Overview of available services
Below is an overview of some of the key services in Southampton and Portsmouth that provide support and health care to AS and other vulnerable migrants; there are similarities but also differences in the services offered in the two cities.
Voluntary and community services
The Avenue Multicultural Centre (AMC) is a partnership venture (Avenue St Andrew's Church, British Red Cross, CLEAR and Southampton & Winchester Visitors Group [S&WVG]) offering help and support to AS and refugees every Friday at The Avenue St Andrew's Church. AMC has been running for the past 11 years. Every week clients can seek advice, enrol in English language classes, take part in activities and obtain food. Data on number of AS accessing these services is difficult to obtain but SWVG estimate that they see about a third of all those AS in Southampton as clients, particularly the longer term and complex cases. Visitor attendance at the AMC is normally between 60-70 per week, excluding children, with the main countries of origin being Iran, Zimbabwe, Nigeria, Iraq, Pakistan, Eritrea and Somalia. Clients also come from Sierra Leone, Albania, Sudan, Syria, China, Mauritania, Saudi Arabia and other countries.
The agencies involved in the AMC also offer further support in addition to the drop-ins, such as befriending, financial support and assistance in getting legal advice41. The Red Cross also offers practical support and a service to try and reunite family members42.
In Portsmouth there is a drop-in at All Saints church on Mondays and Thursdays which is run collaboratively by Red Cross and Friends Without Borders43. The drop-in offers a chance for social interaction as well as professional advice and advocacy. Food parcels are provided at the Thursday sessions. Friends Without Borders also offers access to legal advice.
As a snapshot, on one Thursday in August 2019, about 60 visitors were recorded as coming to the Portsmouth drop-in (80 including children). The countries they came from included Afghanistan, Iran, Zimbabwe, Cameroon, Iraq, China, Ethiopia, Eritrea, Portugal, Albania, Bangladesh, Turkey, Pakistan and Ghana.
At the focus groups, AS gave a clear message of the tremendous benefits they get from the drop-ins and the voluntary services in both Southampton and Portsmouth.
There are also various multi-cultural groups that meet in both cities run through a mixture of voluntary, religious and local authority partnerships. For instance, Portsmouth has a Cross-Cultural Women’s Group44 which meets weekly and in Southampton there is a regular group to support mental wellbeing at the New Testament Church of God in St Denys.
Both Southampton and Portsmouth have declared themselves Cities of Sanctuary45. This is a fairly recent initiative for Portsmouth (launched June 2019) but the Southampton group is more established and has set up different ‘streams’ of sanctuary such as the welcome stream which puts together packs for AS newly arriving in the city, libraries of sanctuary and the school stream which engages local children.
In both Southampton and Portsmouth, Home Office dispersal accommodation is distributed in various locations across the cities so AS may register with several different GP practices. However, in Southampton there are two practices which see the majority of AS and other vulnerable migrants; Homeless Healthcare and St Marys. These practices are both experienced in providing services to this population group. For instance, at St Marys a refugee-appropriate health check has been developed, within the SystemOne clinical system, and staff are regularly reminded to use it. The Homeless Healthcare Service is the practice that is most likely to serve failed asylum seekers who are not in official accommodation.
Mental Health Services
Solent Mind provides some peer support programmes in Southampton46, where people, who have themselves had mental ill health, offer support and sign-posting to others, but there is no service specifically for AS and vulnerable migrants currently commissioned in the city.
Portsmouth is launching a new service in Autumn 2019, called ‘Positive Minds’47, which will be fronted by peer supporters but also have clinical support available. This service will be available to AS in the city if they chose to access it.
Across the UK, short-term psychological therapy is now provided by Improving Access to Psychological Therapies (IAPT) services. In Portsmouth the IAPT service is ‘Talking Change’, provided by NHS Solent48, and in Southampton it is ‘Steps 2 Wellbeing’49, provided by Dorset Healthcare University NHS Trust.
Secondary mental health services are available through Solent NHS Trust in Portsmouth and Southern Health in Southampton. Southampton Homeless Healthcare hosts mental health nurses on site and a new initiative in Portsmouth will provide mental health workers within the city’s homeless services50.
Services for PTSD are largely offered through IAPT unless the patient has reached crisis point, or poses a significant risk to either themselves or others, when they may be referred to secondary mental health. Neither city has a dedicated trauma service.
Several stakeholders mentioned that offering therapy to AS can be difficult for mental health services because there is often a policy of not starting therapy with people who are transient and, therefore unlikely to be able to finish treatment, because of the harm this can do. How this policy is defined and enacted differs between services.
Services for UASC
When UASC arrive in Portsmouth there is no initial health screen at the port. Instead they will receive the same medical assessment as any other Looked-After Child (LAC) which is done by the community paediatrician within 20 days of a complete referral. The referral documentation needs to include name, date of birth, GP details and NHS number, all of which can be challenging to obtain accurately for a variety of reasons. Delays in providing the complete referral have often occurred in the past (for instance, if the age assessment proves difficult or registration with a GP is delayed) although stakeholders felt that this process is improving.
The LAC assessment covers physical and mental health and results in a report which is sent to all professionals involved in the care of the UASC, including the GP, social worker and the UASC themselves. This report includes details of the UASC’s history which, on being shared with relevant agencies, should mean that the young person does not have to keep re-telling their story.
The community paediatric team sends out, to the key workers of new UASC arriving in the city, a checklist of health issues to be aware of.
In October 2018 Portsmouth City Council commissioned a two-year project to develop a trauma-informed model of care for UASC in the city. This has been developed from the work of Dr Ana Draper from the Tavistock Clinic and involves four key elements51 52:-
- Continuing bonds – hopeful relationships back in the child’s home country
- Fast feet forward – a sports group using adapted Eye Movement Desensitization and Reprocessing (EMDR) therapy
A psychologist is in post to deliver this model through training of those professionals who come into contact with UASC, such as social workers and Looked-After Children nurses.
Both Portsmouth53 and Southampton54 are working towards becoming ‘restorative’ cities. ‘Restorative working’ focuses on building relationships that create positive change to improve outcomes.
For instance, in Southampton the restorative, child-friendly initiatives include the Cultural Education Partnership55 and the Schools of Sanctuary Network56. Through this work there have been regular sessions57 to raise awareness of adverse childhood experiences and the impact of trauma but these do not specifically cover AS.
CCG Commissioners in both Southampton and Portsmouth have ensured that providers of healthcare services have a ‘Safeguarding Adult Policy’ which reflects the Care Act 2014, is compliant with the Hampshire 4LSAB Multi-Agency Safeguarding Adults Policy & Guidance and includes specific information on Female Genital Mutilation, Modern Day Slavery and Radicalisation. Although this policy is in place, dynamic changes of movement such as removal of AS to other cities and into immigration detention centres raises several implications of safeguarding in practice58.
Several years ago the PEPSI (Patient Experience and Public and Service Involvement) group existed in Portsmouth to provide a place for the local community to voice their needs and concerns to healthcare providers. The group met monthly and was well attended by people from a range of different communities. However, due to service reconfiguration the group no longer exists. (S. Ahmed Khan, personal communication, 10/10/2019)
The Independence and Wellbeing Team at Portsmouth City Council offers cultural awareness training for NHS staff59.