Nassir Hassan- July 2015
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
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:
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)
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).
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)
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 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)
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)
- 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)
- 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.
- 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)
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
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.
- 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.
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.
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.
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 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.
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).
Ahmedani, B.K., 2011. Mental Health Stigma: Society, Individuals, and the Profession. Journal of Social Work Values and Ethics, 8(2), pp.414-16.
Allen, R., 2014. The Role of the Social Worker in Adult Mental Health Services. London: The College of Social work The College of Social work.
Allsopp, J., Nando, S. & Phillimore, J., 2014. Poverty among refugees and asylum seekers in the UK. Birmingham: Birmingham University.
Allsopp, J., Sigona, Nando, P. & Jenny, 2014. Poverty among refugees and asylum seekers in the UK An evidence and policy review. Birmingham: IRIS WORKING PAPER SERIES, NO. 1/2014: Birmingham University.
Aspinall, P.J., 2006. A review of the literature on the health beliefs, health status, and use of services in the refugee and asylum seeker population and of appropriate health care interventions. Cardif: Welsh Assembly Government.
Aspinall & Watters, 2010. Refugees and asylum seekers, A review from an equality and human rights perspective. EQUALITY AND HUMAN RIGHTS. COMMISSION RESEARCH REPORT SERIES. Glasgow: University of Glasgow: available at http://www.gla.ac.uk/media/media_146312_en.pdf. Accessed 10th May 2015.
Association of Visitors to Immigration Detainees, AVID, 2011. Immigration Detention: a handbook for visitors. London: Association of Visitors to Immigration Detainees,.
Atkinson, D., 1999. Advocacy: A review. Brighton: Pavilion Publishing.
Bacon, L. et al., 2010. Immigration policy: implications for mental health services. Advances in psychiatric treatment, 16, pp.124-32.
BASW, 2015. Promoting the Dignity and Worth of Peoples’: World Social Work Day 2015. [Online] Available at: https://www.basw.co.uk/resource/?id=3821 [Accessed 10
Bates, L., Mnurssci, R. & Stickley, T., 2013. Journal of Psychiatric and Mental Health Nursin. Confronting Goffman: how can mental health nurses effectively challenge stigma? A critical review of the literaturejpm_1, 20, pp.569-79.
BBC, 1999. The origins of community care. [Online] Available at: http://news.bbc.co.uk/1/hi/health/229517.stm [Accessed 06
Beard, P., Hayter, D.J. & Shenkar, E., 1989. The diagnosis and treatment of mental illness: in introduction. Detriot, Michigan: Wayne state universtiy press.
Bowen, G.A., 2005. Preparing a Qualitative Research-Based Dissertation: Lessons Learned. The qualitative Report, 10(2), pp.208-222. Electronic version (accessed 07/04/2015), retrieved from: http://www.nova.edu/ssss/QR/QR10-2/bowden.pdf.
Boyatzis, R.E., 1998. Transformation Qualitative Informaiton: Thematic Anaylysis and Code Development. Thousand Oaks, CA: Sage Publications.
Brayman, A., 2008. Social Research Methods. Oxford: Oxford University Press.
British Medical Association, 2012. Access to health care for asylum seekers and refused asylum seekers – guidance for doctors. London: British Medical Association, British Medical Association.
Chantler, K., 2012. Gender, Asylum Seekers and Mental Distress: Challenges for Mental Health Social Work. British Journal of Social Work , 42, p.322.
Chronister, J., Chou, C.-C. & Liao, H.-Y., 2013. The role of stigma coping and social support in mediating the effect of societal stigma on internalized stigma, mental health recovery, and quality of life among people with serious mental illness. JOURNAL OF COMMUNITY PSYCHOLOGY, 41(5), pp.583-600: available on wileyonlinelibrary.com/journal/jcop.
Clarke, V. & and Braun, V., 2013. Teaching thematic analysis: Overcoming challenges and developing strategies for effective learning. The Psychologist, 26(2), pp.120-23.
Cohen, J., 2008. Safe in Our Hands: a study of suicide and self-harm in asylum seekers in the UK. Journal of Forensic and Legal Medicine, 15, pp. 235-244.
Corrigan , P., Druss , B. & Perlick, D.A., 2014. The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychological Science in the public interest, 15 (2), pp.37-70.
