The UK Equality Act and Access to Mental Healthcare for Refugees and Asylum Seekers

By Amy Stoddard Ajayi

The Equality Act

The Equality Act 2010 (“The Act”) is an amalgamation of previous antidiscrimination laws that came into force in the UK on 5th April 2011. It is in place to ensure public services are made accessible to, and meet the needs of all people, regardless of their age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage and civil partnership, or pregnancy and maternity.

The Act requires public bodies and their staff to focus on the following as a priority:

• Eliminating unlawful discrimination, harassment, victimisation and any other conduct prohibited by The Act;
• Advancing equality of opportunity between people who share a protected characteristic and people who do not.
• Fostering good relations between people who share a protected characteristic and people who do not.

All NHS staff receive mandatory training that covers NHS policy on Equality and Diversity, including The Act, but this has not had a sufficient impact on strengthening the equality of care for asylum seeking and refugee people in the UK or for people from Black, Asian and Minority Ethnic (BAME) Groups.

The UK relationship with immigration

The most commonly printed word in the UK press associated with migrants is “criminal”. [1] This tells us something quite significant about the messages that the UK population receive about each other, absorb, and function with in their personal and working lives on a daily basis. The Migration Observatory at Oxford University conducted a European survey in 2016, which demonstrated that out of the UK sample, 69% of respondents thought that immigration levels should be decreased, while only 5% thought that they should be increased. [2]

A 2009 BSA survey regarding immigration found that the UK respondents overestimated ‘non-western’ migrants as being 25% of the population, when the full (western and non-western) foreign born population was actually only approximately 11%.3 This highlights some very real concerns about how our UK population’s inaccurate interpretations of immigration may undo or disable the basic principles of the Equality Act in the work place.

Statutory services and therefore clinicians working within these services are influenced by policy, which is in part, driven by the common negative media and political rhetoric about immigrants. In turn current policy is increasingly being developed to stigmatize and often criminalise people who have experienced forced migration. [4] This is compounded by the media, who use immigrants as pawns in the process of government spin and false alarm resulting in a growing and escalating fear that the nation holds about ‘the other’. [5]

The state of mental healthcare equality in the UK

Refugee and asylum seeking people struggle to obtain both physical and psychological care from UK statutory services and much of the vital work is carried out by underfunded charitable organisations, despite the fact that refugee and asylum seeking people have far greater healthcare needs than most. [6]

Health care clinicians worry about, and are uncomfortable with, their own capacity to meet the needs of asylum seekers and refugees, and can feel disempowered and hopeless in their professional roles. [7] Clinicians can be fearful of the kinds of problems that refugees and asylum seekers often present with, as well as seeing asylum seeking and refugee people as a group with problems that are too complex and difficult to attempt psychological interventions. [8]

From an anthropological perspective, Bridget Anderson discusses the politics of immigration and how the term ‘asylum seeker’ describes both a person’s legal status, and also their value. Anderson comments on how the asylum seeker is conceptualized by the British nation as ‘the failed citizen’ or ‘non-citizen’, a person without value and therefore a person without rights. [9] The results are that comparatively, people from BAME communities are underrepresented and much less likely to be referred to psychological therapies than other groups. [10]

It is without doubt that we have a problem. Worryingly, in a post Brexit world, we face increasingly negative political and media rhetoric that focuses on the population’s socioeconomic fears, often centred on immigration. There is growing pressure on policy makers to reflect these views. This is mirrored in the nation’s growing fear, intolerance and hostility towards people who are conceptualized as outsiders, which is evidenced by the fact that Hate Crime soared by 41% after the Brexit vote. [11]

Research

Research was conducted to investigate the way in which practitioners within NHS statutory psychological services in Greater London and the South east of England respond to specific descriptors that are associated with Asylum Seeking and Refugee People (ASRP).

Clinicians beliefs were measured using RECBT theory, where irrational beliefs are defined as demand based, catastrophic thinking, reduced emotional tolerance and self/other or world depreciation beliefs. Irrational beliefs are theorised as being, inflexible, and inconsistent with reality, rigid, illogical and unhelpful to ones emotional, physical and social health. These beliefs form the primary cause of psychological disturbance, resulting in dysfunctional negative emotions and associated behaviour. [12]

60 Psychological Therapies Service clinicians were surveyed as to their work experiences, concerns, as well as whether a patient was (a) an asylum seeker, (b) a survivor of politically motivated torture, and (c) a patient required a translator. Analysis of the survey revealed the following insights:

When prompted “I can’t stand being tense or nervous and I think tension is unbearable,” the responses demonstrated evidence in support of the literature suggesting that clinicians are uncomfortable with the prospect of working with ASRP and that their anxieties are increased when faced with these prospects. Influencing factors could be:
• Clinicians rely on language in their work as their main tool and anxieties are raised when not being able to use this tool to its full potential.
• The subject of politically motivated torture intimidates the clinician.

When prompted “I deserve to access help and care more than some other people,” the responses suggested that participants (clinicians) believe people who are seeking asylum, have experienced politically motivated torture and require translating service are less entitled to access help and care than the norm. Here it is possible to find a relationship between Anderson’s suggestions that ASRP are conceptualized as people without rights, impacting on the general populations notions of entitlement and worth when evaluating ‘who’ and ‘what’ we are. [13]

From these results, it is possible to understand how and why the types of beliefs that the population, and therefore at least some of the clinicians working within statutory services hold may well impact on the fact that ASRP struggle to access psychological care in the UK.

