle with a hole. With some juice in it maybe? It just looks tasty- it gets my saliva going! I want to try that thing!” he told me.

But being well known for a love of America and American culture can also be dangerous. As the Islamist al-Shabab rebel group took control of much of Somalia, Abdi was forced to follow his brother Hassan into exile in Nairobi.

Continue reading the main story

“Start Quote

There was one moment, when I thinking – ‘OK, this is the end of it, man’”

Abdi Nor Iftin

By the time he applied for the lottery, he was considering any way to try and reach the West. Several of Abdi’s close friends had tried to make it to Europe by boat from North Africa. A few had made it. Others had drowned in the attempt. Even more were planning to try it in the future.

Unfortunately for Abdi, being selected as a winner in the lottery is very far from being a guarantee of reaching the United States. Each person selected also needs to present lots of papers and pass a final interview at a US embassy. On that day, each applicant’s entire future is decided.

A majority of applicants never successfully complete this process. In fact, the system is deliberately designed this way. The Diversity Visa Program has to distribute 50,000 visas each year, but to take account of interview failures and substandard applications, the number of randomly chosen applicants like Abdi is more than double that. In 2013, when he applied, approximately 105,000 hopeful applicants were picked by the system. Once the full quota of visas has been assigned, all remaining applicants are automatically refused.

The odds of success for Abdi were soon to get even worse. While he was waiting for his embassy interview, al-Shabab launched the horrific Westgate Shopping Mall attack in Nairobi, killing and injuring dozens of innocent people. Further terrorist attacks followed, and the Kenyan authorities responded with a huge police crackdown on Somalis in Eastleigh.

A soldier stands guard during a tour, on January 21, 2014, of the destroyed Westgate mall in Nairobi

Although al-Shabab supporters were the official target, it felt as though every Somali refugee was at risk of arrest, deportation or internment in camps. Hassan, Abdi’s older brother, was particularly concerned for Abdi at that time. “Being a refugee became a crime,” he told me. “We would hide in our houses. And you could hear screams, children crying, women being hauled away on trucks. Being in that room, listening, waiting for someone to take us both away – can you imagine how that feels?”

Continue reading the main story

“Start Quote

These wildebeest are risk-takers – they have to cross to the other side or die trying… We are now the wildebeest”

Abdi Nor Iftin

For Abdi, it felt as though his entire dream of a better life in the states was being snatched away just when it was within his grasp. Any arrest, however unjustified, could have led to deportation or internment, making it impossible for him to attend his US embassy interview.

During this period, Abdi and Hassan went into hiding, but we continued speaking regularly on the phone and via Skype, recording our conversations. As a journalist working safely and comfortably in London this was often a strange and humbling experience.

On one occasion I spoke to him while the police were still in his building, having extorted a bribe from the neighbours. I would finish my day at the office, and call up Abdi to ask him how his had been. Abdi described the situation, then politely asked me how my work was going and how my family were. Fortunately, the police left without further incident.

Worse was to come. As the police operation went on, week after week, Abdi and Hassan began running short on food. So many Somalis in the area had either been arrested or fled that most shops in Little Mogadishu had been abandoned. Eventually, when the two brothers were down to just bread and tea, Abdi took a huge risk, and ventured out to central Nairobi, where life continued as normal. To his huge relief, he was able to make it back to their room safely carrying a few vegetables and tinned foods.

Residents of Eastleigh on their balconiesResidents of Eastleigh watch as a suspected roadside bomb is defused nearby

But another of our conversations took place a few hours after Abdi narrowly escaped a Kenyan vigilante mob armed with rocks and machetes. He had managed to dive through the gates of a local mosque, but another Somali man on the street had not been so lucky.

Had Abdi expected to die at that time, I asked? “I did, yeah. There was one moment, when I was thinking, ‘OK, this is the end of it, man. They were coming…”‘

The key documents required for a green card interview include a birth certificate, proof of education or work experience and a police clearance document (essentially a criminal records check). It was the last of these that was a particular challenge for Abdi. He had no criminal record with the authorities, but in order to prove this in writing he had to apply to the Kenyan police headquarters directly. Exactly the place in Nairobi where Somali refugees were least welcome.

A young man arrested in EastleighPolice arrest a young man in Eastleigh for lacking ID documents, in April 2014

The strain began to tell. In one conversation around this time, Abdi told me he had been watching National Geographic documentaries on YouTube – it is a feature of urban refugee life that wi-fi connections can persist even when food and water runs low. “Have you ever seen wildebeest?” he asked me. “Every year these wildebeest have to cross this big river, and the river is infested with crocodiles. So I think that these wildebeest are risk-takers. They have to cross to the other side or die trying. What I am saying is: we are now the wildebeest.”

