Associate Professor Mina Fazel ‘Child refugee mental health needs’ – In Conversation

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Associate Professor Mina Fazel talks child refugee mental health, the predominant symptoms seen in this group, and how are these children and young people can be best supported. The conversation includes discussion about unaccompanied minors, many of whom end up in care, the ‘red flags’ to look out for refugee children joining a school, and the school based interventions to help.

You can listen to this podcast directly on our website or on the following platforms; SoundCloudiTunesSpotifyCastBox, DeezerGoogle Podcasts and Radio.com (not available in the EU).

Associate Professor Mina Fazel

Associate Professor Mina Fazel

School-based mental health interventions is the current focus of my research. I am working with Oxford Health NHS Foundation Trust to develop better school-based mental health services for all children across Oxfordshire secondary schools. As part of this we are conducting an Online Pupil Survey for children in years 4 to 13. Schools can sign up here. I previously had an NIHR post-doctoral fellowship to develop a mental health toolbox for schools that any front-line worker, even if they do not have a mental health background, can utilise in the school setting. Refugee mental health needs have been a longstanding interest. I have conducted work on the epidemiology of and the risk and protective factors for mental health problems in refugee children, I am concerned about the psychological impacts of immigration detention and have an active interest in Narrative Exposure Therapy for PTSD. For Children’s Mental Health Week 2019 we have made a 6-part Podcast Series on Mental Health Interventions for Refugee Children aimed at anyone wanting to learn more about the needs of these children. Do listen! My clinical work is as a child and adolescent psychiatrist in the Department of Children’s Psychological Medicine at the Children’s Hospital, Oxford University Hospitals. Bio via Univerity of Oxford

Transcript

Interviewer: Hello and welcome to the In-Conversation Podcast Series for the Association for Child and Adolescent Mental Health or ACAMH for short. I’m Jo Carlowe, a freelance journalist with a specialism in psychology. Today I’m interviewing Mina Fazel, Associate Professor in the Department of Psychiatry at the University of Oxford and a Consultant Child and Adolescent Psychiatrist in the Department of Children’s Psychological Medicine in the Children’s Hospital at Oxford University Hospitals.

Mina has worked for almost two decades on mental health issues concerning refugee populations and that will be the focus of today’s conversation. If you’re a fan of our In Conversation series please subscribe on iTunes or your preferred streaming platform. Let us know how we did with a rating or review and do share with friends and colleagues. Welcome Mina. Thank you for joining me. Can you introduce yourself?

Assoc. Prof. Mina Fazel: I’m Mina Fazel. I’m a child psychiatrist, as you kindly said, and I’m really a researcher interested in the social context of people’s lives and I’m particularly interested in children and how to help those that are most vulnerable in society.

So all of my research has been really thinking about improving the ways that young people, especially those from the most vulnerable backgrounds, can access better support and care, and also in my clinical work I work as a Consultant the Children’s Hospital. Again trying to work to help these children who poorly access services often have a better experience of care.

Interviewer: And as I mentioned today we’re going to focus on the work with child and adolescent refugees. How did this become an area of interest for you?

Assoc. Prof. Mina Fazel: Well I’ve always been, I suppose, a social psychiatrist. So in my medical training I did spend one year studying social anthropology and I think that really has changed the way that I think about my role as a doctor in society and also all of the research interests I have which have been very much more focused on the cultural and societal influences on individuals as well as the biological.

So I think refugees and working with refugee children in particular seemed to be important to me on so many levels. So I’m really interested in cross-cultural, mental illness. How the expression mental illness changes different cultural context, but also, I suppose a refugee child living in the UK has a whole set of biological predispositions, mental health problems but also psychological, also social, also cultural.

So all of those areas that I’m interested in I think are really important to study in populations like refugee children where the interplay of all these factors becomes crucial.

Interviewer: When you work with that population group what adversities do you learn of that might put a child or young person at a particular risk of mental health difficulties, and I’m assuming there will be adverse experiences that occur before and during transit to a new country, but also once that young person arrives in their host country?

Assoc. Prof. Mina Fazel: Yes, exactly. So there’s been quite a lot of studies about refugee children and their experience and what we’re learning is that I think there are two main areas of adversity that seem to place a child at greatest risk.

