Promoting the mental health and psychosocial wellbeing of unaccompanied refugee minors in Denmark Claire Mock-Muñoz de Luna University of Copenhagen Slide 1
Content 1. Unaccompanied refugee minors (URM) in perspective definition, time trends, statistics 2. URM and trauma: What do we know? 3. The Danish approach to URM: a) Policies for reception and integration b) Access to mental health and psychosocial support c) Guardian system 4. Examples of good practice at the municipal level. 5. Key areas for improvement: a) Assessment and screening b) Professional competence and awareness c) Interdisciplinary and intersectoral collaboration d) Mental health and psychosocial support for refugee children Slide 2
Unaccompanied refugee minors (URM) in perspective Definition: The United Nations and the European Union define an unaccompanied asylum seeking child, also known as separated child, as an immigrant who is under the age of 18 not in the care of a parent or legal guardian at the time of entry, or left unaccompanied after entry, and who does not have a family member or legal guardian willing or able to care for them in the arrival country. In the European Union, this designation refers explicitly to children who are not EU citizens (thirdcountry nationals) or who are stateless. Slide 3
URMs in Denmark, in numbers: In 2015, Denmark registered 2 125 asylum applicants considered unaccompanied minors. The top three sender countries were: Afghanistan 835 applicants (39 % of all URM applications) Syria 585 applicants (27 %) Eritrea 165 (8 %) 90 % of applicants were males 14% of applicants were aged below 14 URM asylum applications made up over 33 % of all minor asylum applicants Slide 4
Increase in URM seeking asylum in Denmark from 2005-2015 2500 2000 2125 1500 1000 500 0 109 432 2005 2010 2015 Slide 5 Based on data from Eurostat, 2016
Content 1. Unaccompanied refugee minors (URM) in perspective definition, time trends, statistics 2. URM and trauma: What do we know? 3. The Danish approach to URM: a) Policies for reception and integration b) Access to mental health and psychosocial support c) Guardian system 4. Examples of good practice at the municipal level. 5. Key areas for improvement: a) Assessment and screening b) Professional competence and awareness c) Interdisciplinary and intersectoral collaboration d) Mental health and psychosocial support for refugee children Slide 6
How widespread is trauma among refugees in Denmark? Danish Research Centre for Migration, Ethnicity and Health 30.000 45.000 refugees from waraffected countries may be suffering from the effects of trauma. This means that in 2012 between 30-50 percent of all refugees in Denmark may have been suffering from trauma This number does NOT include children or family members who may be suffering the effects of secondary trauma or intergenerational transmision of trauma. Slide 7 Source: Ministry of Social, Child and Integration Affairs (2013). Traumaundersøgelse Undersøgelse af indsatsen for flygtning med traumer i Danmark.
How widespread is trauma among URM in Denmark? Danish Research Centre for Migration, Ethnicity and Health A Danish Red Cross internal investigation of health and wellbeing among newly arrived refugees found that 80 percent of unaccompanied refugee minors had been exposed to one or more severely traumatic experiencies and hardship. Slide 8
URM Possible exposures and risk factors a) Problems and experiences before journey b) Stress related to departure c) Stress related to the journey, waiting periods, time in detention centres d) Stress related to settlement in host country, adaptation to new context e) Accumulation of above factors Slide 9
Impact of trauma-related symptoms on children and their daily life 6-12 year-old children: Problems concentrating Difficulties in school, with learning and keeping up Anxiety and psychosomatic symptoms such as head and stomach aches. Aggressive and/or externalising behaviour Depressive and/or internalising behaviour Teenagers: Self-destructive behaviour Impulsiveness, oppositional behaviour towards authorities Internalising behaviour and difficulties building relationships Low self-esteem Hopelessness, depression, as well as physical symptoms such as diffuse pain. Slide 10
Content 1. Unaccompanied refugee minors (URM) in perspective definition, time trends, statistics 2. URM and trauma What do we know? 3. The Danish approach to URM: a) Policies for reception and integration b) Access to mental health and psychosocial support c) Guardian system 4. Examples of good practice at the municipal level. 5. Key areas for improvement: a) Assessment and screening b) Professional competence and awareness c) Interdisciplinary and intersectoral collaboration d) Mental health and psychosocial support for refugee children Slide 11