And then, unexpectedly, a further stroke of luck – or fate. After several terrifying visits to the police station, Abdi was told that yes, he would be issued with a formal police clearance letter, confirming his status as a valid applicant for a green card. That evening he told me he could not stop staring at his ink stained fingertips, still marked from the police fingerprint pad. He did not even want to wash them, he said, just to keep the ink there a little longer. Abdi was finally ready for his interview.

A Somali man in Eastleigh is taken away for questioning in April 2014A Somali man in Eastleigh is taken away for questioning in April 2014

The evening before the interview, I wished Abdi good luck and made arrangements for us to speak as soon as he left the US embassy. Everyone who knew Abdi was quietly confident. With his love for America, his fluent English and his dreams of becoming a journalist in the US, he seemed like the ideal candidate. Abdi said that he could not wait to tell his parents and his friends that he had a green card.

Early on the the morning of the interview, I received a text message from Abdi while I was brushing my teeth. It was not what I was expecting. The interview had been a failure and his application had been rejected: “Today is my worst day on earth,” he wrote.

It emerged that Abdi’s police clearance letter was in order, but one of his university transcripts was a copy rather than a signed original. Any paperwork errors can be the kiss of death when so many candidates are applying. Hassan and all of Abdi’s friends were heartbroken. Many of them had seen him as a role model for how to escape the grind of refugee life.

But Abdi had been overhasty in concluding that it was all over. In fact he had not been refused outright. Although it made his application less likely to succeed, there was scope for him to resubmit the papers he was missing, and ask for his application to be reviewed. He got the necessary document from the university in Nairobi and rushed round getting officials to sign it.

A few days later, the result came in. Abdi had been finally, accepted on to the Diversity Visa Program. As a refugee from a failed state, he had no passport, so the visa was printed loose-leaf for Abdi to take to the airport.

Abdi Nor Iftin holds his visa

Abdi America is now living legally and with his green card in snowbound Maine in the US. So far life in the States has lived up to his bofis. He has found work with an insulation installation company, and has sent his first instalment of cash home to his mother in Mogadishu. The appeal of snow has worn off, but his favourite doughnut at Dunkin Donuts is the classic glazed kind (without “fruit juice”).

His diet is changing in other ways. “You know what I just love more than anything?” he asked me recently. “Ice cream! People say it will make me fat, but I want to be fat. I’ve been skinny my whole life, and now I don’t care, Leo, I don’t care!”

Abdi Nor Iftin

You can listen to Abdi and the Golden Ticket on BBC Radio 4’s Crossing Continents on 29 December at 20:30 GMT or catch up afterwards on iPlayer. The programme ran on the BBC World Service’s Assignment programme on Christmas Day, and can be heard on the Assignment website.

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The late Somali President Siad Barre explaining why Somalia had failed to receive the backing of many African countries

First published on jaalesiyaad.com on Friday, 06 June 2014 06:41

E-mail

There was an African leader, whose country recently received independence and was a good friend of mine. When he was an independence activist, I supported him wholeheartedly in his struggle for his country’s independence. In one of OAU’s regular sessions, I requested a meeting with him and he blatantly refused.

Whilst the session was in progress, I managed to bump in to him outside the chamber. I grabbed him by his arm and took him to a corner and asked him, perplexingly, why he refused to meet me. He looked at me anxiously, with sweat dripping down his face, and answered:

"You know that my country is heavily depended on aid. Therefore, I have been forbidden to talk to you or work with your country by my sponsors. I cannot jeopardize the foreign aid that my country receives from these foreign powers."

This reveals that many African countries haven’t left the clutch of colonialism. Many of them who have received independence are still controlled indirectly [neo-colonialism]. Because of that, not a single country in Africa has supported Somalia’s decolonization policies. Now they have distanced themselves [from us]… because some of the developed countries demanded it. (I Somalia, Bo Bjelfvenstam, 1982. p. 141)

Case study 1: Dave and Jenny Smith

Background information about the family.

__________________________________________________________________

Dave and Jenny Smith are white, married, in their early twenties and live on a London housing estate. They have two children; Sean aged four years, and Sarah, aged two. Their marriage is very stormy, prone to repeated rows and occasional violence. Jenny accuses Dave of spending the house-keeping money on drinking and gambling. Dave admits that he spends about £40 a week at the bookies, and he goes to the pub about three times a week. Jenny spends money each week on a mail order catalogue.

The family have rent arrears and hire purchase debts. Two weeks ago they received a letter from a loan company threatening to repossess items to the value of the money owed to them.  Most of their problems are about money, and each blames the other for Sean’s behaviour, which is described by the nursery staff as wilful and aggressive. They only seem to communicate when rowing. Dave works irregularly on building sites as a labourer. Jenny’s mother lives in another part of London, but Dave’s parents are from the north of England. The couple moved into the estate two years ago and hardly know anyone in the area.

Sean is attending the local day nursery and a mother and toddlers group was offered for Sarah, but the offer was never taken up. Both Dave and Jenny would like help with their financial difficulties. Jenny would also like their relationship to improve. Dave says the only thing wrong with their relationship is their lack of intimacy since Sarah was born. The family was referred by the Health Visitor, who felt the family’s problems were affecting Sarah.

