The importance of meaningful integration for the mental health of asylum seekers and refugees

Recent research, published in Frontiers in Public Health, has explored the different aspects of community integration that are valuable to supporting mental health, quality of life and thriving among asylum seekers and refugees. Professor Hanna Kienzler, co-director of the ESRC Centre for Society and Mental Health, led the study based on interviews with mental health and psychosocial support service providers who work with refugees and asylum seekers in London.

The findings have been featured as part of the recent report by the Commission for Integration of Refugees that calls for a complete rethink of the current asylum system in the UK with a focus on integration and human rights to enable refugees and asylum seekers to live flourishing lives with good health and mental health.

Integration and the current asylum system

Since 2012, the UK has operated a ‘hostile environment’ policy that makes it difficult for asylum seekers and refugees to integrate into communities. There is a huge backlog of unprocessed asylum applications and tens of thousands of asylum seekers are accommodated in sub-standard housing, don’t have the right to work and only very limited access to ESOL classes. They also face severe restrictions to claiming welfare benefits, education, and free secondary healthcare.

Such non-medical factors (also called Social Determinants of Health) have been shown to greatly influence asylum seeker and refugee mental health. Data for England shows, for example that asylum seekers and refugees are five times more likely to have mental health needs than the general population and 61 per cent will experience serious mental distress. Those who carry the greater burden of mental health problems are women and girls, people with disabilities, those experiencing discrimination and racism, and those who have lower socioeconomic status. Many refugees experience this intersectionality where multiple forms of inequality and disadvantage compound and create barriers to integration and impact mental health.

Maybe surprisingly, the UK government  has designed an ‘Indicators of Integration Framework.’ with the stated aim to support and monitor the integration of asylum seekers and refugees. Unfortunately, the framework is little known, and it’s not clear how the integration indicators work within the current asylum system and how they might affect mental health outcomes. Kienzler’s study aimed to shed light on this exploring how the concept of integration proposed in this framework is experienced by refugees and asylum seekers from the perspective of mental health and psychosocial support service providers.

What does community integration look like?

Service providers were explicitly asked what they believe community and integration might meant to asylum seekers and refugees. Community was associated with geographic place, social connection, belonging, familiarity, identity and support. It was perceived as something positive but, at the same time, belonging to a community was considered difficult to achieve due to attitudes of those within the community and barriers linked to legal status and the transient nature of accommodation for this group.

According to all interviewees, refugees faced key barriers to community integration. Among them stood out exclusion from British society, limited access to work and earning an income, barriers to education, unsafe and inhumane accommodation, and inadequate healthcare. These aspects were linked to feelings of isolation and mental health problems such as depression and anxiety which can provide a further barrier to integration due to lack of motivation, fear of stigma and fear of registering with health and social services. This bidirectional relationship between mental health and integration suggests that integration policies need to be rethought with a focus on mental health.

Facilitators and barriers to community integration and mental health

The major hindrance to community integration was the asylum system itself. All interviewed service providers considered the current system as ‘broken’, ‘unfair’ and ‘dehumanizing’. The long waiting times were thought to be particularly negative for the mental health of asylum seekers who were described as living ‘in limbo’ and surrounded by uncertainties that were a result of the hostile environment policies. These were linked to the development or worsening of mental health problems such as PTSD, depression, and anxiety as well as hopelessness that could culminate in suicidal ideation and even suicide.

At the same time, it would be wrong to assume asylum seekers and refugees are passive victims of the UK’s asylum system. Interviews described how they proactively tried to build social bonds with people from similar backgrounds which provided a sense of security. Over time, when asylum seekers and refugees feel more secure, they are also able to belong to multiple communities, something that was perceived to enhance their sense of belonging and overall wellbeing, including mental health. However, this was not understood to be a straightforward process and is especially difficult for those who did not speak English as they could not easily partake in social life, education, and work.

Means to integration and good mental health

Work, housing, education and health and social care are central to community integration and the mental health of refugees and asylum seekers.

In terms of employment, many stressed that the lack of the right to work for asylum seekers was a large barrier for integration and that refugees were excluded from work due to discrimination, lack of language skills and lack of recognition of their professional and education certificates. As a result, many have to accept work that is below their skill level and poorly paid, which results in poverty and is linked to feelings of disempowerment and depression.

Education was also recognised as central. Although education was relatively easier for young people to access, it is reported that adults and especially women find it challenging to access ESOL classes and further education.

This lack of access to education and work is often exacerbated by the housing situation as asylum seekers are frequently forced to move accommodation which interrupts work and education and fragments social connections. Accommodation itself was described as ‘inhumane’, ‘very poor’, ‘insecure’ and ‘unsafe’.

Compounding the impact of lack of provision of education and work on mental health, asylum seekers and refugees face difficulty accessing mental health and psychosocial support services and have no support to navigate the United Kingdom health system. Those who managed to access mental health support were reported to struggle which was not helped by the absence of translators and cultural mediators.

Is it possible to thrive in the context of hostility?

All service providers in the study reported that integration has to be meaningful and enable people to thrive so they can reach their potential and fulfil their aspirations and lead the lives they valued. Thriving was perceived to be located both within the individual as a form of resilience, but was also understood to be a reciprocal process in which people support each other. It was commented that thriving is very difficult in the current hostile environment where policies and political attitudes are anti-immigration and rights are limited.“It’s so challenging and with the hostile environment and the way the Home Office immigration and asylum process works, it’s very, very difficult and very challenging to be able to thrive.”

Recommendations to enable meaningful integration and support mental health

Based on its findings the study made a number of recommendations to help build meaningful integration and support mental health of refugees and asylum seekers:

• A complete reform of the current asylum system to one that is based on human rights and social justice. Reference is made to the central proposal in in the Commission for Integration of Refugees and Asylum Seekers report.
• Government and third sector organisations should carry out assessments among asylum seekers and refugees to establish social and mental health needs which could be adapted from the Department of Health’s commissioned Joint strategic needs assessment (JNSA) toolkit.
• Asylum seeker and refugees should benefit directly from NHS Inclusion Health framework which is for people who are socially excluded and experience multiple interacting risk factors such as poor health, discrimination, poverty and violence. Engagement with the NHS Inclusion Health Framework would enable them to better access mental health services and the support they require.
• More needs to be done to address the systemic racism and xenophobia experienced by asylum seekers and refugees in society and the healthcare systems and acknowledge that they are marginalised communities that need additional support to access support.

These recommendations chime with and fed into those outlined by the Commission for Integration of Refugees which proposes a system based on human rights with clear criteria for measuring success, transparent and proper funding, and a focus on empowering communities to support refugees. Central to all of this is the involvement of asylum seekers and refugees alongside other stakeholders in the development, evaluation and maintenance of this new system.

'Community integration, quality of life, thriving, and mental health among refugees and asylum seekers. A London service provider perspective' (2024) by Professor Hanna Kienzler was published in Frontiers in Public Health. DOI: 10.3389/fpubh.2024.1358250