URM and immigration law Key elements of the immigration laws affecting URM: Most URM are granted temporary leave to remain They must reside at a child reception centre for 6 months, even when a family member resides in Denmark Age assessment Family reunification 3 years rule Slide 12
From asylum centre to municipality URM remain at dedicated asylum centre during the processing of asylum application (6-12 months) Red Cross assessment When URM is given Leave to Remain (Opholdstilladelse), typically for a max of 4 years, or until their 18th birthday, he/she is transered to the municipality Municipal assessment Based on the needs assessment conducted by the municipality, URM accesses relevant care provision and support. Slide 13
Municipal care provision and entitlements for URM in Denmark Danish Research Centre for Migration, Ethnicity and Health Access to education Housing Integration Act, Social Services Act, Parental Responsibility Act, Public School Act Social services support Temporary guardian Slide 14
How do municipalities address the mental health and psychosocial needs of URM? Spotting trauma symptoms many actors Needs assessments (Asylum centre, municipality) GP Social worker School Guardian or adult with parental responsibility NGO and volunteer initiatives Referral to mental health providers specialising in refugees with trauma (11 specialised services in total) Leisure activities - sports Excursions and holidays organised and funded by the municipality Initiatives to promote social network building Slide 15
Content Danish Research Centre for Migration, Ethnicity and Health 1. Unaccompanied refugee minors (URM) in perspective definition, time trends, statistics 2. URM and trauma What do we know? 3. The Danish approach to URM: a) Policies for reception and integration b) Access to mental health and psychosocial support c) Guardian system 4. Examples of good practice at the municipal level. 5. Key areas for improvement: a) Assessment and screening b) Professional competence and awareness c) Interdisciplinary and intersectoral collaboration d) Mental health and psychosocial support for refugee children Slide 16
Good practice at the municipal level Children who flee alone Project: Placement of URM with intercultural foster families, as seen in Sweden and Holland. Aim: to give URM a normal everyday life, in an atmosphere of familial care and support. Slide 17 Evidence-based collaboration Municipality Red Cross Ministry of Foreign Affairs University College Sjæland/UCC
Good practice at the municipal level Systematic, child-centered, multi-disciplinary and intersectoral collaboration Slide 18 URM municipal reception strategy in place, including 5 meetings with psychologist in initial municipal reception period. Psycologist coordinates strategy and has consultative function for other municipal actors involved in the care and wellbeing of URM, i.e. social worker, teachers, education advisors, NGO/volunteer organisations Flexible approach -
Content 1. Unaccompanied refugee minors (URM) in perspective definition, time trends, statistics 2. URM and trauma What do we know? 3. The Danish approach to URM: a) Policies for reception and integration b) Access to mental health and psychosocial support c) Guardian system 4. Examples of good practice at the municipal level. 5. Key areas for improvement: a) Assessment and screening b) Professional competence and awareness c) Interdisciplinary and intersectoral collaboration d) Mental health and psychosocial support for refugee children Slide 19
Key areas for improvement a)assessment and screening Not systematic at municipal level (mandatory offer of health assessment with GP) b)professional competence and awareness Municipal professionals Health sector c) Interdisciplinary and intersectoral collaboration d)mental health and psychosocial support for refugee children Slide 20
References LG Insight (2013). Traumaundersøgelse. Social-, Børne- og Integrationsministeriet. Social og Integrationsministeriet (2012). Den gode modtagelse af uledsagede mindreårige i kommunerne. Montgomery, E. (2010). Trauma and resilience in young refugees: a 9- year follow-up study. Development and Psychopathology 22, 477-489. Vitus, K., Liden, H. (2010). The status of the asylum-seeking child in Norway and Denmark: comparing discourses, politics and practices. Journal of Refugee Studies, Vol. 23, No. 1. Deveci, Y. (2012). Trying to understand: promoting the psychosocial well-being of separated refugee children. Journal of Social Work Practice. Eurostat. Pressrelease: Asylum applicans considered to be unaccompanied minors. 87/2016. www.ec.europa.eu/eurostat (accessed on 15 June, 2016). Ministry of refugee, immigration and integration affairs (2010). Statistical overview-migration and asylum 2010. Ny i Danmark. Slide 21
Thank you for your attention! Slide 22