Corrigan, P., 2004. How Stigma Interferes With Mental Health Care. American Psychologist, 59( 7), pp.614 – 625.
Corrigan, P.W. & Watson, A.C., 2012. Understanding the impact of stigma on people with mental illness. World Psychiatry., 1(1), pp.16-20.
Coyle, A., 2000. Discourse Analysisin G M Breakwell S. Hammond, C. Fife-Scaw (Eds) Research Methods in Pyschology. London: Sage Publicationn.
Craig, T., Dinesh, B. & Kamaldeep, B., 2010. Mental Health of Refugees and Asylum Seekers. Oxford: Oxford Univiersity Press.
Crawley, H. & Crimes, T., 2010. Refugees Living in Wales: A Survey of Skills, Experiences and Barriers to Inclusion. Cardif: Welsh Assembly Welsh Assembly Government, WSMP and WRC.
Cree, V., 2003. Becoming a Social Worker, London, Routledge. London: Routledge.
Cresswell, J.W., 2009. Research Design: qualitative, quantitative and mixed methods approaches. London: SAGE publications.
Crisp, A.H., 2004. Every Family in The Land; Understanding Prejudice and Discrimination Against People with Mental Illness. London: Royal Society of Medicine Press.
Crisp, A.H., Gelder, M.G. & Rix, S., 2004. Stigmatisation of people with mental illness. British Journal of Psychiatry, 177, pp.4-7.
Cross, J. & MacGregor, H.N., 2010. Knowledge, legitimacy and economic practice in informal markets for medicine: a critical review of research. Social Science and Medicine, 71, pp.1593–600.
Dalrymple, J. & Boylan, J., 2013. Effective Advocacy in Social Work. London: SAGE Publications Ltd.
Dalrymple, J. & Burke, B., 2006. Anti-Oppressive Practice: Social Care and the Law. 2nd ed. Maidenhead: McGrow-Hill Education-Open University Press.
Davies, M., 2012. Social Work with Adults: Policy, Law, Theory, Research and Practice: Mental health law and social work. Basingstoke: PALGRAVE MACMILLAN.
Department of health, 2007. Implementing the Overseas Visitors Hospital Charging Regulations: Guidance for NHS Trust Hospitals in England: London Department of health. [Online] Available at: http://www.dh.gov.uk/prod_consum_dh /groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_081516.pdf [Accessed 23
Dickerson, F.B. et al., 2012. Experiences of Stigma Among Outpatients With Schizophrenia. Schizoprenia Bulletin, 154(1), p.143.
Dudley, J.R., 2000. Confronting stigma within the services system. Social Work, 45(5), pp.449-55.
Durkheim, , 1982. the Rules of the Sociological Method. New York: The Free Press.
Faoucault, M., 1967. Madness and Civilisation, London; Routledge. London: Routledge.
Fell, B., 2013. ‘Social work practice, asylum seekers and refugees’ in M. Davies (ed.), The Blackwell Companion to Social Work. 4th ed. Chichester: Wiley-Blackwell.
Fell, B. & Fell, P., 2014. Welfare Across Borders: A Social Work Process with Adult Asylum Seekers. British Journal of Social Work, 44, pp.1322–39.
Forbat, L. & Atkinson, D., 2005. Advocacy in Practice: The Troubled Positoin of Advocates in Adult services. British Journal of Social Work, 35, pp.321-35.
Gary, F.A., 2005. Stigma: Barrier to mental health care among ethnic minorities.. Issues in Mental Health Nursing, 26, pp.979-99.
Gillespie, M., 2012. TRAPPED: DESTITUTION AND ASYLUM IN SCOTLAND. Research Report. Glasgow: Glasgow Caledonian University Scottish Poverty Information Unit, Institute for Society and Social Justice Research.
Goffman, E., 1963. Stigma: Notes on the Management of. Englewood Cliffs, JN: Prentice Hall.
Goodwin, J., 2012. SAGE Secondary Data Analysis. Thousand Oaks, CA: SAGE Publications.
Hayes, D. & Humphries, B., 2006. Social Work, Immigration and Asylum. London: Jessica Kingsley Publishers.
Heaton, J., 1998. Secondary analysis of qualitative data. [Online] University of Surrey. (http://sru.soc.surrey.ac.uk/SRU56.pdf) [Accessed 21 April 2015].
