Chapter 15. Working with refugees and asylum seekers
challenging occupational apartheid
Richard Davies
The day service I work in serves a population of people aged 16 and upwards who are experiencing mental health problems in a major city in the north of England. Based in an economically disadvantaged area of the city, the area is culturally diverse and has long been home for people from a variety of ethnic origins. The day service has for some time attempted to engage creatively with hard to reach communities in its locality who have not accessed secondary services for a variety of reasons, not least of all the stigma associated in many communities with mental illness.
In response to this problem the day service has sourced community funds to appoint two workers, one Pakistani woman and one Yemeni man, to work with their respective lingual communities to improve mental health care provision in non-traditional settings. Called ‘emotional wellbeing workers’ to avoid the stigma often associated with mental health issues, the concept of sukhoon, meaning relief or inner peace in Urdu and Arabic, forms the focus of their interventions with their communities. They often work in community centres to identify individuals not currently accessing the health care system. This may be followed up by offering individual and group work in culturally appropriate ways. In this way they aim to engage meaningfully with the issues that people face in their respective Urdu- and Arabic-speaking communities.
Through this work and a wide range of other contacts the day service has been able to uncover previously unmet mental health needs. Consequently an increasing number of asylum seekers and refugees with occupational needs are being introduced into the service.
The local and national picture for asylum seekers and refugees
During recent years the numbers of asylum seekers coming to the UK increased from 26 205 asylum applications received by the UK Home Office in 1990 to a peak of 84 130 asylum applications in 2002 (Peach & Henson 2005). This figure fell dramatically to 25 710 in 2005 following a range of changes introduced by the UK government to reduce the number of asylum applications made by foreign nationals entering the country (Heath et al 2006).
The point of arrival for most asylum seekers is London and the ports on the south-east coast. This raised concerns about the pressures being placed on local services in these areas and the government responded by introducing a dispersal system in an attempt to relocate asylum seekers more equitably across a greater number of host cities. The system obliged asylum seekers to move to northern UK cities in order to continue receiving accommodation and support.
A specific terminology is used in the UK to describe those at various stages of the asylum system. A person whose asylum application has been successful and who has been offered indefinite leave to remain is described as a refugee. In 2005 only 7% of initial decisions granted refugee status, although a further 24% were allowed appeal or discretionary leave. Someone who has fled persecution and has applied for asylum but whose application is still being processed is described as an asylum seeker. For those whose asylum claim has been rejected the term ‘failed asylum seeker’ is most usually applied, although ‘denied asylum seeker’ and ‘unsuccessful asylum seeker’ may also be used. For the purpose of this piece the term ‘denied asylum seeker’ will be used, as the location of the marginalization is identified as systematic, that is within the structure of the asylum process rather than within the pathological agency of the individual.
The largest groups of asylum seekers in the city where the day service is based are Iranians, Iraqis, Somalis, Yemenis, Congolese and Afghans. In March 2005 the National Asylum Support Service, the part of the Home Office that offers support and accommodation to asylum seekers, supported 1450 asylum seekers from 56 different nationalities in the city. This probably underestimates the true number of asylum seekers in the city; many new arrivals may be supported by their family and friends who are already resident there. This is a common pattern of migration, where people often move along patterns initiated by ‘bridgehead communities’ who facilitate the settlement of other people from the same region to their host region.
In addition to this, a significant number of denied asylum seekers have not been successful in their application and have exhausted all rights of appeal. This population is not supported by the government and does not show up in National Asylum Support Service figures. A local asylum seeker charity estimates this population at around 1000 people who are receiving no help from the state and rely solely on support from friends and charities.
Asylum seekers and refugees have been located in many areas around the city and the ethnically diverse area where the day service is located was identified as one of a number of appropriate locations for refugees and asylum seekers to be relocated into. This places the day service at the centre of a large population of occupationally disadvantaged individuals who have difficulty accessing traditional routes to social inclusion.
Working with individual experience
Whiteford (2004) details the experiences of Maria, a Bosnian woman, as a refugee in Australia and highlights the challenges she faced as she sought to engage in occupations in order to recreate a life in a new country with her two young daughters. Difficulties included:
• isolation through lack of language competence
• reduced opportunities to participate in leisure and work because of language difficulties and financial status
• loss of family for practical and emotional support
• loss of sense of ‘connectedness’ to others in the community because of a contrast between the social and physical environment of the country of origin and the host country.
The difficulties encountered by Maria are familiar to the client population I work with in the UK. Similarly, some of the occupationally focused interventions she identifies are familiar. ‘Facilitating community and social participation through the use of pre-existing structures and facilities’ (Whiteford 2004, p. 196) is possible by linking people into a diverse range of activities, from groups offering community walking programmes or community vegetable gardening to a local employment project for refugees.
Additionally the bureaucracy of the asylum system impacts upon the occupational life of the asylum seeker, as Helen Claire Smith (2005, p. 474) has identified: ‘Asylum, and the long wait for approval, is a dehumanizing process forcing people into an apathetic and passive position. Occupationally speaking it is a disaster. Individuals are not permitted to work and often find it difficult to integrate into an unwelcoming society.’ An additional irony is that much of this population has skills that the economy needs. A spokesperson from a non-governmental organization, the National Institute of Adult Continuing Education (2001, p. 1) has commented: ‘asylum seekers may have skills, qualifications and qualities which are needed in the UK and in the local economy’.
Smith (2005) sees her role as working with the drive and abilities of individuals who have demonstrated great resilience and resourcefulness in seeking a better life. However, she has identified one important structural barrier for refugees in that the government places restrictions on those individuals’ occupational activity.
Currently asylum seekers in the UK are denied access to paid work, which in itself would be an important therapeutic tool in developing feelings of self-worth and promoting good mental health within the asylum seeker community. In a briefing paper, the Refugee Council (2007, p. 6–7) states: ‘[B]eing able to get a job opens up many more opportunities. There is potential to meet a wider range of people and experience different working environments … It will help lift people out of poverty, gain greater self respect and help regenerate their neighbourhoods. It is what asylum seekers want.’
How is it possible for a therapist to maintain a positive outlook in the face of such bureaucratic intransigence when people are prevented from working? In short, it makes the job more difficult but not impossible. As Smith says:
Start by remembering that many of the issues that we face when helping refugees are not really new to us. It is easy to see all the differences and forget what is common to us all. Use your everyday helping skills: listening, demonstrating respect and seeing the client as an individual with a unique identity and aspirations. Our clients are searching for empathy more than an answer to their complex problems and needs.
Smith 2005, p. 475
In this I am reminded of a recent discussion I had in my car with a client I shall call Patrice. He is deeply traumatized by events in Africa where he was a teacher and a peaceful member of a political group who opposed the government. His trauma began 4 years ago when government soldiers forced their way in to his home and arrested him in front of his pregnant wife. They took him to a prison where he was tortured and sentenced to death. He managed to escape and fled to the UK but does not know whether his wife and child are still alive. His first asylum application has failed and at the time of writing he is appealing the decision.
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