So the first of those is exposure to potentially traumatic events, be that in their country of origin, in their transit to a safe haven, a place of refuge, I put refuge in inverted commas really because obviously that leads us to the second area, which is the post migration environment and the experience of navigating that environment.

So the two of those, I think, are I suppose the advice we need to think about. It’s not only, it seems, what a refugee child might have experienced in their countries of origin that seems to be influencing their current experience and their current mental health.

It is the whole interplay of not only the country of origin, but also what might have happened to them in transit and then navigating this really at times very complicated, somewhat unfriendly, harsh, post migration which more and more refugees seem to find themselves in.

Interviewer: When a family arrives in the host country, I’m imagining that issues around housing, schooling and immigration status are all consuming. So do mental health needs get somehow lost in all of that?

Assoc. Prof. Mina Fazel: I think we shouldn’t underestimate the fact that all of these factors interplay.

So I think it’s correct that, you know, their housing needs, their educational needs, their immigration status need to be prioritised because if we don’t get those right they have major negative impacts on mental health, not only for the child, but for their system, for their family, their siblings.

So, you know, we need to think about the social determinants of health and all these components. So it’s having poor housing. Having a negative experience at school of peer victimisation, of kind of isolation, the lack of acceptance, as well as the family experience of poverty, not being able to contribute to the society around you.

All of these factors interplay on their mental health and immigration status, you know, it is really problematic and toxic right now. So a minority of asylum seekers who arrive in the UK get granted refugee status, and in that period of time where that status is being determined, be that two months or seven years or 10 years, that kind of period of total instability. Not knowing what’s happening. Not knowing where they can stay. Thinking about how they might tomorrow or tonight when they go to bed get a knock on the door in the middle of the night of being removed from the UK into, for example, a Detention Centre and them to their homes of origin.

It’s very difficult to separate out these areas. So I think we need to appreciate that all these areas are incredibly important, but they’re important for mental health as well. So I can see how there is a concern that mental health issues can get lost but, you know, I do think that if we consider all of these components as essential to good mental health, we need to be happy that they’re all addressed.

Interviewer: With so much else going on in refugees life, as we’ve said, perhaps some of the mental health issues could get lost or missed, let’s say. What are the red flags that imply a refugee child or young person is struggling with their mental wellbeing?

Assoc. Prof. Mina Fazel: Well I think that we need to prioritise a positive education experience for many of these children, as well as a feeling of acceptance by their family in the community around them. So I suppose the red flags looking at the different components that are needed to enable the child to settle. So it could be that the linguistic difficulties and not being addressed properly.

So a child isn’t able to learn the native language or not properly supported to do that, and children with interviewed they all say how important it is to be able to speak the host language in order to feel a sense of belonging and feeling settled in this new environment.

The red flags will be areas where we see that children aren’t able to settle, but obviously you can’t expect the young kid to arrive in a new school and make friends immediately, but after a period of adjustment with some support if they’re unable to do that, to settle, to make friends, to engage with learning, to interact with adults and children, either in a structured or unstructured environments I do think we need to start, kind of, thinking then at these moments is there something else going on.

As a child psychiatrist what I think is quite interesting and important is just to unpick it. So, for example, a child might come who’s just incredibly shy, so unable to settle. They might come and they might be on, for example, the autism spectrum that’s not been identified before and that might make it difficult for them to settle.

It might be that they come and they’re severely traumatised and they’ve got PTSD and they might be a difficult sort and that from a teacher’s perspective, of the school, that child might look exactly the same to them, but actually the reason as to why the child isn’t settling can be incredibly different.

I do think, you know, these children and these families we need an investment of time. We need to kind of invest and building relationships to really try and unpick and understand this is an intellectual impairment. Is this a developmental difficulty?

Is this trauma? Is this anxiety? Is this just the personality of the child? To unpick that with associated linguistic barriers and cultural barriers is not an easy task.

Interviewer: You mentioned PTSD. I’ve heard that up to 50% of refugees experience PTSD. Can you tell me about PTSD and refugee children? How common is it? What symptoms do you see in this group and how are these children and young people best supported?

Assoc. Prof. Mina Fazel: So PTSD is much more common in child and adolescent refugee populations than in host populations.

