In this blog the author discusses her recent book chapter ‘Security over Health: The Effect of Security Policies on Migrant Mental Health in the UK.

This is the fourth blog in the Blogmas 2021 series.

Recent reports of tragic deaths among the unprecedented numbers of people crossing the Channel in small boats have fuelled a renewed outcry in the UK and France over the so-called “migrant crisis”. Amidst the heated political debates and diplomatic disputes around border security, it is also important to consider the issue of care provided to those who reach the UK. Worryingly, this summer it was reported that The Home Office’s rush to deport asylum seekers who had crossed the Channel last year led to “unprecedented levels” of those at risk of suicide, with one third of detainees at an immigration removal centre placed on constant suicide watch. There have also been recent distressing media reports of suicides among young refugees in the care system or among those who have left care; there are, however, no comprehensive reports from official sources – as there is no requirement for coroners to record nationality or immigration status.

I recently published a book chapter which highlights the mechanisms by which mental health problems among forced migrants are created and exacerbated by policies intended to prioritise security concerns, both worsening the mental health status for these persons and further impeding access to necessary mental health services, whilst doing little to enhance “security”. I detail some of the arguments made in the chapter here.

Immigration detention and mental ill-health

A substantial body of international and UK research demonstrates that immigration regimes contribute to refugees’ and asylum seekers’ deteriorating mental health. In particular, immigration detention both exacerbates existing mental health disorders and also contributes to the onset of new ones. In the UK, a review conducted by the former Prisons and Probation Ombudsman for England and Wales, in addition to other reports commissioned by the Home Office and the NHS, as well as reports by the HM Chief Inspector of Prisons, all point to poor conditions in detention which lead to increased mental ill health among detainees, as well as poor quality mental health care in these settings. These findings raise particular concerns in the UK, which has one of the largest immigration detention estates in the world, detains asylum seekers indefinitely and illegally detains those who are deemed mentally ill. The re-location of asylum seekers from detention centres to hotels and hostels during the COVID-19 pandemic has not helped the situation; rather, the extremely poor quality conditions have led to further mental distress.

The wider “hostile environment” and mental ill-health

However, harmful policies and practices are not only found in the context of detention. My chapter also details problems caused by further prioritisation of security over mental illness among forced migrants in the UK, in their daily lives.  In the UK, everyday forms of security action designed to deter immigration take place in the context of what, until recently, was officially termed by the government as the “hostile environment” policy (as a result of widespread criticism, since the summer of 2017 the government has used the term “compliant environment” instead). This policy has led to increased security concerns in many aspects of everyday life, both for migrants and the wider population. In the job market and housing, for example, employers and landlords are put in the position of internal border guards in order to police the implementation of immigration policies and detect undocumented migrants. These policies accompany measures within the asylum system which also seek to deter asylum seekers by limiting access to employment and social welfare. Many of these measures are more restrictive than in comparable countries such as Spain, France and Germany.

This process of securitisation, in which the government seeks to deter refugees and undocumented migrants through restricting their access to housing, employment and health care, as well as prolonging and complicating the asylum process, adds to the effect of previous trauma in creating risk of ongoing post-traumatic stress disorder, psychiatric symptoms and other mental health problems.

Adding to the tragedy of this situation is the irony that the prioritisation of security issues not only harms health but also seems to provide no benefits to “security”.

Adding to the tragedy of this situation is the irony that the prioritisation of security issues not only harms health but also seems to provide no benefits to “security”. While the Home Office does not have in place measurements to evaluate the effectiveness of the hostile environment provisions, internationally, the UN Generally Assembly has pointed out there is little evidence to suggest asylum seekers are in fact a threat to security. Evidence suggests that rather than policies of deterrence, structural factors that largely lie beyond the reach of asylum policy makers determine asylum seekers’ choice of host country. In the UK, most detainees are not deported, suggesting they were never a threat to security in the first place.

Inadequate mental health service provision

Further compounding the harm done to those seeking asylum in the UK is that the provision of mental health services to forced migrants in the community is inadequate, although the extent of the problem is difficult to ascertain in the UK partly because data collection on this issue is poor. Whether improved data would ameliorate the situation is questionable, especially considering the currently available data do not seem to be used to inform policy. Rather, forced migrants’ psychological suffering is often dismissed and considered “ungenuine” by bureaucrats working in the asylum system. I am currently undertaking research to explore these and other barriers to forced and undocumented migrant mental health care, their causes, and the efforts of health service providers to overcome them.

These multiple dysfunctions point to a system in desperate need of reform – not only to improve mental health service provision to forced migrants but also to adopt a more humane asylum system that protects and promotes human rights and does not actively create further mental health problems in this population.

The views expressed in this post are those of the author(s) and in no way reflect those of the Global Health at LSE Blog or the London School of Economics and Political Science.

Photo by Aude-Andre Saturnio on Unsplash.