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Supporting the Mental Health of Refugees

Updated: May 27

As horrifying scenes of the Russian invasion of Ukraine were broadcast on our TV screens, many Britons were moved to want to help the innocent civilians caught up in the devastation. The Homes for Ukraine scheme was launched on 14th March, to allow individuals and families to offer rooms in their homes or properties to refugees fleeing the conflict, and since then 64,800 visas have been processed.


We use our experience of working with refugees and those suffering from trauma, to offer a Psychological perspective on what hosts and those supporting the newcomers can expect, and how to best support their emotional and psychological wellbeing in the coming weeks and months.


Conflict in Ukraine and Mental Health


Millions of Ukrainians have been forced to leave their homes and everything that is familiar to them, such as their friends, relatives, personal belongings, routines, livelihoods and even pets. They may have been separated from or have lost loved ones. Many people have witnessed extreme destruction, violence, sexual assault, intimidation and even death. Some will have been victims of violence and assaults themselves.


Experiencing conflict and displacement can have a profound effect on an individual’s mental health. Around a third of Asylum Seekers and Refugees experience high rates of depression, anxiety and Post Traumatic Stress Disorder (Psychiatry.Org).


The journey to the UK itself will more than likely have been traumatic, with many people walking for days, sleeping in freezing temperatures and going for periods without food, water and basic hygiene. Visa applications and the process of finding hosts itself is a stressful and frightening process during which individuals are putting their trust in strangers and journeying to new places.


The people of Ukraine were already experiencing the consequences of war, following Russia’s last invasion in 2014. A study in 2019 found that among the 1.5 internally displaced Ukrainians, 21% were experiencing Depression and 27% were suffering from Post-Traumatic Stress Disorder. This number is now likely to be significantly higher. According to Trauma UK ‘Often, it’s multiple, cumulative traumas that leads to PTSD or major depression, adjustment disorder or anxiety’.


"A factor that worsens the mental condition of Ukrainian refugees is the speed in which they have passed from a normal life, similar to that of many other Western countries, to a state of war, death, and injury," writes Arash Javanbakht, MD, associate professor of psychiatry at Wayne State University in Detroit, Michigan, and an expert in PTSD in war refugees. "Furthermore, they are experiencing an awful feeling of injustice, as the democracy and freedom that they have fought so hard to have has been put at risk, and they don't feel sufficiently supported by their allies."


Post-Traumatic Stress Disorder


Post-Traumatic Stress Disorder, or PTSD, is a mental health condition that some people develop following traumatic and distressing life events. Symptoms often include flashbacks, nightmares, insomnia, trouble concentrating, feelings of guilt, irritability and isolation. PTSD often appears within the three months after a trauma, but symptoms can present immediately after the event, or weeks, months and even years later.


Consultant Clinical Psychologist Dr Maria Downs has worked extensively with those suffering from trauma, including refugees and torture survivors. She explains that symptoms of PTSD can surface at any time, following traumatic events, which can sometimes take friends and relatives by surprise;


“We often find that when they arrive in the UK refugees are still in survival mode... There will be a lot to organise initially, such as getting their children enrolled in school, finding a GP, familiarising themselves with their host family, accommodation, local area, the language and the culture… It is not uncommon for symptoms of PTSD to surface later”


Dr Downs therefore advises those living or working with refugees to not be surprised if a person’s mood or presentation changes in the future. Symptoms of trauma may include trouble sleeping or eating, irritability, anger, difficulty regulating their emotions, confusion, depression and anxiety. Physical symptoms can include heart palpitations, headaches, aches and pains, sweating, trouble sleeping and loss of appetite.


“Another common feeling among those suffering from trauma is a sense of shame, at having survived when others have not and guilt at reaching safety while others are still fighting, hiding or trying to flee” adds Dr Downs. “Many will continue to worry about those left behind or those who have fled to other countries”.


Find out more about Children in conflict here.


How to Support Those with Trauma


Not all refugees experience PTSD or mental health problems, however we know that rates of mental health problems including PTSD are often impacted by the support that they receive following their resettlement.


