REFUGEES AND MIGRANTS in Ireland are not receiving adequate support as they deal with the impact of traumatic events such as war, torture and human trafficking, the Oireachtas mental health committee has heard.

A high percentage of people in the international protection (IP) system face ongoing mental health challenges that are linked to traumatic experiences, as well as their migration journey itself, Tahereh Fardin Tabrizi told the committee.

Tabrizi, project coordinator at Doras, an NGO that works with refugees and migrants, said there is “a very poor understanding of the effects of trauma” among some people who regularly interact with asylum seekers and refugees.

She said that medical professionals, as well as staff who work in Direct Provision centres and emergency accommodation, need to receive training in this regard.

“Lack of training for staff on how to respond is a real concern. So too is the lack of privacy, and the fact that people have to live for years in a state of forced idleness.

“The consequences are withdrawal, high levels of domestic violence and substance misuse, and in some cases suicide,” she said.

Garda vetting

The committee also heard that not all staff who work in emergency accommodation centres are garda vetted, despite the fact they work with refugees and other vulnerable groups.

Sue Windle, Welfare Coordinator at Doras, said that while staff who work at IP centres are garda vetted, there is no such requirement for people who work with BOTPs – Beneficiary of Temporary Protection – mainly refugees from Ukraine.

“In terms of BOTPs, it’s not regulated,” Windle said, despite the fact these centres are “housing and accommodating and feeding a very, very traumatised” group.

“[There is] ongoing trauma for the Ukrainian people. The war hasn’t finished, and that comes with a myriad of issues,” she said.

“In terms of BOTPs, there is no requirement for providers to have garda vetting or Children First (national guidance on protection and welfare of children) or any training relating to housing vulnerable cohorts of people.”

Green Party TD Neasa Hourigan said her mind was “boggled” at this fact, noting she had to be garda vetted to teach an art class to older people in her local community. She said garda vetting should be the “basic minimum” in this scenario.

The committee heard that this lack of vetting is related to the increasing privatisation of Direct Provision and emergency accommodation as the Government struggles to house the number of international protection applicants.

Falling through the cracks

Emilia Marchelewska, Health Advocacy Officer with Cairde, an organisation that works to reduce health inequalities among minority ethnic communities, said many international protection applicants have dual diagnoses due to the complex nature of what they have experienced.

She said, for example, refugees who came here from Mariupol – a city which was under siege at the start of the Russian invasion of Ukraine – are often “more traumatised” because of what they witnessed.

Oireachtas.ie Emilia Marchelewska from Cairde Oireachtas.ie

In some cases, she said people turn to alcohol when “trying to cope”.

“The accommodation is not suitable, their behaviour may be labelled as antisocial, and they’re moved from one centre to another, not getting appropriate support.”

Marchelewska said refugees are sometimes moved from one side of the country to the other, disrupting their access to services.

She told one story about a Ukrainian man who had mental health and addiction issues. He was “thrown out” of the accommodation centre he was staying in due to his behaviour and the fact he didn’t pay his meal fees.

“He couldn’t get any other any other accommodation and he turned up to a hospital twice with suicidal ideation,” she said.

BOTPs and IP applicants have access to some mental health services, but long waiting lists are a major issue, the committee heard.

Vulnerable children

Tabrizi told the committee that, for children in particular, the “after-effects of forced migration are pervasive”, adding: “Their needs must be included in all assessment of mental health care needs.”

She said mental health professionals need to be “trained in and practice cultural competence” as well as consider issues such as gender, sexual identity, ethnicity and religion when treating patients.

“The lack of timely, confidential, and consistent interpretation services, and the lack of trained interpreters and regulation in the industry, needs to be addressed,” she added.

Tabrizi said that early and ongoing vulnerability assessments are also necessary in order to identify pre-existing and new conditions.

“Once a person is identified as vulnerable, effective access to adequate and appropriate supports need to be put in place for them.”

Last month the Ombudsman for Children’s Office published a report on the safety of children in Direct Provision, saying that a lack of vulnerability assessments was putting the welfare of children at risk.

The Department of Children made a commitment in 2021 that a vulnerability assessment would be carried out within 30 days of a child applying for international protection.

However, to date, the OCO said that only 10% of children seeking international protections have received a statutory vulnerability assessment.

Unconscious bias

Fiona Coyle, CEO of Mental Health Reform, told the committee that Ireland “is in urgent need of a mental health services that can truly serve the entire population, with a particular focus on those identified as being at a higher risk, including ethnic minority communities”.

Coyle said all staff working with people with mental health difficulties need to be trained in anti-racism, cultural competency and unconscious bias.

“Specific measures for reducing discrimination in mental health services should be implemented. This could include actions such as employing individuals from ethnic minority communities and educating local communities to target stigma and discrimination,” Coyle said.

She said refugees from Ukraine and all international protection applicants should have access to appropriate mental health services.

She noted that this recommendation is outlined in Sharing the Vision, the Government’s policy framework to develop mental health services between now and 2023, and must be acted on.

In terms of meeting the needs of members of the Traveller and Roma communities, she said funding needs to be ring-fenced.

Coyle said there needs to be a cross-departmental approach through the new National Traveller and Roma Inclusion Strategy to “rectify inequities and inequalities experienced by the Traveller community, especially in areas like early school leaving, low educational attainment, unemployment, poverty, and inadequate accommodation”.

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