So that has been demonstrated in numerous studies, and I’ve just been involved in publishing a new systematic review looking at that and that shows that the rates of PTSD aren’t quite 50%, but they’re around 23% when you bring all  the different studies together, and that it’s slightly higher in more recent arrivals. So if they’ve come within two years to this country your rates might be in the 30s.

But, you know, we have to always remember there’s no such thing as a refugee experience.

You know, these refugees come from very, very different countries of origin. They have incredibly different experiences of transit and then the destination countries in which they arrive are also vastly different. So, you know, it might be that in some population the rates of PTSD are much higher and other groups they’re much lower.

So what we do know is though that the rates are higher than host populations. They’re closely related to exposure to potentially traumatic events and the symptoms we often see are children who might be more withdrawn, who might not be thriving and we have to keep in mind the family context here, because if a child has PTSD there’s a very high likelihood that the family they’ve come  with experience and similar event.

That’s why I think we need to think when we think about interventions we shouldn’t really just take refugee children in isolation. We need to be really thinking about the context. That if you’re a mother this experience, terribly traumatic events if you’ve also got PTSD the range of symptoms you might be experiencing which are going to be impacting your ability to parent your child.

That child also has PTSD, then it’s a really complicated, difficult area.

Interviewer: What would you like to see then in terms of policy changes?

Assoc. Prof. Mina Fazel: Well I think it’s just first a mind-set shift, isn’t it? There are a  large number of refugees right now in the world and there have been at any time since the World War 2. Those that arrive in high income countries like, for example, the UK are not a representative group of refugees. So the vast majority of refugees live very close to the area in which their native country and difficulties were.

So either in a completely different part of the country in which they are from or in a neighbouring country. A very small number at the high income nations. You know, less than 10% of the global refugee population are ending up in the high income nations, and those groups that do come to high income nations are probably the most resilient, the most resourceful, the most educated.

Now we’ve got a select group of individuals actually from a policy perspective these are exactly the type of people you want in your country and what we’re doing is not valuing that at all.

We’re doing everything we can to deter those individuals coming. So from a policy perspective I think it’s, I suppose, just finding a way to prioritise a little bit of speed in the refugees. So, you know, these refugee determination processes take a long time. We’ve detained refugees. We’ve even started to increasingly detain children in the UK again.

You know, these are policies that are likely to have lifelong negative impacts on the families and children we move. They move house frequently.  For children that’s moving schools frequently. For a settled child to move school is a massive disruption on their life, but for a child who’s experienced so many potentially difficult events that keep adding to that we know is likely to massively increase their risk.

So policy needs to just keep these things in mind about the importance of and provided support. So, you know, very few refugee families feel supported when they leave something. In the world of research if I were to write a letter to recruit a refugee into a study I have to go through so many appropriate processes that ensure it’s properly translated.

It’s well explained but, you know, not one refugee family in the UK has received any information in their native languages that’s accessible, even when it comes to the determination decisions about their own immigration status. So we need to just start thinking a little bit more respectfully towards these groups that we need to actually look after.

Interviewer: Yeah, it’s quite shocking. I’m assuming that the media’s depiction of refugees is also impactful as well.

Assoc. Prof. Mina Fazel: So, yeah, that goes both ways, doesn’t it? I suppose I read media that is actually giving very good messages as documented stories.

It’s highlighting risk. So there are very good examples of, you know, all of the understanding of the difficult migrant journeys that are taking place are depicted in the media as well as very negative messages. So the media is incredibly powerful, but we need to pick and choose what we read and, you know, you can learn a lot of very helpful, constructive stuff from the media, but also that there can be a pandering to certain kind of tendencies that blow his issue way out of proportion.

The numbers coming to the UK are so small right now that we could definitely do a much better job considering the millions that are housed in countries like Turkey and countries like  Lebanon, countries like Jordan. We have numbers in the UK.

Interviewer: Mina, I want to return to some of the mental health issues that affect some refugee children. We talked about PTSD. What other issues might arise, such as mood disorders and anxiety.

Assoc. Prof. Mina Fazel: So depression is the next most common mental health difficulty and the systematic review, the meta-analysis show the rate of around 14%, and anxiety disorders as well is similar proportion. So it’s mainly depression, anxiety. Interestingly, in this latest systematic review we also looked at ADHD and those rates were also quite high at 70%, but that was a smaller sample.

