Risk and resilience Migrant & Refugee Mental Health and Wellbeing

Transcription

1 Risk and resilience Migrant & Refugee Mental Health and Wellbeing Vaasa Wednesday 24 th October 2018 Dr Alison B Strang Senior Research Fellow Institute for Global Health and Development Queen Margaret University Edinburgh

2 Outline of this session Research and theory what can it tell us? Lessons from humanitarian contexts Social connections and resilience Q&A Measuring social connections a new tool Practical exercise Patterns of social connection examples and implications from Scotland and Iraq Discussion Copyright Getty images

3 In recent years. 117,234 refugees living in the UK (UNHCR, 2016) 0.18% of total population The majority of refugees arrive through asylum applications rather than resettlement The UK received 38,878 asylum applications in % were granted asylum

4 In recent years. 117,234 refugees living in the UK (UNHCR, 2016) 0.18% of total population The majority of refugees arrive through asylum applications rather than resettlement The UK received 38,878 asylum applications in % were granted asylum

5 Migrants in Europe? An increase of 1.3 million international migrants per year from 2000 until In 2015, 76 million refugees were residing in Europe, Refugees making up 10% of the overall population WHO, 2016 Migrants in Ostrobothnia? Migrants with documents (migrant workers, family reunion, students) Refugees Asylum seekers Undocumented migrants Copyright Getty images

6 European Migration Crisis September 2015 Copyright Getty images

7 Conflict and disaster disrupt societies and the lives of individuals at multiple levels Copyright Getty images

8 All refugees have experienced some level of trauma. Such as violence and destruction. They may have been personally threatened or even tortured or witnessed others suffering. Refugees suffer multiple losses of people, place and personhood. Being forced to flee your home is itself a traumatic experience. Does this mean that all refugees are traumatised? Should we expect most refugees to suffer from poor mental health? What about other migrants?

9 Migrant & Refugee Mental Health and Wellbeing Learning from humanitarian contexts

10 WHO Report 2016: Priebe S, Giacco D, El-Nagib R. (2016) Prevalence Rates of psychotic, mood and substance use disorders similar to host populations rates of post-traumatic stress disorder in refugees and asylum seekers are higher. Risk factors Country of origin (former Yugoslavia & Cambodia) Country of resettlement (USA) Poor socioeconomic conditions associated with depression 5+ years after resettlement. Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC Int Health Hum Rights. 2015;15(1):29. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365(9467):

11 A meta-analysis of all published research on refugee mental health (Porter & Haslam, JAMA, 2005) RISK Pre-displacement: RESILIENCE Being a woman Being young or over 65 Rural origin Post-displacement: Highly restricted economic opportunities Temporary or institutional housing Displacement continues after conflict resolved Better educated Wealthier Repatriation Copyright Getty images

12 All refugees have experienced some level of trauma. Level of exposure to trauma does not appear to be a significant risk factor amongst adolescent Jordanians and Syrian refugees (Panter-Brick (& Ager) et al. 2017) Scholars recommend us to look beyond psychopathology to address refugee mental health (Betancourt et al., 2015; Hobfoll et al., 2015) Attention is increasingly paid to resilience and protective factors including individual, relational and contextual factors (Ungar, 2013)

13 IASC Guidelines on Mental Health and Psychosocial Support in Emergencies, Copyright Getty images

14 SAFETY & SECURITY BONDS/NETWORKS JUSTICE ROLES & IDENTITIES EXISTENTIAL MEANING The ADAPT Model 5 pillars of psychosocial wellbeing Derek Silove, UNSW Silove, D. 2013, the ADAPT Model: a conceptual framework for mental health and psychosocial programming in post-conflict settings. Intervention, 11, 3, pp Copyright Getty images

15 Five Essential Elements of Immediate and Mid-term Mass Trauma Intervention: Empirical Evidence. Hobfoll et al. Psychiatry, 70(4) Winter (2007) 1. Sense of safety 2. Calming 3. Collective and self-efficacy 4. Connectedness 5. Hope Copyright Getty images

16 Indicators of Integration Ager & Strang, 2004 & 2008 Markers and means Social Connections Facilitators Foundation Copyright Getty images

17 Individuals Social Capital Putman RD Bowling Alone: the collapse and revival of American community. NY Simon & Schuster. Institutions links bonds bridges Social relationships are a form of capital and contribute to resilience because we can mobilise them to access and exchange resources

18 Questions Thinking of migrants that you have known what impacts has migration had on access to social capital? What extra challenges do refugees face in building and maintaining social networks?