Humphries, B., 2004. An unacceptable role for social work: implementing immigration policy. British Journal of Social Work, 34, p.107.
Hynes, P., 2011. The dispersal and social exclusion of asylum seekers: Between liminality and belonging. Bristol: The Policy Press.
icar.org.uk, 2006. Destitution amongst refugees and asylum seekers. [Online] ICAR Available at: http://www.icar.org.uk/Destitution%20briefing.pdf [Accessed 25
icar.org.uk, 2007. Vulnerable groups in the asylum determination process- thematic breifing prepared for the Independece Asylum Commision, London ICAR. [Online] Available at: http:www.icar.org.uk/11787/briefings/vulnerable-gourps.html [Accessed 24
Kohli, R., 2008. Child and Family Social Work with Asylum Seekers and Refugees: CFS Special Issue. London: Blackwell Publishing.
legislation.gov.uk, 1948. National Assistance Act 1948. [Online] Available at: http://www.legislation.gov.uk/ukpga/Geo6/11-12/29 [Accessed 22
legislation.gov.uk, 1990. National Health Service and Community Care Act 1990. [Online] Available at: http://www.legislation.gov.uk/ukpga/1990/19/section/47 [Accessed 24
legislation.gov.uk, 2002. Nationality, Immigration and Asylum Act 2002. [Online] Available at: http://www.legislation.gov.uk/ukpga/2002/41/schedule/3 [Accessed 22
legislation.gov.uk, 2004. Asylum and Immigration (Treatment of Claimants, etc.) Act 2004. [Online] Available at: http://www.legislation.gov.uk/ukpga/2004/19/section/9 [Accessed 25
Lester, P., 2014. Social work and poverty: A critical approach. Bristol: Policy Press.
Liewellyn, A., Agu, L. & Mercer, D., 2008. Sociology for social workers. Camdridge: Polity Press.
Link, B.C..P.J.C., 2001. Conceptualising Stigma. Annual Review of Sociology, p.363.
Link, B.G. & Phelan, J.C., 2005. On Stigma and its Public Health Implications. New York: Columbia University and New York State Psychiatric Institute.
Masocha, S., 2011b. We Do the Best We Can: Accouning Practices in Social Work Discoursed of Asylum Seekers. British Journal of Social Work, 44, pp.1621-36.
Masocha, S., 2013. How do social work professionals construct asylum seekers as objects of knowledge and targets for intervention:Doctoral Thesis. Dundee: Dundee University.
Masocha, S., 2015. Asylum Seekers, Social Work And Racism. Basingstoke: Pelgrave MacMillan.
Masocha, S. & Simpson, M.K., 2011a. Developing mental health social work for asylum seekers: A proposed model for practice. Journal of Social Work, 12(4), p.427.
McKenzie, K., McColl, H. & and Bhui, K., 2007. Improving services for refugee and asylum seekers: Position statement. London: : Royal College of Psychiatrists.
Mendenhall, A.N. & Frauenholz, S., 2013. Mental Health Literacy: SocialWork’s Role in Improving Public Mental Health. National Association of SocialWorkers, 38, p.366.
Mind, A civilised society, 2009. A civilised society Mental health provision for refugees and asylum-seekers in England and Wales. London: © Mind 2009.
Mind, 2009. A civilised society Mental health provision for refugees and asylum-seekers in England and Wales. London: © Mind 2009.
Mind, 2014. What are mental health problems? [Online] Available at: http://www.mind.org.uk/information-support/types-of-mental-health-problems/mental-health-problems-general/#.VGUQYTSsVu4 [Accessed 13
Morris, G., 2006. Mental health issues and the media: an itroduction for health professional. London: Routledge.
Neale, D., 2012. A prison in the mind: the mental health implications of detention in Brook House Immigration Removal Centre. London: Gatwick Detainees Welfare Group Gatwick Detainees Welfare Group.
