Mental Health and Psychosocial Support for Refugees, Asylum Seekers and Migrants on the Move in Europe

This guidance note provides advice on protecting and supporting the mental health and psychosocial wellbeing of refugees, asylum-seekers, and migrants on the move in Europe on their way to a destination country. Amidst the multiple needs of these populations, the organisations who have created this resource stress that due attention must be given to the protection of their mental health and psychosocial wellbeing due to the many challenges associated with forced migration, such as lack of information, uncertainty about immigration status, potential hostility, changing policies, undignified and protracted detention, and abuse and neglect. Rates of disorders related to extreme stress, such as posttraumatic stress disorder (PTSD), are higher in refugees than in people who are not forcibly displaced. However, for most refugees and migrants, potentially traumatic events from the past (e.g., war and persecution in their countries of origin) are not the only, or even most important, source of psychological distress. Most emotional suffering is directly related to current stresses and worries and uncertainty about the future.

The guidance note describes key principles and appropriate interventions - providing links to related online resources - to guide those who are designing and organising emergency services and/or providing direct assistance to affected people. The following excerpts offer a summary of the guidance:

1. Treat all people with dignity and respect and support self-reliance - "Everyone, including children, people with specific needs, or minority groups have a right to be treated with equity and without discrimination. Wherever possible, support should enable people to choose how they would like to do things in order to maintain a sense of personal control. Importantly, this includes consulting with refugees and migrants to identify their needs and capacities, and build the assistance around their suggestions."
2. Respond to people in distress in a humane and supportive way - "Psychological first aid (PFA) is a set of simple rules and techniques that can be used by anyone (non-professionals and professionals) to respond to people in distress. Facilitating PFA training workshops, for a half to two days, can be an effective way to foster specific interpersonal skills in responders, including volunteers, government officials, police officers and border guards."
3. Provide information about services, supports, and legal rights and obligations - "Provision of up-to-date factual information about where and how assistance can be obtained, can greatly reduce distress in a constantly changing situation. Such information can be provided through physical access points, leaflets, radio, TV, and telephone and Internet. Helpers need to be able to provide adequate facts and refer people to places where they can obtain information. Access to information technology, telephones and phone charging services is vital to help people find information themselves and contact others. Information must be understandable for all different groups on the move, such as children, people with disabilities, people who do not read or older people."
4. Provide relevant psycho-education and use appropriate language - "Given the high mobility of this population, providing brief and practical information in languages that people in this situation can understand is helpful. Information should use everyday language and avoid using clinical terms outside clinical settings. Most importantly, do not use words like 'traumatized', 'psycho-trauma', [or] 'PTSD' to denote a whole population."
5. Prioritise protection and psychosocial support for children - in particular, children who are separated, unaccompanied, and with special needs - "Identification and registration of children can enable their protection and save lives. Providing assistance adapted to children's specific needs, such as help with contacting family, guidance on their options, legal advice and appropriate shelter will encourage unaccompanied or separated children to register."
6. Strengthen family support - "Help keep families together. Where families have become separated connect them with family reunification services....Family and social supports are the best protection in response to distress and attachment to a caring adult is a key protective factor for children....If families experience the death of a loved one during their journey, facilitate dignified burials and mobilize people from the same religious background to attend burials and support families."
7. Identify and protect persons with specific needs - "People who may be particularly vulnerable include children who travel alone, older people, people with disabilities, pregnant women, victims of torture, victims of trafficking, survivors of sexual and gender-based violence (SGBV) and persons with diverse sexual orientation and gender identity. Seek out feedback on interventions from participants and pay special attention to enabling vulnerable groups to share their opinions."
8. Make interventions culturally relevant and ensure adequate interpretation - "Where possible, interventions should be planned with input from people directly affected by the situation. Use of community or family members as interpreters is best avoided and trained interpreters should be used, ideally from the countries of origin of migrants. With training and supervision, some interpreters can have a more comprehensive role as cultural mediators. A cultural mediator serves as intermediary between a person and a service provider using knowledge of the values, beliefs, and practices within their own cultural group, along with knowledge of different care systems in the host context."
9. Provide treatment for people with severe mental disorders - "Treatment can only be provided by certified clinicians, and in accordance with national regulations. Where possible, refer people with severe mental disorders to appropriate secondary services....Give all patients a written text about the prescription to show at border checks. Use simple health travel cards to enable refugees and migrants to carry information with them about their medical problems and the required treatment."
10. Do not start psychotherapeutic treatments that need follow-up when follow-up is unlikely to be possible - "Do not inadvertently harm the person by encouraging them to talk about difficult experiences outside a stable, clinical context. Do not use trauma-focused single-session interventions..."
11. Monitor and manage wellbeing of staff and volunteers - "Staff and volunteers providing assistance to refugees and migrants on the move will be repeatedly exposed to tales of terror and personal tragedy....Humanitarian workers should be alert to signs of stress within themselves and colleagues. Team managers should monitor their staff, through informal observation and periodic routine inquiry or by organizing informal or formal group stress evaluation sessions. A supportive, inclusive and transparent organizational climate protects staff and volunteers."
12. Do not work in isolation: Coordinate and cooperate with others - "It is important that helpers connect with each other and learn from the work others are already doing, so that their work does not overlap or leave major gaps."

Click here in order to download the resource (PDF, Spanish, 8 pages).
Click here in order to download the resource (PDF, Spanish, 8 pages).

Publishers:

Antares Foundation, CARE International, Church of Sweden, IFRC - International Federation of Red Cross/ Red Cresent Societies, IMC - International Medical Corps, IOM - International Organization for Migration, IRC - International Rescue Committee, Medecins du Monde, Mental Health & Psychosocial Network (MHPSS.net), Psycho-Social Services and Training Institute in Cairo (PSTIC), Save the Children, Terre des Hommes, UNHCR - United Nations High Commissioner for Refugees, UNICEF - United Nations Children's Fund, Un Ponte Per, War Child, War Trauma Foundation, WHO - World Health Organization, World Vision