The mental health experience of refugees - Refugee Council
October 7, 2021

The mental health experience of refugees

To honour World Mental Health Day 2021, we spoke to Angelina Jalonen, our Head of Therapeutic Services, to understand more about the unique situation of refugees and people seeking asylum, and the interventions that can help them.

We work with a very unique client group. Refugees and people seeking asylum have a shared experience of trauma. It's quite understandable having left a country abruptly, perhaps also being separated from family.

Things can happen very suddenly – we have seen the example with Afghanistan. Sometimes people don’t have much time to make decisions. We saw that horrible image of people clinging on to an airplane in a bid to escape.  They don’t have passports, they don’t have any documentation to travel, but they have to flee. There is no visa for asylum. People are desperate and the need to leave pushes them to take very risky journeys, to leave through any means necessary.

People go through many countries, and experience horrendous journeys. We hear really horrible stories about passing through countries like Libya. Some are abused, some are exploited along the way.

We don’t see many women, because women don’t make it. It’s really difficult to make that journey.

Once people arrive, it is really difficult for them to integrate because of issues like language. Many don’t have their basic needs met. We all know what humans need—we need food, we need water, we need shelter, we need clothes. They are the very basic things you need to survive.

Imagine you are running away from an animal that is going to attack you. Adrenaline floods the body to help you survive. Refugees are in that mode from the moment they start to try and leave their country, we call it 'anticipation state'.

They are thinking, “Can we survive here? Can we go? Can we reach a neighbouring country?” Adrenaline is rushing and they stay in that mode for so long – throughout their journey. They make it here and they have to apply for refugee status at the Home Office. They are still in a state of anxiety because they are still not safe.  They are afraid. Are they going to be accepted? Are they going to be deported? Are they going to be put in an institution? There are so many risks, so they are always preoccupied with fear.

It is a sympathetic state of activation—fight, flight or freeze mode—a state of hyperarousal and vigilance. When we see them, they are still in a state of fear, even though they are in the UK they are not safe yet as they are still seeking asylum. They have very little determination of their own lives. Everything is determined for them—where they stay, what they eat—and they become dependent on the system.

We try to help them make sense of everything, to create a new meaning of the complexity. We try to help them make sense of their traumatic experiences.

In order for them to engage with the Home Office or the refugee protection journey, they have to try and make sense of what is going on. We help them manage their emotions. We help them move from a sympathetic state of fear and fright to a parasympathetic state of ease. We try and validate their journey but at the same time, help them to make sense of it. Help them calm down their anxiety.

Most of our work in therapeutic services is what we call crisis intervention.  We need to expand the window of tolerance of emotions. We help our clients understand what is going on so they can try and stay calm. We use interventions like breathing: long, deep, intentioned breaths. That really helps them to slow down. Most of our clients present with flashbacks because of the things they have seen.

One client I worked with told me that as a child, going to school with other children, they used to count some things hanging from a crane. They used to count 3 today, 4 today, they were having fun and laughing. It was only through engaging in therapy as an adult that he realised they were counting dead bodies.

He knew that they were dead bodies at the time, but his body tried to protect him, so that he didn’t actually comprehend. Images like that, horrific images, will keep coming back to someone.

Most of the people we work with have nightmares, intrusive thoughts, anxiety, fear and depression. It’s completely understandable. I wouldn’t call it abnormal. You could argue that it’s not mental illness, it’s a normal response to an abnormal situation.

The number one priority is psychoeducation – to educate the client on the impact of trauma. They need to be able to make sense of their symptoms. We tell them how the body reacts after traumatic experiences. If they can understand the body’s responses then that’s half the problem solved. If someone has a panic attack, they can understand  why they are breathing fast, why they are sweating, why they feel so edgy. They can understand that when they feel like that they need a physical release for the adrenaline, such as going for a walk or taking deep breaths.

We do a lot of work on mindfulness to help ground our clients. When we do that clients are able to engage with their surroundings, the system, the Home Office, accommodation issues.

We also validate our clients. We bear witness. It is really important that we bear witness by listening to them because our clients have gone through many narratives. It takes them months to get here.

Without the kind of support we provide, if they don’t get that holding or containment, it can be very difficult for refugees. They are also struggling with the language, they are already disadvantaged with many barriers. At the same time many of them have been abused, or suffered human rights violations.

It can be really difficult for refugees to trust people. They have often been let down by their own Government or people in positions of authority. Trust is such a big issue. Whether it is Home Office officials, accommodation providers, or their doctor, they lack that trust so it is difficult for them to build healthy relationships and get the support they need.

It’s possible that the Home Office has interrogated them and not believed them. They may have been interrogated many times in different circumstances, so what we want to do is gain their trust by accepting them and believing in them and being non- judgmental.