So we don’t know what to make of that, but it is quite interesting. So I would say post-traumatic stress disorder, a range of all the other anxiety disorders and then depressive disorder are the most important psychological difficulties we need to consider.

Interviewer: Who generally picks up on this? Will it be teachers or parents?

Assoc. Prof. Mina Fazel: That’s a very good question, but it’s got quite a miserable answer, I suppose. I just think the reality is it’s not picked up on. So the most vulnerable groups in society right now in the UK are the least likely to access services.

So while we think that maybe one in three children in the UK who need mental healthcare actually get it. It’s  probably around one in nine of those populations of [inaudible 17:30]  would be represented. So who picks up on this? Probably no one. If it’s picked up on it’s usually by school teachers who often don’t know what to do with what they’re picking up on because they don’t know who can help or who could support.

A lot of third sector organisations and charities do incredible work in this area as well. The reality is that I think very few people pick up on it. With PTSD it’s quite complicated, I think, because avoidance is such a core symptom. So if you have experienced a terribly traumatic event one of the core symptoms is to avoid any potential reminder of it.

If you have PTSD and you know that the treatment is likely to get you to explore and remember this terrible event and with refugees it’s often multiple events, but you’re trying to avoid any memory of it or any recollection of it and you know that going into a therapeutic environment is likely to put you in a position where you’re going to have to talk about it. Then you’re naturally disinclined to go and get that support because the core thing in this disorder is to avoid.

So I think we also just need to understand what that means and try to provide services. Oh they didn’t come to their last three appointments. We’re going to discharge them. It’s really not a way to address PTSD because we have to build relationships.

So I think if it is picked up there are still lots of complex barriers about getting young people and families to accept appropriate mental healthcare because they might come from cultures where these types of services don’t exist or  cultures where mental illness is highly stigmatised, alongside having a very strong message coming from your brain or your symptoms saying don’t ever talk about this. Avoid any memory of it. So I think that once we pick up on it we now need to think how do we make services more accessible?

Is it that we provide health services within third sector organisations, for example, or with the schools which is why I’ve become so interested in the school.

Interviewer: If a child is somehow picked up, so if they’re the one in nine, what then happens in terms of assessment and what interventions are then offered?

Assoc. Prof. Mina Fazel: So that is very variable depending on where you live in the UK. So there are parts of the UK that have a long history of accepting and welcoming and supporting refugee communities. So these areas, usually the bigger cities, will have a range of services that can address, you know, they’re incredible organisations, like the Victims of Torture. The medical foundation used to be  within the NHS to provide care.

If you’re living in a more remote rural area, I think that’s very, very patchy. Who knows what’s available. So I think that what you have access to is incredibly varied across the country and it’s unacceptable really that you get such variation. When it comes to specific trauma treatments I do think then there are very few that are able to actually access these interventions once they’ve overcome all the barriers and hurdles to get there it can be difficult.

And on top of that you might have linguistic difficulties that make it even harder to access care without interpreters. Having an interpreter in the room when you’re talking about really, really difficult experiences might make it harder for some. It might make it easier for others. So that the services and the needs of services can be quite labour intensive as well.

What we’ve seen during the covid-19 pandemic and lock-down is how actually these communities have become incredibly isolated. So they’ve become even harder to reach, because I do think treating trauma using virtual platforms is incredibly difficult and not something I have been able to manage.

The universal experience across different services that actually these groups have suffered disproportionately as a result of some of the changes that have happened as well.

Interviewer: Where interventions have been offered pre-covid and hopefully in the future, which are known to be effective? I mean, perhaps you could tell me a bit about narrative exposure therapy.

Assoc. Prof. Mina Fazel: Lots and lots of different types of interventions have been tried because a lot of people have been wanting to do something to help, but not many of them have been well evaluated.

So our ability to draw conclusions about what else is limited. So the data that we currently have does show that exploring the original traumatic events using verbal techniques does seem to be where the best evidence lies now. So the treatments that do that are, you know, trauma focussed CBT and narrative exposure therapy, and I’m particularly interested in narrative exposure therapy or NET which has been developed to address multiple traumatic events.  

