Questions of inclusion and exclusion. Are there ways of achieving ‘real participation’ of users from refugee and asylum seeking groups in service development at an institutional and treatment level?
| DOI | https://doi.org/10.1108/17556228200800017 |
| Published date | 01 September 2008 |
| Pages | 14-21 |
| Date | 01 September 2008 |
| Author | David Palmer,Cath Maffia |
| Subject Matter | Health & social care |
14
Questions of inclusion and exclusion.
Are there ways of achieving 'real
participation' of users from refugee
and asylum seeking groups in service
development at an institutional and
treatment level?
Abstract
Refugees areamong the most socially excluded and
marginalised groups in the UK. This paper examines
ways in which the refugee service user’s voice can
be heard and the power imbalance between service
provider and service user addressed. Lessons
learned from addressing the needs of refugees can
be extrapolated for other disadvantaged groups.
Key words
refugees; user participation; power imbalance;
mental health; transcultural psychiatry
Introduction
Research into the mental health needs and the experience
of black and minority ethnic refugee (BMER) groups has
shown that they are likely to experience poorer mental
health than native populations and areamong the most
vulnerable and socially excluded people in our society
(Littlewood & Lipsedge, 1997; Fernando, 1995, 2002; Tribe,
2002; Palmer & Ward, 2007). Studies have also found that
BMER groups are more disadvantaged in relation to health
care access than the ‘white’ British population. This is due
to the experience of migration, the stress associated with
racism, social and economic disadvantage, misdiagnosis
and unequal access to provision as a result of institutional
racism and the power relationships that exist between
health careworkers and the ‘service user’ (Fernando, 2002;
Bhui & Olajide, 1999; Barnes & Bowl, 2001). Refugees and
asylum seekers (forced migrants) experience various
practical difficulties in addition to the personal and
administrative migration process and accessing services,
such as health care. Without knowledge of the system and
the English language, accessing the right service can be
daunting, and refugees and asylum seekers often face
multiple barriers in both the initial stages and any
subsequent participation. Symptoms of psychological
illness are much more common in this group compared to
the general population and other migrants, however,
symptoms of psychological distress do not necessarily
signify mental illness. Symptoms need to be understood in
the context in which they occur – distress and suffering are
not in themselves pathological conditions. Social and
cultural isolation, English language difficulties, poverty,
hostility and racism, ongoing factors of severe stress due to
lack of immigration status, fear of deportation, lack of
occupational status and lack of family and community
support have been shown to have compounding negative
effects on well-being.
The relationship between the refugee and
‘participation’ in service development is, however, about
more than the rules governing entitlement; it incorporates
debates about the basis for entitlement and membership of
the community as well as practices concerning the social
integration of citizens and newcomers.
David Palmer
Director,Mind in Bexley and PhD student, University of Kent
Cath Maffia
Specialist Health Visitor
The Journal of Mental Health Training, Education and Practice Volume 3 Issue 3 September 2008 © Pavilion Journals (Brighton) Ltd
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