__________________________________________________________________

 

 

‘..to practice without a theory is to sail an uncharted sea;

theory without practice is not to set sail at all…’

(Hardiker and Baker, 1991)

 

This paper seeks to examine the above case study. It first explains what social work theories are and their limitation. It then goes on to explain the different types of theory I intend to use and why I chose such theories. Finally, I will analyse the case study using my chosen theories, followed by brief conclusion and any references I used.

Beckett (2006: 33) defines social work theory as a “set of ideas or principles to guide practice”. Howe ( 2009: 2) contends that if we can understand theories, then we are ‘half way towards knowing what to do’. However, one needs to understand that there are different types of theories and they have limitations, for example “informal” theories might not be useful in this case as they tend to incorporate prejudice and assumptions’ and hence do not ‘merit the word theory’ but they need to be taken into account for their existence. (Beckett, 2006: 185) Formal theories however, are more complex, beneficial and express our understandings of social issues and might help us understand and make sense of a complex human world. For example, how family become dysfunctional? Why people become offenders? Or why some children misbehave? And so on.

The difficulty of choosing a particular perspective in Dave and Jenny’s case is that, while some theory can be right for their case; incorrectly applied theories could prove disastrous. For example, a social worker who rely his or her own informal theory for assessment and interventions would be very limited in scope. Having said that, there are number of social work theories that I believe are suitable for this case. Payne, (1997) emphasises that the use of multiple theories are more effective than single theory, and use of single theory can be defective and out of scope. (Payne, 1997: 36) Thus, I intend to use more than one theory for this case study.

And for this reason I intend to use Psychodynamic, Attachment, and system theories Feminist viewpoints, behavioural therapy and Person-centred approach would also be considered. My choices for these theories are based on the idea that Dave and Jenny’s relationship problems might be rooted in their childhood upbringings. The case study shows that their relationship is not healthy, and their argument often lead to violence, and their behaviour is affecting the wellbeing of their children.

The couple have indicated that they are willing to accept help in finding solution for their problems, and most importantly, seeking help should be seen as a sign of responsibility and not failure.  The first thing a social worker needs do in this stage is to talk to them, and  explain that the only way they can fix their problems is to talk and   communicate well and  be ready to receive professional advice and support. The social worker should be holistic in approaching their problems, keeping in mind that this is not onetime event but, rather continuing process which would lead to plan of action that is suitable for them. ‘When the problems are identified, the social worker and the family need to agree to prioritise their problems and to identify which ones they want to work on’. (Cree and Myers, 2010: 93).

Anti-oppressive practice requires that social workers need to undertake least interventions (Payne, 2005: 286), working in partnerships with a social worker and finding ways to enable Dave and Jenny to become more aware of their own problems, One element of anti-oppressive practice is to make sure that people’s rights are not violated. (Dalrymple and Burke, 1995: 57) Social worker must put the needs of the children’s first, but also need to respect the family’s human rights, including rights to liberty, private and family life.

In the case study, it’s not clear who is oppressed, one can only assumed that Dave is using his masculine power to his advantage. My aim here is to avoid placing oppression into a hierarchy and prioritising one form of oppression over another, as Jenny might also be the oppressor. Feminist theory in domestic violence emphasizes gender and power inequality in family relationship, it points out the traditional norm that endorses a male’s use of violence and aggression against their female partners  (Pence and Paymar, 1993). They also pointed out that the cause of violence against women is that, the society turns blind eye to the violent behaviours perpetrated by men against them. (Pence and Paymar, 1993) In this regard, Dave might be using his physical power to oppress Jenny; however, critics of this theory would also point out that, this is not always the case as issues of power and abuse have also been identified in lesbian relationship. (Lawson, 2003) Therefore it is difficult to pin point who oppressing who.

As professional worker, it is important to note that the main concern here is the family’s ‘problematic situation’, it would be unethical and judgmental to see either of them as problem.  (Thompson, 2009) I would encourage the couple to take the lead in solving their problems, ‘given that empowerment is central to social work intervention’ (ibid, p 15). Educational skills such as communication skills might be needed to overcome their problems. Seeking counselling might help ease tension, learning basic budgeting skills might also help reduce their financial problems, and better communication skills might also reduce tension. And lastly they need to learn how to ‘channel their emotion and feelings more responsibly’ (Thompson, 2009: 80-81)

Sigmund Freud’s Psychodynamic theory suggests that “ our behaviours come from movements and interaction in our minds” (Payne, 1997: 72-73)  according to this perspective, Dave and Jenny’s repeated rows and aggression is driven by their id, thus a good co-operation between their ego and superego would have resulted a better understanding of Dave and Jenny’s marital problems. Furthermore, Dave’s intimate violence against Jenny might mean that he did not receive adequate nurturing in early years. Therefore understanding his early childhood experiences might be central to understanding their trouble relationship. Talking to Jenny’s mother might be helpful if both parties are willing to accept, with support they would need to develop solution to overcome their problems. They would also need to learn and to focus as a team a meaningful goal to improve their relationship, such as seeking anger management treatment and taking responsibility for their actions (Thompson, 2009)

