‘Fleeing home’ — A psychologically informed reflection on supporting young refugees and asylum seekers’

04.03.2022: As I write this week’s PIE blog, as the lead for Psychologically Informed Environments (PIE), at the national youth homeless charity — Centrepoint, it is hard to ignore or not reflect upon the events occurring in Ukraine, which are all over the current world news. This invasion of another country and the start of a war in Europe has been headline news for the last week, and is something that I feel personally connected to. Regular readers of this blog will know that last year I finally completed our house renovation, a project that lasted several years and was undertaken entirely by a group of Ukrainian construction workers, from a local building firm. This group of men were not only some of the hardest working and strongest men I have ever seen in my life but were also some of the kindest and most tolerant regarding the numerous changes and inevitable challenges throughout the project. They became part of our family due to the length of the project and being in our home every day, and consequently, I was worried but not surprised to hear this week that many of them have since returned to Ukraine to defend their country. Many of them spoke about coming to the UK to earn money to provide for their families back home, families that are now fighting for their lives in a war zone. Consequently, this current international crises, and these men in particular, have been at the forefront of my thoughts and prayers this week.

Leaving my home pre-sunrise this morning to travel to deliver reflective practice to our ‘frontline’ teams in Manchester, I was also walking to the train station reflecting on how it must feel to have to pack up suddenly and leave your home, perhaps fleeing under cover of darkness and leaving everything behind that you cannot carry. Of course, I will return ‘home’ this evening, and my journey will be safe and easy (despite a few delays caused by the overrunning underground strike in London!) However, what if this was the last time I might see my home, my friends and my family? What if, like many Ukrainian families, I was separated from my husband or father, who were unable to leave and had to stay and fight for my freedom and homeland? What if I did not know whether I would ever be able to return to my ‘home’? These thoughts filled my head with anxiety and fear, and I realised that I could not imagine the trauma and distress that many ordinary Ukrainian civilians are facing right now.

Supporting our amazing ‘frontline’ teams in our Centrepoint supported accommodation services on our PIE journey; I know that there are many homeless young people who are ‘unaccompanied minors’ or asylum seekers from many other parts of the world who have faced exactly this situation as they have travelled to the UK for safety. In some of our services, we have young people from other conflict zones in the world such as Iraq, Iran, Eretria, Sudan and Afghanistan, and perhaps sadly we may now start to see Ukrainians in the future. Our own Centrepoint data (2019) notes that around 21% of the homeless young people accessing our ‘frontline’ services are ‘refugees’. This number is likely to be an underestimation though, as anecdotally I have seen numbers increasing over the past year. I have also noticed that this particular group of homeless young people are no longer just housed in our specialist ‘unaccompanied minors assessment service’ (e.g. Oak House, Camden — https://centrepoint.org.uk/about-us/blog/how-centrepoint-supports-young-refugees-asylum-seekers/) but are also being referred to more of our supported accommodation services across the UK. The UK Trauma Council highlights these increasing rates, noting that from 2020–2021 alone there were 2,773 applications for unaccompanied asylum seeking children in the UK (Sturge, 2021) and as a result statutory social support systems are struggling to cope.

Therefore, what would be a psychologically informed approach to working with this population and what might be the unique challenges that we need to be aware of if we have this specific group of homeless young people within our supported accommodation services? Of course, the most important consideration is that not all unaccompanied minors or refugees are the same. Although we often categorise them into one group, they actually form quite a wide group of unique individuals, all of whom have their own story, come from different countries (and even different cultures or backgrounds within these countries), and they may have experienced different challenges in both their home country and on their journey to the UK.

For example, these challenges may include the experience of being forced to flee their home, imprisonment, torture, loss of property, status, education or livelihood, malnutrition, physical or sexual assault, and extreme fear or even torture. The ‘flight process’ may have lasted days, months or even several years, and could have involved a dangerous and illegal journey at the hands of the ‘people smugglers’ in lorries or other transportation, along with separation from family and friends, being the victim or crime (e.g. robbery or assault) and/or enduring harsh environmental conditions (e.g. in refugee ‘camps’). On arrival, a young person is then faced with the challenges of adaptation to a new ‘alien’ culture, including dealing with their possible shattered expectations of this ‘new life’, an unfamiliar language, and with an uncertain future and circumstances including housing, employment and relationships. Re-establishing their sense of home and identity whilst also trying to manage their tasks of daily living can be another challenge, and can result in significant stress and detrimental effects on their mental well-being (Beiser et al, 1999; Silove et al, 1997; Lindencrona et al, 2008; Fenta et al, 2004).

