There have always been people who have had to flee from wars, or natural disasters or severe persecution because of their ethnic origin or their political, religious or social activities. If we all had our DNA tested, few of us would not reveal traces of ancestors who have landed in these islands due to such circumstances; cold, wet, tired, with nothing but the clothes they wore – and traumatised by both the horrors that forced them to flee and the terrible travails that they had along the way.

The incredible will power, vigour and drive needed to make those journeys perhaps explains why refugees and their descendants have then often contributed so significantly to the cultures to which they have fled, all around the world.

There is a strong argument for saying that it was the arrival of Muslims fleeing the Spanish inquisition, bringing new mathematical knowledge, that triggered the Renaissance in Italy. Though the arrival of the Huguenots caused riots in London and Canterbury in Elizabethan times, now their descendents are woven through the establishment and elite of British society. Many Jewish refugees who fled from Europe to escape the death camps are now so rightly lauded for their achievements in the fields of medicine, law, music, art, and literature.

Safe but not settled

Sadly, arrival in this country does not, in itself, bring peace of mind. Though someone who has arrived in the UK may be physically safe, the intricacies of the asylum system and attending to their basic welfare needs then require immediate attention. At the same time, they live in a country with a different culture, language and structure and wait in a state of limbo, anxious to hear if they will be forced to leave again.

In addition, they must now come to terms with the losses associated with their flight and, perhaps just as importantly, with a loss of a belief in an imagined future. Even if accepted as refugees, this country will, very likely, not be what they imagined and dreamed it to be.

Of course the terms asylum seeker, refugee or migrant are all too frequently used in a negative and derogatory way. Our media and many politicians tend to focus on issues of economic migrancy rather than refugee issues. This has the effect of marginalising all asylum seekers and refugees. Thus the reality of being a refugee, with the sometimes terrible mental traumas that have led someone to flee everything they know to seek sanctuary abroad, is too easily ignored or minimised.
Being elderly or an adolescent can increase this trauma, as does a lack of knowledge of the host language and, for some, a loss of their previous socio-economic status. Many of us will have met refugees who were qualified chemists or doctors in their own countries but who are now working as taxi drivers or cleaning floors.

Psychological distress

However, this is not only a problem that should be seen in terms of us just not wanting to hear their stories. It is also a problem because it can be very difficult for those who have suffered to tell us of their experiences. Cultural interpretations about psychological distress, trauma and mental health are seen differently around the world, and these cultural nuances are not so likely to be picked up by those who have not shared the experiences that have created them.

We tend to try to get people to describe the horrors they have experienced and what these have done to them in the language and symbols of our own culture and fail to recognise that in order to help them most effectively we would be better served using the meaning and symbolism available in their own culture where possible, to help them come to terms with their experiences.

Furthermore, though we all know that there is still plenty of stigma about mental ill-health in this country, in many other cultures that stigma is still much more pronounced. It is just not a subject that can be openly discussed. Somatisation among refugees is frequently high as physical pain is so much more acceptable than psychological pain.

For many survivors of severe psychological trauma it may be especially unacceptable to discuss such things with a professional of a different gender or a different religion, and we have to remember what that other religion or gender might symbolise for that person. We must also remember that the idea of trusting a psychiatrist, or any doctor, with descriptions of deeply hidden feelings, may be an extremely alien concept for them.

What are Psychiatry UK doing to help?

At psychiatry-uk.com, we are trying to develop a model to help with these issues by placing an emphasis on developing culturally-sensitive services. We are taking advantage of the variety of languages and backgrounds of our psychiatrists. Our (non-location based) model offers patients a chance to choose to talk to someone who will be be able to share in at least some of their cultural identity.

We believe that this is one of the major benefits of our online service and would be keen to work with GPs and Clinical Commissioning Groups to develop these further. We are already working with a number of specialist solicitors’ firms and refugee charities and we are always willing to discuss doing work in this field.

The here and now

Becoming an asylum seeker is a major event in someone’s life, though it is not their whole story. Therefore, how and why individuals are forced to become asylum seekers, refugees or displaced people and to flee to this foreign country, is perhaps not that important. They are here. The important thing is to think about how to help them to come to terms with their experiences, to settle into their new lives and to become the same sort of significant contributors to our futures as all those other refugees that this island has assimilated in its rich and varied history of providing refuge to those who most need it.
Dr Chi-Chi Obuaya is an NHS Consultant Psychiatrist and a partner with Psychiatry UK. You can view his profile here.

If you need any further information about this or would like to talk to one of our psychiatrists please contact us here.