One of the strength of psychodynamic theory is that it focuses on the causes of one’s aggressiveness and behavioural problems and links this to their early childhood experiences (Trevithick, 2011). Freud’s theory also led to other theorists such as Piaget developing theories on childhood development. It is weaknesses are that, it suggests that behaviour is pre-determined and individuals are “under control of instinct” this contrast to Humanist perspective, which suggest that individuals are able to decide for themselves and have “potential for their own development” (Atkinson and Wells, 2003: 25) Another weakness is that Freud theory is Eurocentric and did not take into account other none European cultures.

The case study, suggest that Dave is using the housekeeping money on gambling and alcoholic drinks, these tragic problems are not specific to Dave.  In fact, studies suggest that gambling is a major problem in the UK and is out of scope of social care agencies (Rogers, 2013: 41-60). People of similar life style and income situations as Dave and Jenny’s are known to spend significant amount of their income on gambling than those on higher income (ibid). Thus, Dave’s gambling problems needs to be addressed as it’s a major source of their conflict. Much of the literature I have come across seems to have said little about gambling problems, and as Roger (2013) suggests, “It remains an inadequately understood entity and an under-theorised area of human behaviour”. (Rogers, 2013: 50) Psychodynamic theory would suggest that Dave’s gambling problem happens at an unconscious level. In sociological theory on understanding compulsive gamblers’ Bernhard (2007, 137) argues that “our habitual process are products of sociological as well as psychological factors”. (Bernhard, 2007: 122-138)

 

 

Good relationship between social worker and the family are central to the effectiveness of good anti-oppressive practice. Another social work theory that might be suitable for this case would be Person-centred approach. This perspective seeks to understand the needs of the family, what do they want and how can this be accommodated. The social worker needs to explain what support is available for them and how they can get access to such support. These include counselling, support and budgeting and other support that can best meet their needs (Thompson, Kilbane and Sanderson, 2008). Not all interventions work for all, thus, social worker needs to consult with the family. Using person-centred approach, both should be reminded, that Dave’ tendency to use the housing keeping money for drinking and gambling and Jenny compulsive catalogue spending would have dire effects on their lives. The rent arrears, hire purchase debts as well as the threat of repossession to their personal belongings needs to be addressed too. This theory emphasises self-empowerment, so Dave and Jenny are aware of their situations and are  able to take responsibility for their actions, however they may make too lofty of goals that are not achievable.

It is clear in this case study that financial difficulties and unemployment are another major cause for their problems. The main goal of intervention should therefore be, to restore the family’s stability as there are two vulnerable children among them. Thus, the social worker should identify any financial support the family might be entitled to and how to get such support, work with Jenny’s mother and apply the intervention that will be most effective in restoring the family’s stability. The logic behind all these is the social worker to enable the family to help themselves.

The social worker should not jump into conclusion regarding child removal, and remind him or herself that the best interest of parents and the children is to “support children and family to stay together.” (Children Act 1989). it is clear in this case that Dave and Jenny’s rows and repeated disputes has affected  their children,  Sean’s behavioural problems at the nursery is a good example. The fact that the family has moved into this areas recently suggests that they are experiencing social isolation, contacting and consulting other family members are therefore vital for this case.   Even though none of the children is physically abused, Hague and Malos (1998) believe that the kind of behaviour shown by couple constitute child abuse (Hague and Malos, 1998). In this scenario children need emotional support to help them emotionally and to enable to sustain attachment and pleasure’ with their parents (Caroll, 2000: 11-12).

Evidence suggests that, parents who mistreat their children often have drinking problems, and in some cases may be suffering mental health problems. (Davies and Carolyn, 2011: 4) Jenny’ apparent detachment from Sarah and the lack of intimacy with her partner might be sign that she is suffering a depression. In these scenarios attachment theory might help explain Jenny’s lack of attachment and intimacy with Sarah and Dave.

This perspective focuses on the parent and child relationship as well as spousal relationships. It suggests that mother and child attachment is vital for emotional development of the child. Like Psychodynamic approach, attachment theory suggests that children’s earliest bonds with their caregivers shapes the development of their childhood and continues to affect throughout their life. Thus, violence at home affected their children and therefore they may not develop an emotional security. The argument here is that ineffective or lack of attachment in their childhood could have been responsible for the mother child detachment in this case study (Lishman, 1991: 59)  so Jenny’s detachment with her daughter and lack of intimacy with her husband may have its roots to her early childhood development. Attachment theory is an ideal for to use in dysfunctional family situations because it seems to correctly explain behavioural and relationship problems as typical to Dave and Jenny’s (Lishman, 1991: 14)

It is paramount importance that the social worker needs to get as much information as possible in advance before he or she first arranges meeting with the family. This ideally involves checking multi agency records to see whether the family is known to the authority, and what information is held about them, particularly the children. The report on the  death of Victoria Climbié in 2000 stressed the importance of social workers reading case files, this is to substantiate whether common assessment framework on Sarah already exist, this will allow the social worker to decide whether Sarah is considered to be child in need under  section 17 of Children Act 1989 (Laming, 2003). And if this is the case, carry out the necessary steps.