Consequently, many of these homeless young people may struggle to articulate their experiences of getting to the UK, or even be able to speak about what and whom they have had to leave behind. This is not surprising, as this is likely to have been a significant traumatic experience as noted above. It may therefore take some time for them to feel safe enough with us as staff to be able to open up about these experiences, if they ever do. Therefore, what is critical is that we do not force the discussion as part of any assessment, but rather create safe spaces within our relationships with them that allow these young people to feel able to speak about their past potentially traumatic experiences as and when they are ready. This is important because of the process of talking about trauma within the context of safe and supportive relationships, as per a PIE, can be helpful for recovery (Angel et al, 2001). However, it should be acknowledged that even then, these young people might only ever speak about parts of their trauma rather than share all the details, which could be too difficult or painful. Of course, hearing about such trauma can be difficult for the listener (i.e. ‘vicious trauma’), so it is also important for support staff to look after themselves (and each other) in such circumstances.

When working with homeless young people who are also refugees, we also need to be mindful of the range of possible trauma responses that might manifest in a young person’s feelings or behaviour, as well as the possible increased risk of developing mental health issues. For example, a review by Montgomery (2011) found that around 75% of young people (aged 3–21 years) from the Middle East who were refugees in Denmark, displayed high levels of anxiety, depression and sleep disturbance on arrival and immediately thereafter. Positively though, this research noted that the extent of these issues reduced over time in exile, helped by a lack of discrimination and the opportunity for social support to enable their adaptation. Another research study of Cambodian refugees in the US found that around half of their sample suffered from symptoms of Post-Traumatic Stress Disorder (PTSD) (Kinzie et al, 1986) and a literature review by Flood & Coyne (2019) found that children seeking asylum in Europe experienced a range of mental health difficulties including PTSD, depression, self-harm and behaviour problems. Finally, the UK refugee council (2022; https://www.refugeecouncil.org.uk/our-work/mental-health-support-for-refugees-and-asylum-seekers/) reported that 61% of asylum seekers experienced serious mental distress, with refugees around five times more likely to have mental health needs than the UK population. As a result, it is important that we are alert to possible mental health issues in this population.

One of the key features of PTSD is trauma related memory disturbances, such as intrusive memories, re-triggering, nightmares and inability to recall certain parts of the traumatic experience. However, we also need to be mindful that there can be issues of diagnosing PTSD in non-western populations, including whether the symptoms expected for a diagnosis of PTSD are even culturally appropriate. Moreover, the understanding of mental illness in non-western cultures is often very different, and consequently, many of these young people may not define their experience as PTSD or may fear the consequences of a mental illness label due to the associated stigma or shame around mental health issues within their cultures. This can led to them hiding distress or ‘symptoms’, and an unwillingness to engage in mental health services that may be able to help them (although arguably many of these services lack cultural sensitivity or understanding compounding the problem further). Therefore, sometimes the role of peer support and local cultural organisations can be useful, wherein the young person has the opportunity to speak about and process their experiences with others that have been through similar challenges.

It is therefore important to avoid focusing solely on typical PTSD symptoms because the young person’s reactions to trauma may be far wider than the traditional diagnostic criteria (Montgomery, 2011). Many different individual characteristics can also effect an individuals’ trauma response. For example, intelligence, cognitive capacity, self-efficacy, adaptability and creativity (Qouta et al, 2007). There may also be sex differences in the expression of trauma, although there is a lack of research in this area often because, as we often see in our supported accommodation services, it is more common for young men to seek asylum. This maybe a result of males being more able to travel than females or being viewed by family as the child to ‘send’ to safety because they are perceived as having more opportunities or ability to earn money to send back home once settled.

Consequently, it may be that other behavioural issues seen in these young people (e.g. a lack of motivation, sleep disturbances, social isolation, self-neglect, challenging behaviours) are related to their past trauma, which are often easier to observe rather than self-reported experiences of anxiety or depression, or other mood states. Moreover, difficulties with language can compound these issues, not only in terms of these young people not being able to report how they are feeling, but also in terms of increases in challenging behaviour such as verbal or physical aggression as they struggle to communicate with staff about their difficulties or what their needs may be. It is therefore key to look ‘beyond the behaviour’ or the young person’s presentation, to reflect upon what might be underlying it in order to address this and reduce the frequency of the challenging behaviour. Therefore, throughout our work with this population, the key features of a trauma-informed or PIE approach need to be held in mind within all our interactions, (i.e. encouraging control, choice, trust, empowerment and safety).