So a lot of these other tranche was often focused on a single kind of terrible event, but that doesn’t often work for a lot of these refugee populations who might have experienced five, 10, 15 different or related very traumatic events. So loads of exposure therapy is, I think, quite a remarkable treatment because it has been developed for lay-practitioners to deliver, but if you’re a mental health professional it’s relatively short training.

The treatment can take place relatively quickly, often between six and ten sessions and that can bring a dramatic improvement to the lives of those who receive that treatment. The availability of that for refugee children in the UK is incredibly limited.

Interviewer: Can you describe a little bit about how it works? A little bit more about the actual sort of processes that are involved with NET, particularly when you’re working with refugee children.

Assoc. Prof. Mina Fazel: Absolutely. So it works on the premise that at a highly stressful time, for example, you know, at a time of trauma what’s happening when you’re experiencing that because of the high arousal levels often that you experience that memory gets encoded in a different part of the brain to your normal.

So to keep it simple most, kind of, normal memories about I went to school here. I did this on that day, whatever gets encoded in chronological order in a relatively cold memory we call it, but when you’re highly aroused often there’s a structure on the brain called the amygdala and we kind of think about these kind of very primitive structures this is where these highly emotive memories get encoded.

So it’s not put in the normal part of your memory. It gets encoded in this other part of your memory and that bit of your memory is not…it’s a bit fragmented.

So you kind of remember the sounds and the taste and the smells and they can come back to you at times that’s not in your control. So, for example, a door slams and that might potentially trigger a memory related to a sound that might have been similar to that at the time when you coached your memory and you get suddenly then what we call a flashback into that time and you might feel bodily sensations as well as that.

So what narrative exposure therapy does really simplistically it’s about organising your memories.

So what it does in the therapy is you take a traumatic event in one session and you go through it in incredible detail to, I suppose, I see myself as someone fixing the memory. So we want to get every single bit of memory down in chronological order, understanding what happened and we believe that in the process of doing that it doesn’t take away the pain of what you’ve experienced but enables you to get control of the memory so that it doesn’t come to, you know, in unexpected times and force you into these very negative patterns of avoidance which we’re asking about before.

So in narrative exposure therapy you basically, you know, I often say you’re like a film director. So when you come out of that therapy session you need to go and be able to recreate every single component of that memory. You need to know what the person was wearing, what the temperature was like, every single thing that happened where they were standing and you document that in the sessions, so that after the session I would sit and I would write down that whole memory that that person had gone through with me.

Then in the next session I’ll read that narrative back to the person to make sure I’ve got it right. To expose them to that memory so it’s no longer avoided, but also hopefully in that process we place that in chronological order. We’ve helped the brain process that into the part of the brain that’s been better evolved to deal with most memories and through that process, hopefully the person gets a different perspective. Actually, it wasn’t their fault.

You know, so all these kind of abnormal cognitions that can come about in those who have experienced trauma often self-blame when it shouldn’t be there get resolved through better understanding and better control of the memory. So NET narrative exposure therapy is exactly what it says. It’s getting a narrative. It’s exposing the person to the trauma through that narrative and hoping that through that process they’re able not to fear that memory quite as much.

Interviewer: Let’s turn to your research looking at school based interventions to help support refugees. Can you share some of your findings?

Assoc. Prof. Mina Fazel: The first thing that’s important to show is that obviously we’re able to identify and demonstrate that refugee children had worse mental health than their peers, but that’s no surprise, but what we did was try to develop a package of interventions to be delivered in schools.

So what we really learned through this research was the acceptability of the school location for many of these children and their families. So we would work closely with the schools and the schools would talk to us about the children they were concerned about, but then if they felt like we needed to see a young person and or their family depending on circumstance and that the school would approach, would tell them about our service. Would say that our service came to school, though sometimes a school teacher who had a good relationship with the family would accompany them at the beginning of their first session or whatever felt appropriate.

So it’s really learning about barriers, access and care that even if care is available in for example, a community outpatient clinic that might still just be too difficult for a family who don’t know the cultural and social context to be able to go to this strange place to tell these strangers about some of the hardest things that ever happened to them.