When prompted “If I fail to help others, it means I am hopeless and a failure at my job,” the responses suggested that if the clinician feels disempowered in their ability to help, then they may be more likely to avoid this type of patient.

Interestingly, there are lower responses to groups where a translator was needed or where the patient was a victim of politically motivated torture. Influencing factors could be:
• Clinicians are more forgiving of themselves with these groups because of the perceived difficulty of treating the patient.
• Clinicians have stronger beliefs about helping people in groups in the norm or merely applying for asylum than those who have suffered torture or require a translator.

When prompted “If I get frustrated because I don’t understand someone else’s cultural values, that is evidence of the fact that I am a narrow minded discriminatory person,” responses support the idea that clinicians become anxious about being viewed as discriminatory and may be more likely to appraise themselves harshly if they struggle to understand other peoples’ cultural values. It could be argued that this could lead to an avoidance of this anxiety and therefore these patient groups.

Conclusion

Outcomes from this research support the need for future exploration into questioning whether inadequate psychological care of ASRP in the UK is, in part, driven and maintained by policy makers, senior managers and clinicians lack of rationality and tolerance when faced with working with ASRP, and the common problems that they bring. This could in part be driven by a lack of available accurate information about ASRP within statutory services, coupled with overt denigration and mistrust induced by government spin and media coverage impacting on individuals’ personal belief systems.

By exploring these questions further, and in particular how belief change can play critical role in how we engage with, value and respond to each other, it may provide an avenue to make it easier for practitioners to feel less daunted by working with ASRP. Hopefully this could facilitate the development of a better, clearer understanding of how to improve the services that ASRP receive.

Political correctness may have the unintended affect of masking the problem, because people become afraid to discuss matters relating to equality, but maintain and hold onto private ideologies and inflexibilities that significantly impact on the level of care that vulnerable people receive from the services that they access.

A more unified approach requires an open platform to have these discussions, challenge our ideologies, establishments, and policy makers in a non-threatening and constructive way in order to increase equality of care for all within the UK mental health system.


About the author


Amy Stoddard
Amy Stoddard-Ajayi has a degree in Anthropology and was selected to train for her Masters in Rational Emotive and Cognitive Behavioural Therapy under the world recognised Professor Windy Dryden. Amy is currently a Senior Public Services Consultant to the NHS, charitable and the private sectors, specialising in service development for mental and physical health services, where she plays a key role in supporting the design and development of effective mental and physical health care across the country as well as in international settings. She has conducted important research into advancing mental health care for refugee and migrant communities, written exhaustively on matters of equality, and is published on the subject of improving mental health care by working with diaspora groups in the BMJ.


Notes

[1] Migration Observatory, Oxford University (2013) Migration in the News: Portrayals of Immigrants, Migrants, Asylum Seekers and Refugees in National
British Newspapers, 2010-2012.
[2] Migration Observatory, (2016) Briefing on Public Opinion Towards Immigration: Oxford University, Oxford, England. Available at:
http://www.migrationobservatory.ox.ac.uk/resources/briefings/uk-public-opinion-toward-immigration-overall-attitudes-and-level-of-concern/
[3] Id.
[4] Patel A and Mahtani A (2007 ) The Psychologist. Special Addition: The politics of working with refugee survivors of torture. Volume 20 – Part 3
[5] Greenslade R (2005) Seeking Scapegoats. The coverage of asylum in the UK press. Institute for Public Policy Research, London.
[6] Joint Committee on Human Rights: Tenth Report of Session (2006-2007) The Treatment of Asylum Seekers, Joint Committee on Human Rights, House of Lords, House of Commons, volume 11: Oral and written Evidence.
[7] Rees, M., Blackburn, P., Lab, D. and Herlihy, J. (2007). Working with asylum-seekers in a clinical setting. The Psychologist, 20, 162–163.
[8] Tribe, R., Patel, N. (2007) ‘Refugees and asylum seekers’ The Psychologist, Special Edition. 20 (3) 149– 151.
[9] Anderson, B. (2013) Us and Them? The Dangerous Politics of Immigration Control, Oxford: Oxford University Press.
[10] Joint Committee on Human Rights: Tenth Report of Session (2006-2007) The Treatment of Asylum Seekers, Joint Committee on Human Rights, House of Lords, House of Commons, volume 11: Oral and written Evidence.
[11] The Guardian, ‘Hate crimes soared after EU referendum, Home Office figures confirm, (13 October 2016), available at: https://www.theguardian.com/politics/2016/oct/13/hate-crimes-eu-referendumhome-office-figures-confirm.
[12] Dryden W., Branch., R. (2008). The fundamentals of rational emotive behavior therapy. Second Edition. John Wiley and Sons. Chichester, England
[13]  Anderson, B. (2013) Us and Them? The Dangerous Politics of Immigration Control, Oxford: Oxford University Press.


[Source: The Refuge (May 2017), Volume 1, Issue 3, pages 6-10]

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