The health visitor’s referral did not mention whether Sarah is in danger, social worker needs to take into account about this. In this scenario Social worker must adopt a “position of healthy scepticism” (Laming, 2003) as social worker, I would need to be aware of the concerns raised by the health visitor, but at the same time be ready to independently and fairly assess the situation. In this case ‘Common Assessment will be helpful in clarifying the health visitors’ concerns  as well as the  needs of Sarah and at the same time identifying the services that the family require’ (Cree and Myers, 2010: 32) while it is right that any social worker might be thinking of child protection issue in this case, the Children’s Act 1998 reminds us that, the best interest of children is to “support children and family to stay together” (Children’s Act 1998)

The family’s traumatic situation might be the reason the couple are struggling to meet the emotional needs of their children and the lack of intimacy between them. Because both couple are anxious about financial difficulties, they become preoccupied with their own problems and neglected their children’s emotional feelings. Referral to relationship counselling would probably help the couple to overcome such difficulties. The nursery describes Sean’s behaviour as “wilful and aggressive” the couple’s problems, particularly Dave’s, violence and behavioural problems from the perspective of attachment theory suggest “insecure infant attachment and intergenerational transmission of violence”  (Killeen and McClellan, 2000: 353-360) Thus, Sean’s behaviour at the nursery could be indicative of the caregiver’s deficiency as children’s “patterns of attachment is influenced by what their attachment figures do” (Lishman, 1991: 59) However, contrary to explanations of attachment and psychodynamic theories, not all children who are ‘abused or witness abuse incidents  follow the footsteps of their caregivers  (Killeen and McClellan, 2000: 353-360)

In conclusion, social work theory is ideas and principles that guide us to understand social issues that affect us on daily bases. While theories may not give us expected outcome, the critical and logical approach they provide ensure that assessment and interventions are consistently made on the best information and with professional judgment. Learning social work theory is crucial in understanding social crises such as Dave and Jenny’s case and how we might best respond to such crises. It is vital that social workers read case files before doing any intervention and reach firm but professional judgment keeping in mind the human rights of service users. And finally I would like to share the following interesting quotation as they sum up the importance of social work theory.  “To practice without a theory is to sail an uncharted sea; theory without practice is not to set sail at all”  (Hardiker and Baker, 1991) without social work theory the social worker is at the mercy of discouragements” (Marchal 1946, 1; quoted in Lishman, 1991: 41)

 

Bibliography

Atkinson, K. and Wells, C. (2003) Creative Therapies: A Psychodynamic Approach Within Occupational Therapy, Cheltenham: Nelson Thornes.

Beckett, C. (2006) Essential Theory fodr Social Work Practice, London: SAGE Publications Ltd.

Bernhard, B. (2007) ‘Sociological speculations on treating problems gambler: A Clinical sociological imagination via a bio-psyco-social-sociological modoe’,Ameircan Behavioural Scentist, vol. 51, pp. 122-138.

Bowlby, J. (1984) The Making and Breaking of Affectinal Bonds, London: Tavistock.

Caroll, J. (2000) ‘Evaluation of therapeutic play: a challenge for research’, Child and Family Social Work , vol. 5, no. 1, pp. 11-22.

Cree, V. and Myers, S. (2010) Social work: Making a difference, Bristol: The Poliyc Press.

Dalrymple, J. and Burke, B. (1995) Anti-oppressive practice: Social care and the law, Buckingham and Philadelphia: Open University Press.

Davies and Carolyn, W.H. (2011) https://www.gov.uk, May, [Online], Available:https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/184882/DFE-RBX-10-09.pdf [01 Nov 2013].

Hague, G. and Malos, E. (1998) Domistic Violence: Actoin for Change, Trowbrdige: The Cromwell Press.

Hardiker, P. and Baker, M. (1991) Cited in “Towards social theory for social work, London: Jessica Kingsley.

Howe, D. (2009) A brief introduction to social work theory, Basingstoke, Hampshire: Palgre MACMILLAN.

Killeen, M.R. and McClellan, A.C. (2000) JOURNAL OF NURSING SCHOLARSHIP, vol. 32, no. 4, pp. 353-360.

Lackey, C. and Williams, K.R. (1995) ‘Social bonding and the cessation of partner’, Journal of Marriage and the Family, vol. 57, pp. 295-305.

