Developing support for Young Carers from asylum-seeking and refugee families Jen Kenward Experience of Care Lead, NHS England @JenKenward International Carers Conference October 2017
An introduction to NHS England NHS England leads the National Health Service (NHS) in England Our Commitment to Carers programme employs partnership working with national charities, Carer support organisations, NHS commissioners, local government and armslength bodies, ensuring we reflect the needs and values of Carers in our work. 2
Carers in England
Why support for Young Carers from refugee and asylum seeking families matters The health needs of refugees and asylum seekers can be complex. In addition to experiencing similar health problems to the general population, refugees and asylum seekers may have physical and mental health problems resulting from experiences in their origin country, sometimes worsened by poor access to healthcare; dangerous, stressful journeys to the UK; language barriers; prejudice; lack of knowledge of services; isolation and displacement. Families seeking asylum may have unmet care needs and become reliant on their children undertaking care. 4
The Children s Society Include programme was awarded funding from NHS England to develop information and training resources for professionals to understand the needs of children in refugee and asylum seeking families who may be undertaking caring responsibilities which impact their own wellbeing. This project is running from October 2016 March 2017. The main aims are: - To coordinate the development and update of training and awareness-raising resources for statutory and voluntary sector health care agencies to ensure services are inclusive of refugee and asylum seeking families where there are children taking on caring responsibilities. - To develop new resources for young carers from refugee and asylum seeking families that outline the rights and entitlements for support for themselves and their families and signposts them to the support they need.
Numbers of refugees and asylum seekers in the UK Most recent UN figures show that at mid-2015 there were 117,234 refugees and 37,829 pending asylum cases In the year ending September 2016, the UK received 33,380 applications from main applicants - 41,000 applications including dependants In the year ending September 2016, the largest number of asylum applications came from nationals of: Iran (4,822), followed by Iraq (3,127), Pakistan (2,937), Afghanistan (2,567), and Syria (2,102) The vast majority of refugees stay in their region of displacement, and consequently are hosted by developing countries. Turkey now hosts the highest number of refugees with 1.84 million, followed by Pakistan with 1.5 million. Half of the topten refugee-hosting countries in the world are located in Sub- Saharan Africa. 6
Children in the asylum system Unaccompanied Children Applications From 2010 to 2013 there was a downward trend in the number of applications. However in 2014 and 2015 they rose significantly, but still accounted for just over 10% of all asylum applications in 2015. Dependant Children The annual statistics include figures for the number of asylum applicants who are dependants rather than having an application in their own name. The majority of dependants are children. The table below shows the breakdown of dependants by age over the last 5 years for which data is available. (Refugee Council 2016)
Health problems experienced by refugees: 1 in 6 refugees have a physical health problem severe enough to affect their life Two thirds have experienced significant anxiety or depression. (British Medical Association) As refugees often lack appropriate support from health and social care services their care needs fall to another person with detrimental effects; including their children Physical injury or disability Sensory impairments Communicable diseases often linked to poverty and overcrowding Psychological and social health problems Sexual health infections Chronic diseases such as diabetes or hypertension, Dental problems Poor antenatal care and pregnancy outcomes Consequences of injury and torture.
Common experiences Separation from close family member and lack of extended family support Stress of living with uncertain immigration status can compound health needs Unmet personal care of other needs Communication difficulties Extreme isolation Difficulties accessing support Fear of deportation and stigma can lead to further isolation and marginalisation from potential sources of support
Barriers to accessing healthcare Refugees and asylum seekers may not know what services are available to them or services may be different to those in their home country Language and cultural barriers can cause misunderstanding for families, particularly if medical terms are misunderstood or do not exist in other languages; this is common with some learning disabilities and mental health problems Some terms are not recognised in other languages and can cause worry or confusion and prevent families from accessing support In some cultures there is stigma surrounding particular types of ill health and disability Asylum seekers living with ill health and disability may not disclose health condition or any care needs, as they may fear that it could impact upon their asylum claim Some asylum seekers live in extreme isolation which can have a significant impact on physical and mental health
Barriers to accessing social care support Local authority support is not listed as a public fund within the immigration rules. Therefore if a person has leave to enter or remain in the UK which is subject to a no recourse to public funds condition, receiving community care support does not breach this condition If an adult has care needs they may qualify for support from the local authority under the Care Act 2014. Failed asylum seekers with children generally will remain on asylum support This means that if a person has needs for care in the home, i.e. someone with a physical disability who needs support with tasks or personal care, then they should be eligible for a care package from the local authority support.
Young Refugees Refugee and asylum seeking children have the same rights as any other child living in England. Children are always eligible for support under the Children Act regardless of their immigration status Their rights come under the Children s Rights legislation not the Immigration legislation that their parents come under. However, the duty to support children extends to parents or other family members if it is in the best interests of the child. 12
Young Carers Fear of support services Risk of stigma and bullying Social networks are limited Fall through the gaps in support Loyalty to family Nature of illness Why are they hidden and hard to reach? Refugees and asylum seekers Fear of being sent home Cultural barriers Language barriers Racism Cultural expectations of families Cultural attitudes regarding some illnesses such as mental health problems. Assumptions of professionals In some languages the term carer does not exist. Common themes: Resilience Limited social capital Loss of childhood Maturity Feeling empowered Fear of the future Limited educational opportunities Young carers in refugee families face compounding issues that result in them becoming hidden from support services and impact upon their wellbeing.
Changes to the law: Children and Families Act 2014 This act brought changes to the law which are similar to the Care Act 2014 but start with the needs of the child. This will mean that a local authority will need to consider using a whole family approach when looking at a young carers needs. They will need to:- Evaluate the circumstances of a young carer s family and the impact of those circumstances on any child in the family. Look at the young carer s needs for support; & consider whether to combine a young carer s needs assessment with any other assessment in relation to the young carer,(such as) the person cared for or another member of the young carer s family 14
3 key documents Same principles: Whole council responsibility Whole family approach Joint working Prevent a child from taking on the responsibility for offering a level of care that is inappropriate and/or excessive and affecting their own wellbeing https://makingastepchange.info/resources-2/key-resources/ 15
Further info: Young Carers: www.youngcarer.com www.refugeetoolkit.org.uk Refugee Council: The truth about asylum: www.refugeecouncil.org.uk/policy_research/th e_truth_about_asylum Cultural awareness in Healthcare: www.ethnicityonline.net To find a local young refugees service: www.childrenssociety.org.uk/what-wedo/helping-children/our-programmes/youngrefugees
Further information Patient Experience Team NHS England Email: ENGLAND.PEAdmin@nhs.net Helen Leadbitter Area Manager and National Young Carers Lead The Children s Society Email: helen.leadbitter@childrenssociety.org.uk