19 A tool for measuring Social Connections

20 Measuring Social Connections Most social programmes aim to improve social connections, but they struggle to demonstrate what they have achieved Needs assessment Monitoring Learning and feedback Accountability o Donors o Affected Communities Building Knowledge There is a need for tools that enable us to measure what matters in communities.

21 Measuring Social Connections Social capital is usually measured using questionnaires that were developed in USA and other similar cultural contexts They rely on assumptions about patterns of connection that may not apply in different cultures First we need to find out which connections are most useful and valued Then we can measure the strength of someone s connections There is a need for tools that enable us to measure what matters in communities.

22 QMU Social Connections Mapping tool Stage One : Participatory Group work

23 Stage One : Participatory Group work To identify social resources identified with different locally recognisable problems - each one associated with one of the types of social capital: Emotional support (bonding) finding help when you are feeling lonely Practical help (bonding or bridging) finding someone to repair your phone Access to rights (links) resolving housing problems

24 Sample from participatory exercise: Copyright Getty images

25 Stage Two: Creating a map Create a master list of people and organisations mentioned by participants clarify/remove duplicates and outliers Discuss with participants where they would expect to find these people and organisations and plot on a map :

26 Stage Three: Individual data collection Create a local master list of social resources identified in stage one. Using this checklist ask individuals: Have you spoken to this person/organisation in past 6 months? (Connection) Do you trust them al lot/a little/not at all? (Trust) Have you given this person/organisation help in past 6 months? (Reciprocity)

27 Practical Exercise Please make a group of 4-5 people Find a blank sheet of paper and a pen Think about the following question: If you, or someone like you had was worried about the health of their child, who could they speak to about this worry? And where could they go for help? Share your suggestions with each other and write everyone s suggestions on your paper

28 Practical Exercise Complaints procedure Religious leader Specialist at hospital Mother Friend Nurse Doctor Worried about my child s health Child s other parent

29 Practical Exercise Take another piece of paper and create an empty map by drawing concentric semi-circles: Nation District Town Household Plot the people and organisations on your map

30 Stage Two: Creating a map Create a master list of people and organisations mentioned by participants clarify/remove duplicates and outliers Discuss with participants where they would expect to find these people and organisations and plot on a map :

31 Stage Three: Individual data collection Create a local master list of social resources identified in stage one. Using this checklist ask individuals: Have you spoken to this person/organisation in past 6 months? (Connection) Do you trust them al lot/a little/not at all? (Trust) Have you given this person/organisation help in past 6 months? (Reciprocity)

32 Some examples of social connections mapping data

33 Integration or Isolation? Mapping social connections and wellbeing amongst refugee men in Glasgow We found that single refugee men, particularly from, Middle Eastern and central Asian countries were consistently underrepresented in studies of refugees in Scotland Strang & Quinn, 2014

34 Integration or Isolation? Mapping social connections and wellbeing amongst refugee men in Glasgow We accessed 30 refugee men in Glasgow with the help of the housing provider Each man attended a workshop to map their social connections and talk about mental health and wellbeing Service providers and mental health practitioners provided support and information

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37 Integration or Isolation? Mapping social connections and wellbeing amongst refugee men in Glasgow We have become like brothers! Lack of culturally normal bonds family Friends play the role of family locally People keep in touch with family & friends abroad Service providers play a very significant role in personal lives Yet awareness of services is relatively poor

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39 Integration or Isolation? Mapping social connections and wellbeing amongst refugee men in Glasgow We have become like brothers! Lack of culturally normal bonds family Friends play the role of family locally People keep in touch with family & friends abroad Service providers play a very significant role in personal lives Yet awareness of services is relatively poor They have very little opportunity for reciprocity

