Asylum seekers are being left behind in using health services, because their greatest need is just surviving the day, rather than health issues, according to a report from Healthwatch Croydon.
The report – Refugees and Asylum Seekers: The health and wellbeing of those in Croydon – is based on the experiences of more than 100 asylum seekers in Croydon of all ages, as well as those working in organisations on the front line.
They have found that the experience of expectant and new mothers and children, who have social protection such as benefits and accommodation, can be very different from that of single adults who do not have such access. Without financial support or work visas, adults can find themselves homeless – desperate to work, but without official documentation, not able to secure legal employment. According to the report, this places them in a position of vulnerability and risk and many have said they have experienced exploitation, violence, malnutrition and constant tiredness.
While adult asylum seekers do have good access to primary and emergency care services, this is not necessarily their greatest need. Many are preoccupied with survival – getting through the day and night.
“It is local charities that end up supporting them and this is not sustainable,” Healthwatch Croydon says. “There is a need for a more integrated approach by Croydon Council, NHS providers and local charities.”
• Service accessibility: Children and advocates say there are long waiting times for psychological and emotional support for asylum seekers. Frontline staff say it is virtually impossible to get homeless adults assessed by a psychiatrist, since there is a lack of clarity of whether service exists. Many women would only see female GPs for religious reasons, but there are not enough women GPs available.
• Information and advice: Not all people are aware of the full range of services available and when and how to access them. The Community Mental Health Team has been seldom seen at hostels, and other venues where vulnerable people may be found. Tamil women spoked of anxiety and depression and were not aware that they could get support.
• Language challenges: Children and adults with poor levels of English can feel intimidated at the reception desk and in the consulting room, with a single bad experience being enough to discourage people from returning and seeking future help. People also often struggle to complete application forms and paperwork, with some finding basic questions difficult. There is a lack of awareness of interpreting services, with variable support offered.
Included in the report’s recommendations are:
• Better support and access: Patients on waiting lists should receive meaningful and timely support from local groups. Refugees and asylum seekers need to access rehabilitation support. Sharing female GPs across relevant surgeries would be beneficial in reducing waiting times.
• Clearer information and advice: Better information is needed on when to self-manage, use NHS111, see a pharmacist or doctor, visit a walk in centre, or attend A&E. Posters and flyers in various formats and languages need to be widely available. CMHT needs to link up with charities to visit and educate groups of vulnerable people, continuing existing good practice of professionals working in partnership with charities. Tamil women need to be signposted to relevant support services.
• Understanding: Particular care should be taken with new and recent arrivals to ensure they are welcomed and understood. Staff should proactively support patients to complete paperwork and signpost to support organisations, where they cannot assist directly. GPs and providers should raise awareness of interpreting support, and do their best to identify, and act on, cases where interpretation is clearly needed.
“An integrated approach on these solutions between Croydon Council, NHS providers and charities will deliver a better service for those who need it,” said Jai Jayaraman, Healthwatch Croydon’s interim chief executive.
Whether Healthwatch is around to see any of these recommendations implemented seems unlikely: it’s own funding is due to end in three months’ time, and the status of the local NHS watchdog after that is uncertain.
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