Assessing asylum seekers, refugees and undocumented migrants

Abstract

SummaryIdentifying the causes of psychiatric and physical symptoms in asylum seekers, refugees and other migrants and making definitive diagnoses can be challenging. Ethical and legal challenges in the UK include the likely deterrent effects of upfront charging for National Health Service (NHS) services. This paper focuses on the fictitious case of an asylum seeker presenting to a mental health service in England, highlighting some of the difficulties in assessing and treating this patient group and providing advice to clinicians on clinical and practical management. Current NHS entitlements for migrants are summarised and a list is presented in the online supplement of non-governmental organisations that can provide further support.

Mental healthcare for asylum-seekers and refugees residing in the United Kingdom: a scoping review of policies, barriers, and enablers

“…(2020) [ 44 ] ✓ ✓ Waterman et al . (2020) [ 28 ] ✓ ✓ Total: N = 39 (%) 23 (60) 10 (26) 10 (26) 4 (10) 7 (18) 15 (38) …”

“…GPs are often unaware of current policies and entitlements surrounding healthcare for ASR, as asylum policies can be complex [ 24 , 50 ]. Proof of identity or address are often wrongly demanded [ 23 , 28 ], and rejection creates fears that data would be shared with the Home Office, although data sharing between Home Office and NHS has been abolished [ 41 ]. Healthcare staff rarely have the knowledge of immigration law required to review complex issues of patient eligibility [ 28 ].…”

“…Patients must now pay upfront before receiving treatment if they cannot prove their eligibility, unless it is ‘urgent’ or ‘immediately necessary’ [ 26 ]. This is also a requirement for NHS community health services, including mental health services, with those detained under the Mental Health Act 1983 [ 27 ] theoretically exempt from treatment charges [ 28 ].…”

Basic safety first: trauma-informed care in a hostile environment

“…Practical resources and links to specialist agencies for asylum seekers and refugees can be found as an online supplement to the Praxis article. 1 Trainees may be interested to explore the various communities of healthcare professionals who advocate for human rights-based approaches to healthcare such as Medact (www.medact.org/project/migration-health), Docs Not Cops (www.docsnotcops.co.uk) and the Twitter hashtag #patientsnotpassports. Poetry and storytelling can also communicate and transform, with the potential to both educate and liberate from shame and secrecy.…”

“…There has never been a more timely moment to highlight the needs and rights of asylum seekers and refugees, as so comprehensively described in this month's Praxis article ‘Assessing asylum seekers, refugees and undocumented migrants’, by Waterman et al . 1 This population and those who care for them face many challenges. Not least of these is the ongoing hostile environment.…”