“Refugees present perhaps the maximum example of the human capacity to survive despite the greatest of losses and assaults on human dignity.” ‘New paradigms for refugee health problems’ Marjorie A Muecke, Social Science and Medicine, 35:4, 1992

What traumas and stressors do asylum seekers and refugees experience? Group 1: Experience of torture/violence/persecution Group 2: Escape; The Journey; Losses Group 3: Arrival in UK; Asylum Process in UK; daily stressors and adaptation process Group Feedback

What impact can these experiences have on a persons’ mental health? What might people tell us or we notice?

Cultural bereavement ‘Clinical work with refugees poses a special challenge because the usual difficulties in making a diagnosis with any people of a different cultural background are compounded when they have suffered massive trauma in the wake of war’ ‘Symptoms’ reflect communal suffering, the experience, meaning and expression of which are culturally determined.’ Eisenbruch (1991)

The core experiences of psychological trauma are disempowerment and disconnection from others. Recovery therefore is based upon the empowerment of the survivor and the creation of new connections. Judith Herman

What helps?

Judith Herman’s Stages of Trauma Recovery 1. Re-establish a sense of safety 2. Support environment for remembrance & Mourning 3. Reconnection with community

What is person centred practice? Therapeutic relationship Active listening Acceptance Empathy Quality of presence Being genuine and real ourselves Non-judging

‘Successful participation in everyday occupations and life roles and the fabric of the community enables people to move beyond displacement and strengthens inclusion and peace in a community.’ World Federation Occupational Therapists

Between power and powerlessness: a meta-ethnography of sources of resilience in young refugees. Sleijpen, M., Boeije, H. R., Kleber, R. J., & Mooren, T. (2015). Ethnicity & health, Six sources of resilience emerged: (1) social support (2) acculturation strategies (3) education (4) religion (5) avoidance (6) hope Sources indicated social as well as personal factors that confer resilience in young refugees, but most of them also had counterproductive aspects. Highlighted interplay between protective and risk processes in the mental health of young refugees who have resettled in Western countries Further research is needed to explore the cultural shape of resilience and the long- term consequences of war and migration on young refugees.

Recent Lancet correspondence on planning mental health work with Syrian refugees Resiliency factors and functional capacity. Establish what people need in community- oriented and collaborative ways. Support individuals to restore relationships, build new, healthy patterns of interaction and develop coping strategies. Creativity-based group programmes using the arts, such as theatre, singing, drawing, or writing poetry and centres designed to attract people with social events, workshops, groups might play a part.

What does this work do to us? (and reception, interpreters….) Apathy, feelings of hopelessness, rapid fatigue, disillusionment, melancholy, forgetfulness, experiencing work as heavy burden…. Anxiety, nightmares, feeling of isolation, powerlessness Avoiding obvious questions, not noticing certain statements or emotions, unconsciously changing subject when unnerved, temptation to step back from work too far, lowering professional norms. Too distanced or too strongly identifying?

How do we take care of our strong emotions and feelings? Support Supervision Self care

“Refugees present perhaps the maximum example of the human capacity to survive despite the greatest of losses and assaults on human dignity.” ‘New paradigms for refugee health problems’ Marjorie A Muecke, Social Science and Medicine, 35:4, 1992