Through the work we did I really developed a real interest in what the barriers, access and care. How can we overcome them and what role can the location of the school play in facilitating improved access?

What I think actually is really exciting with work like this has been that actually the benefits have not been for the refugee kids. This has been generalised at all schools. You know, all children. So from a learning about how to work in schools with refugee children we were able to appreciate that from a school perspective they’re worried about all kids, not just the refugee kids and actually they want to talk about a child that has difficulties, you know, regardless of their background.

So on the back of our learning from the refugee school mental health service we were able to build mental health services in our secondary schools and develop a totally new approach to providing care in that context. So, you know, I’ve been involved in training many people in the UK, but, you know, in our local service in Oxford, for example, we don’t have that many refugees kind of services, but we have lots of children with PTSD that hasn’t been recognised and hasn’t been treated.

And actually what we’re learning is how to use NET with, you know, children on the autism spectrum or those with sexual impairments or those who have had child sexual abuse or a whole range of difficulties. So actually that’s what I think is so exciting working with this group group is that, you know, we’re learning a lot, but we’re  also learning a lot about, you know, highly vulnerable populations. How to improve our interventions for those groups and those benefits will not just be for the refugee kids, but actually we’re seeing it’s generalised across the board for all vulnerable children.

Interviewer: Yeah, that’s really interesting. I’m wondering though how well placed and resources schools are to take on this role and also what more can be done to better support schools and in particular to better train school staff in supporting refugee children and as you say there are then the greater across the board benefits of that?

Assoc. Prof. Mina Fazel: Yes. So, you know, the schools have a mighty burden on their shoulders right now. So I think the first thing is to say it’s not for schools to do.

So this is about the location of the school. So we as a mental health service how can we work more closely with schools to take advantage of the fact that the location of us doing a bit of our work from the school location might be much more acceptable to children. We might be able to provide a more acceptable service. More of them might be able to come and they might be able to engage families better. So it’s saying that although we want to work in schools we’re not assuming that this is work that’s done by the existing school staff.

So there are quite a lot of initiatives now in the UK about bringing new types of mental health support workers into schools from health, for example, but there’s no doubt that schools benefit from increased resources, especially in thinking about the pastoral care needs of these children at school, and I think that’s because from our research with children they’re saying that they actually prefer to be seen at school than outside of school.

So our research showed that about 70% of children preferred to be seen in school and 30% of children preferred to be seen outside of school, and my hunch is that that will be, that will remain consistent across the board for the majority of children, but definitely not all of the children. Finding ways to work within the school context as other services like the school context is important.

So schools need to, I suppose, find ways to accommodate that, but we can all try and advocate for increased resources to be put into the school setting to enable these other services that come and work more closely with teachers.

Interviewer: Is it somehow less stigmatising then?

Assoc. Prof. Mina Fazel: That’s the hope, isn’t it? I think it’s more democratic. I see it as it democratises access to care because no matter what, you know, who you are, where you come from, what your family is at school, you might be able to equally access this than if it was for families to take a kid to a referral to somewhere else, but I think the stigma issue I think is really interesting. So we had one school where when we went to set up the school mental health service.

This wasn’t for refugee kids. This was for all kids. I remember the teacher saying that, you know, you can come and you can provide the services, but no one of the school ever wants to come and see you at school. So, you know, sure enough in our first few months that was right. You know, whenever a child from that school was referred to CAMHs, Children’s Mental Health Services, we offered whether they wanted to be seen at home or whether they wanted to be seen at school and they all said they’d rather be seen at home than at school.

But over time with increasing  kind of doing more assemblies, making it more a normal part of the school life within 18 months every single kid was opting to be sees at school rather than outside of school. So I think that the stigma can’t be ignored and it’s an important factor. But but it can be addressed through just making this more of a normal part of provision.

Interviewer: Mina, we haven’t yet talked about unaccompanied minors, many of whom end up in care. What does the research show in terms of the trajectory of their mental well-being?

Assoc. Prof. Mina Fazel: So, you know, these are children who have much higher vulnerabilities because they’re open to exploitation and we know that from the stories and to traffickers, and then on top of that they’ve lost the protective buffer of their primary caregivers. So the vast majority of studies show that they have high rates of PTSD, compared to refugee children who arrive with their families but, you know, the research also shows, you know, that we can’t ignore the fact these are an unbelievably resilient populations.