In addition, work with this population of homeless young people should be mindful that even on arrival the traumatic experience doesn’t just stop. Many experience ongoing difficulties with social isolation, loss of family, community and culture, and challenges accessing social and health services (Goosen et al, 2014). These difficulties can be further compounded by challenges with language, a lack of understanding of the legal process and their rights, and experiences of discrimination and hostility in their new country (Al-Issa, 1997; Hodes et al, 2019; Papadopoulos et al, 2004). For example, experiences of racism is one of the most significant barriers to integration for refugees in European countries (Mestheneos & Ioannici, 2002; Stuber et al, 2008). Moreover, stressors such as housing instability and worries about the asylum process can cause distractions and reduce motivation in education and employment for young asylum seekers in the UK (Fuller & Hayes, 2020). Other studies of adult asylum seekers have also noted an associated between refugee legal status and poor mental health (e.g. Laban et al, 2008; Ryan et al, 2008; Momartin et al, 2006; Steel et al, 2006). This is likely to be because of the distress associated with living with an insecure future as well as the length and stress of the actual asylum process, which can sometimes take several years.

Other challenges in working with this population of young people can be around the lack of information about them, including risk issues, due to this information or paperwork not being available. This can also include the correct date of birth, with many unaccompanied minors not actually being ‘minors’ by the time they present to services in the UK. This can be difficult on staff working with these young people, as it is clear that they be older than they claim, and therefore may struggle with the boundaries imposed upon them within supported accommodation services designed for much younger individuals. Thus they may need a slightly different approach to support work, as they are actually ‘adults’ rather than ‘adolescents’, although of course the final decision on age is a decision for the UK Home Office and not a charity like Centrepoint. Moreover, many of these young people may have very specific expectations of their life in the UK that differ from their current reality, perhaps as a result of having been ‘sold’ an idea of a new life from those they have paid to get to the UK, from family back home or from other peers in the wider system. They may also have different cultural perceptions of the role of males and females, particularly around authority. These issues can all lead to conflict with staff in our supported accommodation services, particularly if they are challenged by females in a position of authority (e.g. a Service Manager) and/or presented with the actual reality of housing options or the benefits system in the UK.

It is therefore critical when working with this population, to work as a team, provide clear and transparent information (that may need to be translated or an interpreter considered), repeat key messages and provide predictable, secure and stable support appropriate to an individual’s presentation or identified needs. A key goal in any support work is to build their resilience and allow them to process their past trauma though our relationships with them (Ungar, 2008) as well as support their adjustment and adaptation to their new life in the UK, by building on their strengths, and increasing their self-esteem and hope for the future (Thomas & Lau, 2002; Montgomery, 2011). Throughout our support work, we need to remind mindful of providing culturally sensitive care and using our reflective practice and supervision spaces to reflect on the issues and challenges relevant to this specific population. I would also encourage us all to remain ‘curious’ about cultures different to our own. This might be in our approach to our 1:1 conversations with the young people we are supporting or considering how we can create opportunities within our supported accommodation services for cultural events nights (e.g. cooking specific foods) relevant to our residents to help create a sense of ‘home’ and provide space for our learning.

Finally, there are many useful resources to access that may be helpful if you are working with this specific population of homeless young people (e.g. https://www.refugeecouncil.org.uk/information/guides/?doing_wp_cron=1646302158.2568469047546386718750 and www.uktraumacouncil.org). In Centrepoint, our CONNECT legal clinics (c.f. https://centrepoint.org.uk/about-us/blog/providing-access-to-legal-advice-for-homeless-young-people/) can also provide useful information and advice for young people in our services who are currently navigating the legal system to seek asylum. The PIE Team are also in the process of developing a new PIE Module training on ‘Working with Unaccompanied Minors and Asylum Seekers’, which will be rolled out later this year. Positively, and most importantly as an organisation, we know we can work in a psychologically informed manner to make a real difference to young people seeking asylum in the UK (e.g. https://centrepoint.org.uk/youth-homelessness/real-stories/alis-story/) so we can #changethestory wherever in the world their story started…