Laming, L. (2003) The Victoria Climbié Inquiry: Report of an Inquiry by Lord Laming, London: HMSO.

Lawson, D.M. (2003) ‘Incidence, explanations and treatment of partner violance’,Journal of Counselling and Development, vol. 18, pp. 19-32.

Lishman, J. (1991) Handbook of Theory for Practice Teachers in Social Work, London: Jessica Kingsley.

Omar, M. and Sawsan (2012) Psychological Testing and Assessment, edition, Psychological Testing and Assessmen: New York, USA.

Oxford Dictionary (2013) Definition of oppression in English, 30 Nov, [Online], Available: http://www.oxforddictionaries.com/definition/english/oppression?q=oppression [30 Nov 2013].

Payne, M. (1997) Modern Social Work Theory, 2nd edition, Basingstoke, Hampshire: PALGRAVE MACMILLAN.

Payne, M. (2005) Modern Social Work Theory, Besingstoke: Palgrave Macmillan, Houndmills.

Pence, E. and Paymar, M. (1993) Education groups for men who batter, London: Springe.

Penna, S. (2004) ‘On The Perils of Applying Theory To Practice’, Critical Social Work, vol. 4, no. 1, Spring, p. 3.

Roberts, A.R. and Yeager, K.R. (2009) The pocket guid to Crisis intervention, Oxford: Oxford University press.

Rogers, J. (2013) ‘PRACTICE: SOCIAL WORK IN ACTION’, Problem Gambling: A Suitable Case for Social Work?, vol. 25, no. 1, Feb, pp. 41-60.

Thompson, N. (2009) practicsing social work, Basingstoke, Hampshire: PALGRAVE MACMILLAN.

Thompson, J., Kilbane, J. and Sanderson, H. (2008) Person Centred Practice for Professionals, London: Open University Pres.

Trevithick, P. (2011) ‘Understanding defences and’, Journal of Social Work Practice: Psychotherapeutic Approaches in Health, Welfare and the, vol. 25, no. 4, DOI: 10.1080/02650533.2011.626642, Nov, p. 394.

 

Essay on Child Observation

This essay seeks to critically evaluate my role as a child observer. Drawing on two or more theories of child development, I will look at the main theoretical concept and critically evaluate in relation to my observation. First, I begin a brief description of the child I  observed and the setting in which the observation took place. Next I attempt to show my understanding of normal child development, and aspects that can disrupt ‘normal’ child development. Throughout the essay, I will critically examine and reflect on the process of undertaking my observation. And finally, issues of ethics and anti- oppressive practises will be discussed.

The child I observed was three and half year’s old girl called Sara (not her real name), of African Caribbean background and English is the only language spoken at home. All three observations took place at the day-centre she attends. The day-care centre gave me permission to observe her, but not to interact and interfere with her educational activities. As this was my first observation, I was a bit anxious about how Sara might react about me watching her, and while her parents consented about the observations, Sara did not know that I am here to observe her; it is this scenario that made me uncomfortable. I was particularly more concerned about the ethical issues of not informing Sara about the observation. One element of anti-oppressive practice is to make sure that people’s rights are not violated. Social workers must put children’s needs first, and to respect their human rights, including rights to liberty, privacy and family life (Dalrymple and Burke, 1995: 57).

In common with anyone who is undertaking child observations, I was quite unsure where to start and how to conduct myself. I was anxious watching Sara in such an intimate way, and thought this could be intrusive to her personal space. For example; early in the observation, Sara was not talking and was mostly sitting quietly and I did not want to upset her. But most importantly, the fact that Sara was the same racial background as mine made my observation a difficult one, because I was not sure whether I would get adequate learning about anti-discriminatory practice. However, because this kind of feeling is common among student child observers, gave me some comfort and internal support. (McMahon, 1994)

During the first 29 minutes of my observations, Sara was not talking at all. I moved closer so that I could see and hear her better. Sara looked up and then smiled at me. I did not know whether Sara talks or not, but to my ignorance I expected three and half years olds to speak at this stage. Up to this point, I was not fully aware what “child development was” I remembered child development lecture we have had at the University, and I recalled the terms “selective mutism” I asked myself whether Sara is in selective mutism mode or whether she is uncomfortable with my intrusion. To my surprise at 10:29 am I heard and saw Sara saying something. When Adult2 said “its playtime” Sara shouted and said something I understood as “playtime” unfortunately, Sara did not say a single word for the rest of the observation for this day. I ask Adult2 about Sara’s ability to speak. “Sara has a delayed speech” She replied. Sara is three and half years old and still is not talking, she says very few words and she seemed to be way behind compared with her peers.

