Supporting people with immigration issues in the context of the Mental Health Act 1983 and Mental Capacity Act 2005.

Abstract

Providing mental health support to migrants and asylum seekers with uncertain or unresolved immigration status and/or with ‘No Recourse to Public Funds’ (NRPF) can pose a distinct challenge for mental health practitioners within both hospital and community settings. As an outcome of the UK’s Hostile Environment policy, some migrants and asylum seekers are precluded from accessing statutory welfare support and services, such as when a person has been refused permission to stay in the UK but has not yet been able to lodge an appeal against this decision or to submit a fresh claim. Yet such support is integral to ensure holistic and effective care planning, particularly for people with serious mental illness. This includes people who are detained under the Mental Health Act 1983 (MHA), or treated under the Mental Capacity Act 2005 (MCA), who may lack capacity to conduct their immigration case, or challenge their proposed removal or deportation from the UK. When planning and conducting an assessment of migrants and asylum seekers under the MHA, difficulties may arise, including mistrust of professionals due to limited or adverse past experience with authorities, unstable accommodation, lack of knowledge of services, concerns about data sharing, lack of reliable collateral history and lack of access to reliable and consistent interpreters. During the period of detention under the MHA, these same issues are likely to persist, with additional concerns including access to legal advice on immigration and ability to maintain links with government agencies on immigration status. These are important additional factors that are likely to influence the detained individual’s care pathway and influence assessments of their prognosis and risk, which are key tasks for treating mental health professionals. In turn, this influences planning beyond the period of detention under MHA, because instability of postdischarge accommodation, uncertainty around supervising team and concerns around removal may combine to inhibit recovery, increase the likelihood of relapse and contribute to associated risk behaviours. These challenges persist even post-discharge, in the community. Migrants and asylum seekers with NRPF are unable to access welfare benefits, housing assistance and, often, support from social services. Further, those with uncertain immigration status are at risk of enforcement actions such as bail reporting conditions, electronic tagging and indefinite detention as well as forced removal and deportations, all of which are known to have a detrimental impact on mental health and wellbeing. Not all migrants are entitled to Home Office accommodation—this depends mainly on the nature of their immigration case, and on whether and if they are destitute. When they are, accommodation is offered on a no-choice basis across the country. This is known as the UK’s ‘dispersal’ policy. This policy has been in place since 2000 and refers to the practice of spreading asylum applicants throughout the country to ensure equitable distribution of resources among local authorities. The accommodation provided may be unsuitable, for example, people with PTSD and associated nightmares being allocated shared rooms. Dispersal may also result in discontinuity of care since the mental health team that has worked with and built relationships with the person can no longer work with them. In addition, issues with the accommodation provided by the Home Office can aggravate pre-existing mental health problems. These include de facto ‘curfews’, monitoring, barriers to accessing healthcare and schools, re-traumatisation due to the sites being ex-army barracks, as well as threats and harassment from far-right extremists. The lack of availability of legal aid representations for migrants and asylum seekers means it is often very difficult for individuals to get the help and legal advice or input that they require to resolve their immigration issues and gain full access to statutory welfare support and services. Furthermore, the new immigration legislation contained in the UK’s Nationality and Borders Act 2022 introduces a further series of policies designed to augment the ‘hostile environment’ approach, including contested proposals to send asylum seekers to Rwanda. It is clearly challenging to provide adequate and appropriate support to this vulnerable group in such circumstances. Considering the high likelihood of problems following discharge, it is, therefore, crucial that the Responsible Clinician (RC) under whose care the person is detained, starts planning for after-care as early as possible in the process. Referrals should be made as early as possible to organisations and registered professionals who are able to provide immigration support and advice. This may Editorial