- Mental health is fundamental to general health and wellbeing
- Mental health problems can present in different ways in different people with diverse backgrounds
- Social support can be beneficial for mental health. Find out what groups exist in your local area for particular communities so that you can signpost to them.
Most migrants do not have mental health problems. Some may be at increased risk as a result of their experiences before, during, and after migration to the UK. This content is taken from the Public Health England Migrant Health Guide (PHE 2017), which can be found in Further Information below.
Issues such as ‘home sickness’, anxiety or sleep disorders may arise for anyone who is separated from family and friends, or integrating into a new community or culture. These may be managed easily without medical or specialist interventions.
In addition to routine distress and anxiety, certain individuals, particularly those affected by emergencies, may experience elevated risk of mental disorders. This has been estimated by WHO and UNHCR in terms of projected prevalence over a 12 month period, before and after the emergency:
- 3% to 4% projected prevalence of severe disorders after the emergency (12 month prevalence), for example psychosis, severe depression, severely disabling form of anxiety disorder, compared to 2% to 3% before the emergency
- 15% to 20% projected prevalence of mild or moderate mental disorders after the emergency, for example mild and moderate forms of depression and anxiety disorders, including mild and moderate post traumatic stress disorder, compared to 10% before
- traumatic events, loss and displacement increase risk of depression and anxiety disorders, including post traumatic stress disorder
Mental health problems may present in unfamiliar ways
As well as being mindful of the possibility of mental health problems, clinicians must be aware that they may present in unfamiliar ways:
- Check for previous history of mental illness, epilepsy and substance misuse
- Some people may express psychological distress in a very physical manner ('somatisation'), describing physical symptoms rather than directly talking about feelings
- Patients may bring with them their own socio-cultural constructs in determining what is a normal and abnormal experience and hence in diagnosing mental illness
- Children may manifest symptoms in a non-specific way such as behavioural problems or bed wetting
Coping with psychological distress
Being a refugee or a migrant alone does not make individuals significantly more vulnerable for mental disorders, however migrants or refugees can be exposed to various stress factors that influence their mental wellbeing.
- The effects of stress can be buffered by basic services, safety, and social support.
- Rates of disorders related to extreme stress are higher in refugees than in people who are not forcibly displaced.
- In cases where past experience of traumatic events are not the only source of psychological distress, most emotional suffering is directly related to current stresses and worries and uncertainty about the future.
- Of particular note is sexual violence: it is important to be aware that this may cause long standing maladaptation.
Psychological first aid (PFA) principles may be helpful. The WHO guide to this is linked under useful resources.
The Public Health England Migrant Health Guide has further information and resources.