Nationality and Borders Bill must consider mental health

We at the Royal College of Psychiatrists, along with our partners at the Helen Bamber Foundation, have been raising awareness of the difficulties that people with mental illness face navigating the asylum system. Tragically, people seeking asylum face many barriers in accessing health services throughout the asylum process, from their arrival in the UK to the conclusion of the process and beyond.

Last week the Nationality and Borders Bill completed the Committee Stage in the House of Lords. We consider that without the implementation of proper protections, including assessments on arrival, the Bill will worsen the mental health of refugees and migrants. It also fails to recognise that those with mental illness have particular difficulty being self-advocates; something that is fundamental within the asylum process. This is something that must be addressed in order to protect the most vulnerable.

It is hardly surprising that people seeking asylum have additional healthcare needs given that many have had distressing experiences in their country of origin, fleeing war, conflict and persecution. Some will have been separated from their families, lost their livelihoods or even struggled to access vital resources such as food. Many others would have also had traumatic experiences in their journey of fleeing their home and seeking refuge in a different country.

The World Health Organization has found that in a humanitarian crisis, the prevalence of depression and anxiety is more than doubled. Among those who have experienced war or conflict in the past 10 years, 1 in 5 will have depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia. Furthermore, 1 in 11 will have a moderate or severe mental health disorder.

Furthermore, people seeking asylum may have any existing mental health disorders exacerbated by their experiences on arrival in the UK. Between April 2019 and March 2020, there were 23,075 refugees and migrants detained in the UK.  Detention exacerbates and triggers mental illness in already very vulnerable and traumatised people. We know that rates for depression, anxiety and PTSD in refugees and migrants in detention are around twice as high as rate for those not in detention.

During last week’s important debate in the House of Lords, my predecessor, Baroness Sheila Hollins, highlighted the impact mental illness can have on the ability of people seeking asylum to present their claims in a coherent way. The assessment of credibility is a fundamental aspect of the asylum decision-making process, where people seeking asylum need to prove the existence of a well-founded fear of persecution if they were to return to their country of origin.

Some of the symptoms of those experiencing a mental disorder include memory loss, inability to express or even feel emotions, or profound guilt and shame at what they have experienced. Many immigration officers will not have an existing understanding of the effects of trauma and will not know how to consider this when deciding the outcome of an asylum claim, especially where the person has not yet received a formal diagnosis due to the difficulty they face in accessing services.

The College recognises that reform of the present system is required, however the tone of the legislation and accompanying rhetoric also raises concerns that this will be perceived as being counter to the work across government, by agencies and others, to reduce the inequalities in our society. This is at a time when Black, Asian and minority ethnic communities were disproportionately represented among people dying from Covid-19 and, among the health and care workforce, it was minority communities who were disproportionately concentrated on the front lines, and at higher risk of catching the disease, and dying. Members have raised concerns that the perceptions of this Bill will potentially undermine international recruitment and cause unease amongst international colleagues who already make a vital contribution to our health and care services.

We need to ensure that the mental health, mental capacity and physical health of people seeking asylum is assessed and considered properly – which as a profession we have and will always do, whether their journey begins overseas or closer to home.