Posted on: 7 March 2022
The Centre for Anxiety, Stress and Trauma (CAST) has been supporting Afghan evacuees in Inner London, led by Dr Jai Shree Adhyaru.
The work follows on from CNWL’s work at Heathrow Airport and at the Managed Quarantine Hotels where people from Afghanistan first arrived at the end of August 2021. The CAST team began work with evacuees in November 2021.
Dr Jai Shree Adhyaru and Dr John Green, CAST Director, developed an outreach approach to assess mental health needs, support access to services required, with a needs analysis to determine whether additional specialist intervention support is required.
To date our work has been on screening and stabilisation; screening for symptoms of Post-Traumatic Stress Disorder, depression and anxiety around 3 months after people had arrived to the UK.
Our Screeners
We have been overwhelmed by how many of our staff have committed their weekends to this project. We are privileged to have within our team staff that speak Dari and Pashto – the two main languages people from Afghanistan speak. We have drawn upon the experience of our peer support workers and staff from services such as Woodfield Trauma Service and other mental health teams across the Trust. Many of our aspiring Psychologists – Assistant Psychologists, Research Assistants and Support Workers have worked alongside nurses, counselling and clinical psychologists and staff from other disciplines to support this project.
Human distress
Our screeners spend time listening to peoples’ stories; stories of leaving their country because they feared for their lives. Their emotions are often mixed – thankful to be in a place of safety; worry and guilt about family and friends who are still in Afghanistan; acute fear about whether they will be targeted in the UK; frustrations with their current predicament.
We hear stories of ‘starting over’ as people tell us they left with only the clothes they were wearing and what their lives looked like in Afghanistan before they were forced to leave. We hear stories of hope about a different life here in the UK and also stories of hope that one day their country will be stabilised so they can return.
Most of all we hear how much people want to know when they will be moved from their temporary hotel accommodation to a place they can call home.
Why are people still in hotels?
The Home Office is responsible for the placement of people arriving from Afghanistan. People are moving into permanent accommodation. However, given the pressures on housing nationally this has unfortunately left many people living in hotel accommodation longer than anyone would have wished. That makes it difficult for them to establish a ‘new normal’ with respect to family life. We do not know how long some people will continue to reside in the inner London boroughs but people are being rehoused and we expect that numbers in hotels will continue to fall over time.
The Screening Model
The team has shaped the screening programme to ensure a culturally sensitive and informative conversation occurs so people can share their difficulties, explain what the NHS can offer and how it works. We’ve worked with a team of regular interpreters, to ensure that we can ask the screening questions with sensitivity. We know that rote translation does not often capture the cultural nuances of what concepts such as depression, anxiety or trauma mean across different cultures.
We are working closely with Local Authority colleagues, who have an outreach team based in each hotel including a representative from Social Care.
We are also working closely with third sector organisations who have provided a range of invaluable support from practical help and advice on settling in the UK and negotiating life in Britain, through provision of activities to counselling services.
Our stabilisation offer involves assuring residents they are safe, providing psycho-education, signposting, making onward referrals, normalising symptoms and explaining why they might be experiencing the symptoms they exhibit. In some cases, we have supported access to GPs where a medical cause of physical symptoms needs to be ruled out.
Overall most of the people we have engaged with have not required an immediate referral to a mental health service and, indeed, the majority have not wanted or needed mental health support. Some will need follow up when they move to new homes and get more settled. Part of the difficulty is that some sorts of therapy, particularly for trauma, can take some months to complete. We do not want to start treatment only to find that people have been moved at short notice to other areas and have to start therapy again. So we have arrangements in place to ensure that we pass on necessary information to services in the areas where they move when they are resettled. Therapy for trauma very often includes a period of stabilisation prior to treatment starting, so our approach is a good platform for further treatment, and something that would have to be done anyway, as well as being valuable in its own right.
However where the need for intervention is immediate, as it is for a minority of residents, we have not delayed and have referred on for treatment. So far we have made 57 referrals to mental health services - this includes to IAPT where relevant. Some residents have explicitly requested support with symptoms of depression and anxiety for which they had previously sought help in Afghanistan. That will not surprise anyone who has followed the tragic history of the country.
What Next?
All of the evacuees have been registered with a local GP. Most of the residents we have spoken to are finding their way into UK life and most are coping well with the situation they find themselves in, albeit being impatient to find permanent homes and settle in.
The CAST team will continue to provide check ins and its screening efforts over the next few months and our team will be sharing their insights into some of the emerging themes, not least how the current conflict in Ukraine has retrigged traumatic memories for many.