We share some practical tips on how you can help;


1/ Listen


It is important that refugees, and anyone who has suffered a traumatic event, knows that they can talk about their experiences and difficulties without worrying about making you feel uncomfortable. Make time to be with them and make it clear that you are available to listen. Try to avoid rushing people due to your own discomfort. It is important not point out positives or tell them they are lucky. Many people will find comfort and reassurance just from being able to speak about their experiences and how they are feeling.


2/ Follow their lead


While it is important to let them know you are there to listen, you should not ask intrusive questions such as where their relatives are or what they have been through. Let me speak in their own time.


If they do not feel comfortable speaking with you about it, perhaps suggest they speak with someone else their age, gender or ethnicity, who they may feel better understands what they are going through. It will also be important not to make assumptions that all refugees will want to talk to other people from their homeland.


It is important to be patient and not have any expectations about how long it will be before they are more settled, and less anxious, depressed or frightened.


3/ Do not take things personally


At times they may be irritable, angry, depressed and frightened. Their mood may be very changeable, and they may appear unable to regulate or control their emotions, sometimes even experiencing emotional outbursts. It is important to remember and to acknowledge that these are normal responses to trauma and not a reflection on you, and not a sign of them being ungrateful for your help or your time. Remind them that their feelings are normal. Do not take it personally if the person’s needs some time on their own.


4/ Offer practical support


Where possible help with practical tasks, such as housework or paperwork, to reduce the stresses on the individual. They may be experiencing cultural and language barriers, as they adjust to being in a new country. Help them to register with a GP, show them how to get around using public transport and, if necessary, assist with paperwork such as setting up a bank account.


Encourage healthy practices and daily routines, such as good sleep habits, eating well and self-care. They may take some time adjusting to their new surroundings and new daily processes, but routine can positively impact stress and anxiety.


5/ Provide Relaxation and Fun


Include the person in activities such as walking or sports; exercise helps to burn off stress chemicals, reduces muscle tension and aids better sleep. Introduce them to friends, family or invite them along to groups or social gatherings to encourage them to meet people and to feel part of a community and less isolated.


When to seek help


If you or someone you know is suffering from any of the symptoms referred to above and the symptoms are persistent or affecting their ability to go about their day-to-day life, it is important to seek help. A GP can refer a patient for diagnosis and treatment as required.


NICE guidance from 2005 and 2011 recommends the use of trauma focused psychological treatments, and specifically Eye Movement Desensitisation and Reprocessing (EMDR)and trauma focused Cognitive Behaviour Therapy. However the NICE guidelines also refer to the need for individuals to have a sense of safety prior to focusing on traumatic material.


Therapeutic input can help with symptom management and reductions in feelings of anxiety and panic. It is important that interpreters are present for non-English speakers, and that the same interpreter is used throughout therapy to ensure trust and continuity of treatment.


As a host or someone helping in other ways to support a refugee, it is also very important to take care of yourself and ensure you have a support network around you. There are various Facebook groups that hosts can join, these are a good place to share experiences and to get advice. There are also many social events organised by refugee charities and community organisations, where you can meet individuals and families going through similar experiences to yourself. This sense of community as well as practical help, tips and advice can help you to be better supported, in supporting your guests.


Useful Resources


Red Cross, Coping with trauma (Ukrainian)

SMH_Coping with Trauma_Flyer_Adults_BRC20-179_ua_LQP (1)
.pdf
Download PDF • 233KB

Red Cross, Coping with trauma (English)

Coping with trauma English
.pdf
Download PDF • 248KB

Red Cross, Coping with trauma - Children (Ukrainian)

SMH_Coping with Trauma_Flyer_Children_BRC20-179_ua_LQP
.pdf
Download PDF • 341KB

Red Cross, Coping with trauma - Children (English)

Coping with trauma children
.pdf
Download PDF • 229KB

Red Cross, Coping with a personal crisis (Ukrainian)

Coping with a personal crisis booklet_Ukrainian
.pdf
Download PDF • 133KB





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