So what is normal child development? Sigmund Freud’s psychosexual theory suggests that children develop through series of stages, he named them as: oral, anal, phallic, latent and genital stages. (see Goswani, 2011) Freud believed normal childhood development is subject to successful completion of these stages. He believed a child becomes ‘fixated’ if any of these stages are not completed. (Parrish, 2010: 59-62).He believed that three parts of personality; id, ego, and superego ‘become integrated during the stages’ (Berk, 2006: 17). This perspective thus suggests that ‘the process of desire and gratification in each stage defines the basis of personality formation’ and paves the way for the type of adult such personality would be later in life. (Avan and Kirkwood, 2010). According to this perspective Sara’s speech delay is caused by unsuccessful completion of one or more of these stages.

While Freud highlights the importance aspects of child development, critics would point out that his tendency to focus on sexual urges to explain his concepts. Another weakness is that the theory seems to be Eurocentric and does not take into account none European cultures. Other theorist such as Erik Erikson’s theory although an extension of Freud’s work ‘placed more emphasis on social influences such as parents and siblings, role models and cultural backgrounds than Freud did, and thus placed less emphasis on sexual urges to explain children’s behaviour’ (Parrish, 2010: 63)

Having said that, understanding developmental expectations of children of similar age would have helped me better understand Sara’s situations. I did not understand why Sara was not able to talk; I was comparing her with my son who was able to talk by the age of two. ‘Slow talking often raises parental and professional concern’. However, knowing what’s “normal” and what’s not is crucial in understanding child development as there are wide variations among the “normal children in the rate of language acquisition” (Sheridan, 1997).

Why do we need to know child development? A good knowledge of child development and understanding theories that underpin such knowledge is essential, because it allows us to understand the concept of child development, hence theories of child development. Similarly, understanding theories of language development can help us identify how children such as Sara develop their own language and communication skills. It is therefore important that Social workers understand the process of human growth and how children such as Sara acquire language acquisition. (Doherty and Hughes, 2009: 5)

There are a number of theories associated with child development; behaviourism and nativists are two of them. Behaviourism focuses on the process of language acquisition, it suggest that children learn through observation and reinforcement. For example, when a parent encourages a child to say ‘Mama’ or ‘Papa’ and the child responds the parent gets excited and encourages the child to so say it again; chances are the child is more likely to try to repeat it. Behaviourist such as Watson (1924) and B. F. Skinner suggested that child development is a ‘continuous process of change shape by the environment and it is one that could be differed according to the individual’. (Doherty and Hughes, 2009: 37) Although reinforcement and imitation can help early language development, this perspective is primarily concerned with visible behaviour, and therefore does not address or ignores important child behaviour such as ‘thoughts, feelings and emotions’. (Berk, 2006: 355).

Clearly, Sara used language to label objects of interest to her. In one occasion, I observed Sara naming shapes. For example, I heard her saying ‘green colour’ ‘yellow colour’ she was also able to name complex shapes such as ‘hexagon’ and ‘octagon. When I enquired how Sara learned these, objects, I was told she uses ipad at home. However, Sara demonstrated difficulty with simple instructions such as ‘put your shoes on’ or ‘take your coat off’ and she found difficult to consistently follow simple instructions, but she was able to repeat phrases such as ‘let’s go’ and ‘ready set go’ she therefore demonstrated the core principle of behaviourism, which is learning through imitation and reinforcement as she was able to repeat what she saw on the ipad and what she heard from others. However, what behaviourism does not tell us are Sara’s thoughts and emotions, and this is the some of the weaknesses of this perspective.

Thus, theoretical knowledge is the key to effective intervention and good assessment when assessing children in need and their families. Critical awareness and self‐reflective has allowed me to re-examine my own values, and biases and as result I have gained basic knowledge of child development. The observation and my ongoing learning of aspect of human growth module allowed me to become aware of positions of power and how such power can impact child development. For example, parents or staff at day-care centres or even a social worker abusing their power when dealing with children.

Berk, (2006) Comments that behaviourist arguments cannot ‘account for language development’. And while early reinforcements may help children learn some phrases, it’s the adults who ‘influence children’s language development through interaction’. (Berk, 2006: 355). Furthermore, while this perspective emphasis on nurturing through reinforcement, in contrast, nativist proponent such as Noam Chomsky would argue that children have their own way of learning language without being reinforced by adults. In other words they have ‘inborn human ability to learn’. Chomsky focuses on grammar and contends that it is, too ‘complex to be directly thought to a child, even if such child is cognitively sophisticated’ (Berk, 2006: 355)

These different views helped me understand more about children growth and their language development. Before the observation, I rarely thought and tried to find out how children develop their language skills. But having read the deference perspectives about children development helped me understand and gave me a basic knowledge about child development. For example behaviourism’s reinforcement concept reminded me how I actually did this to my own children without knowing it.