And if they’re provided with good social support, with good educational opportunities their outcomes are good. So I think we need to see unaccompanied minors as a group that we really need to take special care of. They are the most vulnerable in our midst, but there are examples of how they can be managed well and looked after well and well supported.

Right now I see a few examples of that in the devastating stories we hear of what’s happened to these children across the world.

So I do think it’s important to be particularly aware their needs. You know, I remember I met a young boy and he was an unaccompanied minor and he was one of 14 children in the family from a remote part of Afghanistan.

I just thought, unbelievable. You know, the family number one chose this kid and all their children to leave. He was pursued by the families, the one most capable and most able to manage. He managed unbelievable the difficult journey. It took him over three and a half years to get to the UK with very, very complicated journeys across the mountains and across the Mediterranean, both fraught with terrible death and those around him and he arrives in the UK and I just looked at him and I thought the way we are treating you, so you are someone who has been chosen by your own father to be the most likely to succeed.

You have managed this unbelievably complicated journey at a very young age. He must have been 13 when he left and you arrive in the UK. How are we treating you? You could say no one at school was talking to him. He’s left to fend for himself. He had to live alone in a house. He’d never been able to….never understood how to manage finances. Didn’t know how to cook and I just kind of thought, gosh, you know, this is a kid that is remarkable and look at how we’re treating him.

So I do think we need to be aware of what these unaccompanied minors represent and also what they’ve gone through.

What more could be done? I mean, it sounds so devastating.

Well we know that their social context and the post migration environment can do a lot for them. So feeling welcome in their education environment. Feeling welcome in the community around them. Finding ways to provide consistent support and social networks. The interesting study is looking at patterns of foster caring amongst unaccompanied minors and many examples of how, you know, this has helped.

Some benefit more from similar ethnicity, foster care, for example. So we can study and understand and then find ways to help these young people. A lot can be done because right now really it feels like very little is done. So a little more will make a big difference, and I suppose that’s really what  I think it’s important for everyone to hold in mind. That these might feel like massive, intractable global problems, but the reality is just trying to make a bit of a difference, trying to learn how to advocate or help or whatever it is you could do I think makes a big difference.

Interviewer: Mina, what else is in the pipeline that you’re working on or further research that you’d like to mention?

Assoc. Prof. Mina Fazel: Well I’m just focusing much more now on various access and care. So we’ve just finished a survey of 1,800 children with a lot of questions around their current mental health needs, because that happens to coincide with the covid lock-down, but also within that we’ve put a lot around what would help young people access services?  What would make them acceptable?

So now I’m really starting to analyse that. Look into that. For example, I’ll tell you this. So we asked children do you know who provides mental support at your school and from last years’ data, 2019 that was, 75% said, yes, they know who provides counsel and then we asked would you access it if you felt you needed to and only 30% said yes. So I’m just like, you know, what is going on there?

How can we make services more acceptable to young people? So for me, that is where a lot of this work with the refugees has really led me is that even if we think we’ve got a service that is addressed and needs for the group, actually the reality is that that might not be how that is perceived by the group that we think we’re trying to target. So really to make that better. So I’m really, kind of, interested in unpicking, understanding and improving all of those areas for young people.

Interviewer: Finally, Mina, what is your takeaway message for those listening to our conversation?

Assoc. Prof. Mina Fazel: Well I just think, you know, you see something that is unfair, unjust. I think you can do a lot. I think don’t underestimate just advocating for that one individual. Providing where to support. Learning for that individual and others. You know, a little school service that we set up for refugee children that was initiated by a third sector organisation has actually had massive implications and benefits for all children, I think, because we’ve been able to really start working in schools in a different way. So not to underestimate the value and importance of just trying to unpick and understand a little area of vulnerability and deprivation.

Interviewer: Mina, thank you so much. For more details on Associate Professor Mina Fazel please visit the ACAMH website www.acamh.org and Twitter at ACAMH. ACAMH is spelt ACAMH and don’t forget to follow us on iTunes or your preferred streaming platform and let us know if you enjoyed the podcast with a rating or review and do share with friends and colleagues.

 

 

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