Understanding the mental health and psychosocial experiences of asylum seekers’, refugees’ and undocumented migrants’ and their journey to accessing healthcare and social services.

Problem

Asylum seekers, refugees and undocumented migrants are reported to have higher rates of mental health issues compared to the general population in host countries (Fazel et al., 2005). This is, at least in part, due to difficulties experienced in the post-migration context (i.e. in the country of resettlement). The aim of this research was to identify and better understand the ways in which these migrant groups access services (e.g. mental health) and their experiences related to this. In so doing, the Theory of Candidacy was employed.

Approach

Eighteen asylum seekers, refugees and undocumented migrants based in the Glasgow area were interviewed. Snowball sampling was used for participant recruitment. The interviews were transcribed and analysed using the theory of Candidacy to understand in more detail participants’ journeys to accessing the services needed. Candidacy provides a framework through which access to health and social care services can be explored. Candidacy is composed of seven phases which include identification, navigation, permeability, presentation to the service, adjudication, offers & resistance, and operating conditions.

Findings

The results were presented according to the seven Candidacy phases. However, these are non-linear and inter-related. The perceived stigma and sense of burdensomeness on others associated with experiencing mental health difficulties was described by several participants in the interviews. Communication and language difficulties and lack of interpretation are shown as barriers to accessing mental health services for these populations. Difficulties registering with a GP and limited knowledge of the healthcare system were also barriers to access. The operating conditions identified were composed of macro- meso- and micro-level factors. These included language difficulties and interpretation, access to secondary care and the biomedical approach to mental health (e.g. psychotropic medication) as a barrier to access. The UK’s hostile asylum system, was reported to impact on every aspect of the Candidacy journey.

Consequences

The analysis identified operating conditions as broad, contextual factors, that potentially influence each phase of the Candidacy framework. Results illustrate the importance of the social determinants of health in exploring the mental health and psychosocial experiences of asylum seekers, refugees, and undocumented migrants. The implications of a hostile asylum system on the mental health and wellbeing of these vulnerabilized populations became evident. Findings also show the need for more resources and greater support required to aid GPs’ and practice teams’ delivery of care. We suggest that policy-based interventions could include a strong commitment to the provision of high-quality interpretation services. Also, digitalised forms of healthcare delivery should account for, and mitigate, issues around digital poverty in these migrant groups.