Nottingham Citizens, 2012. Homelessness and Hope. [Online] Available at: http://www.citizensuk.org/wpcontent/uploads/2012/11/2012_11_06_H_And_HReport_CM04.pdf.pdf [Accessed 01
NRPF, 2006. Destitute People from Abroad With No Recourse to Public Funds. [Online] Available at: http://www.nrpfnetwork.org.uk/policy/Documents/nrpf_survey_local_authorities.pdf [Accessed 24
O’Donnell, C.A., Higgins, M., Chauhan, R. & Mullen, K., 2007. They think we’re OK and we know we’re not: A qualitative study of asylum seekers’ access, knowledge and views to health care in the UK. BMC Health Services, 7(75), pp.1-11.
Oliver, M. & Sapey, B., 2006. Social Work with Disabled People. 3rd ed. Basingstoke: Palgrave MacMillan.
Orel, E.T., 2007. Stigmatization in the long term treatment of Psychotic disorders. Neuro Endocrinology Letter, 28(1), pp.35-45.
Phillimore, J., 2011. Approaches to welfare provision in the age of super-diversity: the example of health provision in Britain’s most diverse city. Critical Social Policy, 31(1), pp.5-29.
Project London, 2010. Access to healthcare. London: Project London; avaliable at: http://moderngov.towerhamlets.gov.uk/mgConvert2P.
Refugee Council, 2014. Policy and research. [Online] Available at: http://www.scottishrefugeecouncil.org.uk/policy_and_research/responding_to_policy [Accessed 30
Roberts, R. & Lister, R., 20147. Asylum seekers in the UK: Let them work and let them eat. London: https://www.opendemocracy.net/ourkingdom/roger-roberts-and-ruth-lister/asylum-seekers-in-uk-let-them-work-and-let-them-eat.
Robjant, K., Robbins, I. & Senior, V., 2009. Psychological Distress Amongst Immigration Detainees: a cross-sectional questionnaire study. British Journal of Clinical Psychology, 48, pp.275-87.
Rogers, A. & Pilgrim, D., 2005. A Sociology of Mental Health and Illness. 3rd ed. Berkshire: Open University Press.
scie, 2006. The social care needs of refugees and asylum seekers. London: social care institute for excellence.
SCIE, 2008. Mental health and social work. Research breif. London: socia care institute of excellence scie.
SCIE, 2010. Good practice in social care for asylum seekers and refugees. WORKFORCE DEVELOPMENT REPORT 31. London: social care: institute for excellence social care: institute for excellence.
Shaw, I. & Tablin, S., 2007. Happiness and mental health policy: A sociologicval crtique. Journal of Mental Health, 16(3), pp.359-73.
Shorter, E., 1997. A History of Psychiatry from the Era of the Asylum to the Age of Prozac. New York: John Wiley and Sons.
Smart, K., Grimshaw, R. & McDowell, C., 2007. Reporting asylum: the UK press and the effectiveness of PCC Guidelines. London: City University.
Social Work Task Force, 2009. Building a safe, confident future: The final report of the Social Work Task Force, London. [Online] Department of Children Schools and Families Available at: http//publications.education.gov.uk/eOrderinDownload/01114-2009DOM-EEN.pdf [Accessed 29
Sweeney, A., Beresford, P. & Faulkner, A., 2009. This Is Survivor Research. Ross-on-Wye.: PCCS Books.
TCSW, 2015. The college of social work: capabilities within the PCF. [Online] Available at: http://www.tcsw.org.uk/pcfSearch.aspx [Accessed 26
Thompson, N., 2000. Understanding Social Work: Preparing for Practice,. Basingstoke: Macmillan.
Thorne, S., 1998. Ethical and representational issues in qualitative secondary analysis. Qualitative Health Research, 8(4), pp.547-55.
Trevithick, P., 2012. Social Work Skills and Knowledge: A Practice Handbook. Maidenhead, Berkshire: Open University Press.
UNHCR, 2014. What is the difference between a refugee and an asylum seeker? [Online] Available at: http://www.unhcr.org.uk/about-us/the-uk-and-asylum.html [Accessed 06
Watson, A., Corrigan, P., Larson, J. & and Sells, M., 2007. Self-Stigma in People with Mental Illness. Schizophrenia Bulletin, 6, p.33.
WHO, 2014. Mental health: a state of well-being. [Online] Available at: http://www.who.int/features/factfiles/mental_health/en/ [Accessed 28
Yang, L., A, K., BG, L. & JC, P., 2007. Culture and stigma: adding moral experience to stigma theory. Soc Sci Med. 2007 Apr; 64, 67(7), pp.1524-35.