40 Mental Health A person who is alone, they don t have contact you become depressed straight away. I think most worries occur when you have got nothing to do. On arrival in the UK I was in total shock. I felt like new born baby who can t do anything. Protection Resilience Treatment

41 WHO Report 2016: Priebe S, Giacco D, El-Nagib R. (2016) These groups encounter barriers to accessing mental health care. Good practice for mental health care includes: promoting social integration, developing outreach services, coordinating health care, providing information on entitlements and available services, training professionals to work with these groups. Copyright Getty images

42 REFUGEE PEER EDUCATION FOR HEALTH AND WELL-BEING Elodie Mignard & Dylan Fotoohi, SRC Michelle Hunt, NHS GCC, NE Sector Dr Alison B Strang Queen Margaret University May 2014 March 2015

43 Mapping social connections of displaced people in Iraq Strang & O Brien 2016

44 Kurdistan, Northern Iraq Strang & O Brien, 2017 Workshops with displaced Yezidi people and those living in nearby villages. Basic needs Gender-based violence Community disputes

45 Levels of Connection Copyright Getty images

46 DOHUK DISTRICT Levels of general trust KURDISTAN INTERNATIONAL Iraqi Government Bagdad Kurdistan Government Harekar NGO NGOs Barzani Foundation Peshmerga (Kurdish army) Relatives abroad Baba Sheikh Tearfund NGO Qandil NGO Women s Rights Organisations Courts Members of my community KEY Tribal leader Neighbours Local Respected person Friends Local religious leader Sister Mother Local Community Centre Woman s relatives Head of Household God Husband /wife Mukhtar Husbands Relatives Father Employer Local branch KDP Uncle Extended Family Government Centre for Violence against Women Police Members of another community 80+% trust rating across all participants 70+% Trust rating by women 70+% trust rating by men HOUSEHOLD NEIGHBOURHOOD

47 DOHUK DISTRICT Levels of GBV trust KURDISTAN INTERNATIONAL Iraqi Government Bagdad Kurdistan Government Harekar NGO NGOs Barzani Foundation Peshmerga (Kurdish army) Relatives abroad Baba Sheikh Tearfund NGO Qandil NGO Women s Rights Organisations Courts Members of my community KEY Tribal leader Neighbours Local Respected person Friends Local religious leader Sister Mother Local Community Centre Woman s relatives Head of Household God Husband /wife Mukhtar Husbands Relatives Father Employer Local branch KDP Uncle Extended Family Government Centre for Violence against Women Police Members of another community 80+% trust rating across all participants 70+% Trust rating by women 70+% trust rating by men HOUSEHOLD NEIGHBOURHOOD

48 Mapping social connections of displaced people in Iraq Strang & O Brien content/uploads/2017/07/2017-qmu- Tearfund-Who-Can-I-Turn-To-En.pdf

49 The Mental Health & Psychosocial Network aspires to improve mental health and psychosocial well being in emergencies and situations of adversity. We do this by improving access to people, resources and knowledge.

50 BIBLIOGRAPHY Bourdieu P The forms of capital. In: Richardson J (ed) Handbook of Theory and Research for the Sociology of Education. New York: Greenwood Press, Coleman JS Social capital in the creation of human capital. American J Sociology. 94: Erikson M 2011 Social Capital and Health Promotion, Global Health Action 4:5611 DOI: /gha.v4i Kawachi I, Berkman L Social cohesion, social capital and health. In: Berkman L, Kawachi I (eds). Social Epidemiology. New York: Oxford University Press, pp Portes A Social capital: Its origins and applications in modern sociology. Annual Review of Sociology 24: Putman RD Bowling Alone: the collapse and revival of American community. NY Simon & Schuster. Wakefield SEL, Poland B Friend, family or foe? Critical reflections on the relevance and role of social capital in health promotion and community development. Social Science & Medicine 60:

51 Alison Strang Photo by Karen Gordon