Gap analysis and Recommendations
SUMMARY OF RECOMMENDATIONS
MENTAL HEALTH SERVICES
Southampton and Portsmouth:
- Consider inclusion of a validated, brief screening instrument for PTSD at initial GP registration
- Develop peer support services for AS
- Adapt IAPT services to better meet the needs of AS (e.g. outreach, more flexibility)
- Ensure availability of appropriate interpreter services
- Fund NET training for IAPT therapists
- Review and adapt the UASC pathway to health assessment to expediate appropriate treatment and prevention referrals
- Evaluate and, if found to be effective, ensure sustainability of the trauma-informed model of care for UASC
- Enhance the emerging child-friendly initiative by including AS in all activities
Southampton and Portsmouth:
- Training for healthcare professionals in the health needs of AS and their eligibility for care
- Additional training for GPs in the impacts of trauma that AS may have experienced
- Improve cultural competence through the establishment of cultural advisory groups
- Use this assessment to support initiatives to develop trauma-informed communities in both Southampton and Portsmouth.
Mental health services
This assessment has identified that mental wellbeing of AS and other vulnerable migrants, in both Southampton and Portsmouth, is a key unmet need.
As a first step, peer support services should be developed for the AS population in both Southampton and Portsmouth. These should ideally be in an easily accessible location and somewhere that AS feel comfortable visiting, such as the regular drop-ins run by the voluntary sector. In Portsmouth an outreach service for AS from the new ‘Positive Minds’ service could be considered.
Peer supporters should be trained to deliver basic psycho-education which would help AS understand that physical symptoms they may experience could be due to emotional distress.
Many AS have experienced multiple trauma, but appropriate support often falls in the gap between IAPT and secondary MH services. Use of a validated, brief screening instrument for PTSD when AS first register with a GP would speed up the referral to the most appropriate source of support. IAPT services in Southampton and Portsmouth are already aware of, and attempting to meet, the need for complex PTSD therapy but should be further supported to improve access to their services and to provide appropriate therapies for AS.
In particular, considering the provision of appropriately trained IAPT practitioners as an out-reach service would increase accessibility of the service for AS. Also, services could be designed to be flexible so that AS who find it difficult to engage are able to drop in and out of therapy. IAPT services could also work more in partnership with local voluntary agencies who could offer the practical support that is needed as part of the initial stabilisation phase of treatment.
Appropriate interpreter services must be available for IAPT, and other mental health services, providing care to AS. Telephone interpretation may be considered as this can offer a wide diversity of languages/dialects and facilitate a more flexible approach to appointments.
Mental health services need funding to ensure that their staff have the skills required to meet the needs of AS. For instance, training in complex, comorbid physical and mental health problems. It is vital that IAPT services are able to train some of their therapists in NET as this has the best evidence base for multiple trauma in vulnerable migrants.
Stakeholder consultation has identified concerns from local practitioners that the health needs of UASC arriving in Portsmouth are not being assessed quickly enough due to delays in getting the complete referral information. This process is improving but each step towards assessment needs to be timely and efficient so that the pathway is robust enough to cope with potentially large numbers of UASC arriving in Portsmouth at the same time (as has happened in the past).
A review and adaption of the UASC pathway to health assessment is recommended to expediate appropriate referrals for treatment and prevention, including initiation of immunisations.
The trauma-informed model of care adopted in Portsmouth seems to be an appropriate response to the unprecedented numbers of UASC arriving in the city in recent years. This initiative should be properly evaluated and, if found to be effective, sustained beyond the initial two years.
In Southampton, the emerging child-friendly initiative should be enhanced by including awareness of AS in all activities such as training.
Awareness training for healthcare professionals and CCG staff, covering the findings of this needs assessment, clarity about AS eligibility for care and the impact of ‘hostile environment’ policies, is necessary to better meet the health needs of AS in Southampton and Portsmouth.
Additionally, trauma-focused training should be provided for healthcare professionals, particularly GPs, who are likely to see AS and other vulnerable migrants. Use of an initial assessment in primary care which includes mental health would aid early identification of health issues.
GP training curriculums in Southampton and Portsmouth should be further adapted to cover cultural awareness, the context in which AS seek healthcare and the complexity of physical and mental health symptoms.
There is often a disconnect between AS and healthcare professionals due to a combination of language, cultural barriers and a power imbalance. This should be tackled by developing the ‘cultural competence’ of healthcare professionals. As a minimum requirement, country-specific information could be made available to professionals involved in the care of AS. Most important though is an understanding of AS cultural needs so that the delivery of services can be tailored appropriately to meet these needs. This will help AS feel that they are being treated with respect and dignity and that they are being listened to and believed. ‘Cultural advisory groups’, made up of interested staff and the local community (including AS), should be established within local healthcare systems; this will help develop culturally appropriate services and embed cultural competence within the organisations.
There is also a need to increase awareness more widely across Southampton and Portsmouth of the trauma that AS are likely to have suffered, the impact this may have on their health and appropriate responses. Both cities are already making some progress towards being trauma-informed communities. The results of this needs assessment should be used to support work on these initiatives so that all people who are in contact with AS become more mindful of the impact of trauma and feel more equipped to offer support.