Another theory that interested me is Jean Piaget’s Cognitive development theory. Like Sigmund Freud’s psychosexual theory, also suggests that children develop through series of stages, namely; sensorimotor, pre-operational, concrete operational and formal operational periods (see (Doherty and Hughes, 2009 for more details). But unlike Freudians, the perspective suggests that all these stages take place inside child’s brain (Doherty and Hughes, 2009) the aim of the theory is to explain the process by which a child, develops into a personality that can reason and think. Paiget believed that children’s development is marked by ‘qualitative differences in their thinking as they grow up (Miller, 2011: 653)’. His theory suggested that children do not necessarily learn from their care givers and peers or experience, instead, they ‘actively construct knowledge and experience through interacting with the world and reflecting on these experiences’. (Miller, 2011: 653). He highlighted the importance of ‘maturation’; he believed that children are natural learners. Although Piaget’s theory has been influential and contributed Western understanding of child development, some of the criticism of his work is that, the stages of development seemed to be Eurocentric and therefore overlooked other cultural backgrounds. Furthermore, Berk (2006), comments that although Piaget’s work contributed to the field of child development, he ‘underestimated the competencies of infants and preschoolers’ (Berk, 2006: 23).

In contrast to Piaget’s view, Lev Vygotsky Socio-cultural theory (1978) (see Goswani, 2011: 673) suggested that children’s social interactions with important figures such as parents can have positive impact on their developing. He argued that children learn by example, they tend to copy the language or behaviour they see or hear being used around them. (Goswani, 2011: 673) Although Vygotsky’s theory relates to Piaget’s cognitive development theory, unlike Piaget he did not see children as solitary learners. But as learning through social interaction that involve observing what others are doing, learning from them and then communicating with them. He further, believed that children’s parents, teachers and peers are crucial to their cognitive understanding (Daniels, 2011: 673).

Like Piaget, Vygotsky saw children as active learners in their own right, but believed that this needs ‘access to rich and stimulating environment’ (Doherty and Hughes, 2009: 269) in light of what I have observed about Sara, I think she needs access to speech and language therapy which would help her support her language development needs. During my third observation, I observed number of factors which I taught were crucial in child development. Sara was playing with her peers away from where I was. This gave me an opportunity to observe her in naturalistic setting. I observed that Sara’s playing skills were far better than her speaking ability. She was able to play alone and with groups and was clearly learning from them. From above simple observation, it is clear Sara’s behaviour resembles those described in Vygotsky’s socio-cultural theory. During my observation, I noticed that while Sara was not able to initiate her own speech, she was able to copy and say what she saw or heard. Furthermore, her social interaction was impressive, she played and interacted well with her peers and did not exhibit any sign of isolation. By observing this child, I have gained insight into the child’s strengths, weaknesses interests and skills. I have noted barriers that might be holding back this child’s development, such as speech delay.

As child observation has become an important tool for understanding child development, issues such ethics, values and anti-oppressive practice needs to be taken into account. Good relationship between social workers and services users are central to the effectiveness of good anti-oppressive practice. Dalrymple and Burke (1995) states that social workers should seek knowledge, understanding and be able to identify their strengths and weaknesses. Understanding how one’s own behaviour and emotions impacts on services users is vital for the profession. Although I did not witness any wrong doing during my observations at the day-care centre, I felt that it is paramount important that one needs to be encouraged to use anti-oppressive practices when working with children and families, in settings such as day-cares and nurseries. ‘One element of anti-oppressive practice is to ensure that children’s rights are not violated’ (Dalrymple and Burke, 1995: 30) Anyone working with children also needs to be aware of and familiar with statutory legislations such as Children Act 1989 and Human Rights Acts 1998 in order to effectively engage good anti-oppressive practice.

In conclusion, in this essay I have stated that how child observation tasks I have undertaken has opened my eyes to the world of children. Because I have learned something I knew, but did not realise that I knew it. Every day I observed my own children but I rarely give a second thought about such observations. I have also talked about how my understanding of child development was very limited and the module contents and the child observations boosted my understanding immensely. In addition, I mentioned the child I observed was the same racial background as mine, and felt that I might not get sufficient learning in terms of anti-oppressive and anti-discriminately practice, and because as a potential social worker, it is vital that I need to be exposed to other cultures.

I have also commented that the ethical dilemmas I have faced whilst observing. For example the child was not told that I will be observing her. I looked at the various perspectives in relation to child development, what do they have in common and where they differ, their strengths and weaknesses. I have also talked about how anti-oppressive practice is vital when dealing with vulnerable service users, and those intend to work with children need to be made aware the statuary legislations that underpin child protection and Human rights. And finally, I have stated how this observation boosted my understanding of child development and that not all children speak and grow up at the same rate and how the adverse effects such as speech delay can impact on ‘normal’ child development.

Word count: 2566

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Dalrymple, J. and Burke, B. (1995) Anti-oppressive practice: Social care and the law, Buckingham and Philadelphia: Open University Press.

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McMahon, L.&.F.S. (1994) ‘‘Infant and child observation as preparation for social work practice’, Social Work Education vol., vol. 13, no. 3, pp. 81-89.

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