Exploring the mental health and psychosocial experiences of asylum seekers, refugees and undocumented migrants in the post-migration context

Background and aims: Migration phases (pre-, during and post-) are known to negatively impact on the mental health and psychosocial experiences of asylum seekers, refugees and undocumented migrants. In this thesis, the focus was on post-migration experiences. Research shows that particular areas of concern include: migration detention, the asylum system, fear of deportation, poverty, destitution, housing issues, language and communication difficulties, and poor access to care. However, more in-depth understanding of the mental health and psychosocial experiences of asylum seekers, refugees and undocumented migrants in the postmigration context is needed. The aim of this thesis was to investigate asylum seekers', refugees', and undocumented migrants' mental health and psychosocial experiences in the postmigration context, including an exploration of social determinants of mental health and the barriers and facilitators to access to services. This was met by addressing three objectives: To investigate asylum seekers', refugees, and undocumented migrants' mental health experiences in the context of social determinants of health. To explore how social determinants of health influence the pathway to healthcare services amongst asylum seekers, refugees, and undocumented migrants. To explore the barriers and facilitators to asylum seekers', refugees and undocumented migrants' pathways to accessing the services that they need. Methods: This thesis employed three methodological approaches to collect and analyse data: a systematic review and meta ethnography, Reflexive Thematic Analysis (RTA) and a re-analysis of interview data, applying the theory of Candidacy. These qualitative approaches were built on one another in a sequential manner. The systematic review included the qualitative component of 20 studies (11 qualitative and 9 mixed methods), assessed against pre established inclusion criteria. These were analysed by applying a meta-ethnographic approach. Eighteen asylum seekers, refugees and undocumented migrants based in the Glasgow area were interviewed. RTA was the primary qualitative study. The interviews were then reanalysed using the theory of Candidacy to understand in more detail participants' journeys to accessing the services needed. Results: Combined, the findings from this thesis indicate that the asylum system is a social determinant of health for asylum seeker, refugee and undocumented migrant populations in the UK and internationally. For asylum seekers and undocumented migrants, the inability to work and financial insecurity stemming from Home Office restrictions were found to compound distress. In relation to mental health, psychosomatic symptoms and difficulties with sleep were found, whilst protective factors included family, friends, religion, and hobbies such as exercise and playing music. Access to care was described as arduous due to language and communication difficulties, limited availability of interpreters, and issues registering with a GP. This was due to the limited information and knowledge available to them. Often this was mitigated by third sector organisations. Access to mental health services was consistently shown to be undermined by the Western biomedical approach, which failed to consider socio cultural factors that may further limit access. Often, consultations relating to mental health often resulted in prescriptions for psychotropic medications, which were considered socio-culturally inappropriate by some individuals in these communities and led to the discontinuation of treatment and heightened feelings of isolation. The secondary analysis of the interviews also showed that the operating conditions that influenced access to services comprised of three levels: micro-, meso- and macro. These encompass proximal as well as broader factors that influence these populations' ability and willingness to access the services that they require. Conclusion: Efforts to improve asylum seekers', refugees' and undocumented migrants' access to services, including healthcare, need to consider the psychosocial and cultural aspects of mental health in these populations. These are found to affect individuals' and communities' abilities and willingness to engage with existing services, including the NHS. Health services have a responsibility in lessening the structural barriers and inequity in access that these populations face.