Global Health Society on Mental Health: A Refugee Perspective

Rebecca Farrington is a G.P. in Salford and Senior Lecturer at the University of Manchester. She reflects on how general practice can impact and support refugees and asylum seekers, and how mental illness is one of the greatest health burdens for individuals who have been forced to flee for their security.

For the past 12 years, I have been a GP in Salford for people seeking asylum. I have always been interested in the health of refugees and displaced people and worked as a G.P. for Medecins sans Frontières in the 1990s. These field doctor roles were on the Thai-Burmese border, Liberia, South Sudan and Afghanistan.

People often imagine that I spend my days dealing with cases of rare and interesting tropical disease; however, in reality, the most prevalent issues for asylum seekers in the UK relate to mental health.

We think of displaced people as having pre-exile, exile and post-exile difficulties. People escaping war or persecution may present with multiple traumas, and the toll these have on their health is considerable. Some have been tortured or held in captivity, which has profound effects on mental health. Many are far from their usual sources of support, have a poor grasp of language, and struggle to navigate the NHS. Financial resources are constrained and increasingly people are being made destitute and homeless by the authorities once they have exhausted their claim for asylum.

“It is not the person who is broken, it is his or her world,” said Derek Summerfield, founding psychiatrist of Freedom from Torture.

Post-traumatic stress disorder presents as a chronic and complex diagnosis in exile. There are some excellent and easily readable books on this that I can recommend: “The Body Keeps The Score” by Bessel Van Der Kolk, and “Trauma and Recovery” by Judith Herman. Both are psychiatrists based in the USA and have extensive research and clinical experience focused on combat veterans and survivors of childhood abuse. Their findings are very relevant for other groups who are traumatised.

Being a GP brings a holistic perspective to the care of refugees. Their physical and psychological needs are often difficult to disentangle, and adopting a generalist approach is better. It is challenging work, but very rewarding. I meet some incredible people with fascinating histories, and am often in awe of them.

I have also learned the therapeutic value of active listening, bearing witness, and advocacy for my patients. The role of a doctor includes humanitarianism, defined as promoting human welfare and social reforms. Being in a non-judgmental safe space is often the first step on the road to recovery for people whose lives have been turned upside down.

We are about to advertise volunteering opportunities with asylum seekers for students in year 2. Check out the university volunteering website and keep an eye on OneMed Buzz.

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