Ms Tahereh Fardin Tabrizi:

We welcome the subcommittee’s focus on mental health care for migrants and ethnic minorities. We are grateful for the opportunity to attend here today. Although we are a refugee and migrant support organisation, and not a mental health organisation, we can highlight a number of issues from our work that we feel are important. We will speak primarily about refugees, international protection applicants and other high-risk migrants, as well as migrant workers from outside the EEA. However, there are other groups we hope the sub-committee will consider, including Travellers; black and mixed-race Irish people; international students; and EEA nationals from other countries.

The mental health requirements of the people we support differ from those of the general population. Within the broad categorisation of migrants and ethnic minorities, there are very diverse lived experiences and needs. Existing mainstream services are not meeting these needs and consequently, additional expertise, training and funding is required. A recent report from the WHO highlighted a number of policy considerations to benefit the mental health of refugees and migrants that we believe are important, including the implementation of policies and programmes that promote their social integration and their participation in society. Linked to this, the impact that anti-migrant sentiment and discrimination can have on mental health should be noted. Migrant policies should recognise and address the social determinants of mental health and prioritise basic needs such as food, housing, safety, education and employment. The capacity of healthcare workers to assess and treat mental health conditions among refugees and migrants from diverse cultural backgrounds should be strengthened.

From our work, we see how factors like poor accommodation, poverty, unemployment and homelessness adversely affect the mental health of migrants. Recognising and addressing these social determinants, and reducing the level of inequality and social exclusion faced by migrants, is essential.

The impact of restrictive immigration policies and practice and poor regulation of some sectors of the labour market that result in exploitation and other post-migration stressors increase the prevalence of mental health problems for migrants, and often result in people experiencing ongoing trauma.

What are the barriers to mental healthcare? Research indicates that barriers to access and use of mental health services by migrants include language barriers, cultural perceptions and lack of knowledge of mental health, as well as stigma around

mental illness. From our work, we know there are additional practical barriers such as a lack of childcare, waiting times and a lack of trained interpreters. Mental health service providers also face difficulties. In many cases, they do not have the appropriate training or protected time to care for the unique needs of refugees and migrants. We know from conversations with health professionals that the challenges they experience in attempting to meet migrant needs, while not being in a position to respond adequately or appropriately, is an ongoing cause of frustration.

A high percentage of people in the international protection system face ongoing mental health challenges that are linked to experiences of war, torture, human trafficking and other traumatic situations, including their migration journeys. They survive with little or no supports in direct provision or emergency accommodation where there is a very poor understanding of the effects of trauma. Lack of training for staff on how to respond is a real concern. So too is the lack of privacy and the fact that people have to live for years in a state of forced idleness. The consequences of this are withdrawal, high levels of domestic violence and substance misuse and, in some cases, suicide. Many of the experiences, including the ongoing trauma, are similar for beneficiaries of temporary protection from Ukraine, but more resources have been allocated to this group. For children in particular, the after-effects of forced migration are pervasive. Their needs must be included in all assessment of mental healthcare needs. A final point in relation to international protection applicants is that early and ongoing vulnerability assessments are necessary in order to identify pre-existing and new or ongoing conditions. Once a person is identified as vulnerable, effective access to adequate and appropriate supports need to be put in place for them.

The following are our key recommendations. It is important that the mental health services provide choices, particularly in terms of treatment approach, in order to improve access to care, empower individuals and optimise outcomes for migrants. Equally, it is important that mental health professionals are trained in and practice cultural competence and cultural humility, focusing on identifying their own implicit biases, self-understanding and building an appreciation for the multifaceted components of each individual, which may include culture, gender, sexual identity, ethnicity, religion, etc.

We have a number of further recommendations. A targeted approach to promoting mental health awareness and addressing the needs of priority groups is required, including outreach to vulnerable communities; strengthening community capacity to access mental healthcare by providing information about services and referral pathways and raising awareness. The acute mental health difficulties of international protection applicants in particular cannot be adequately addressed without additional resources, including ongoing vulnerability assessments, improved accommodation standards and specialist outreach services to accommodation centres. The lack of timely, confidential and consistent interpretation services and of trained interpreters and regulation in the industry needs to be addressed. More work is needed on collecting standardised data at local, national and service level in order to properly identify the gaps in mental healthcare for different migrant groups. Last but not least, support and training for healthcare professionals and community and voluntary sector organisations that support migrants needs to be provided in order that they can recognise and respond to the mental health needs of their service users.

I thank the members again for this opportunity to come before the sub-committee.