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6.29 Health promotion information should be provided through a variety of means such as talks, workshops and leaflets (care should be taken that these are culturally appropriate and translated). That includes cascading of information through community and religious leaders in service training of professional staff, possibly involving asylum seeker/refugees as trainers, creating links with schools or setting up groups of mental health promotion specialists/advocates whose brief would be to dispel myths among both asylum seeker/refugees and professional staff and raise awareness of rights and services.
6.30 The next level of service needed is support and guidance for community workers and volunteers in recognising mental health problems (in the broadest sense of the term), to know when a referral to mainstream services would be appropriate. There may be a place here for training members of the community to use listening skills and give direct support to others within the community. Even further, asylum seeker/refugees themselves may be involved in staff training and service provision.
Tavistock Clinic Refugee Services – Tavistock & Portman NHS Trust Professor Renos Papadopoulos - Consultant Clinical Psychologist, Child & Family Department, 120 Belsize Lane, London NW3 SBA, Tel: 020 7435 7111 Training The clinic offers a series of courses for those working with refugees and mental health issues. The courses develop and enhance participants’ understanding and skills drawing on their own experiences using systematic and psychodynamic approaches. Facilitates space within which to consider the complexities of the refugee experience including therapeutic, clinical and theoretical perspectives in addition to organisational and political dimensions.
Child and Family Department Referrals concerning children and families include child-centred concerns such as emotional, behavioural and learning difficulties; family issues relating to loss or family reunions; worries about parental depression and anxieties around dislocation, uncertainty and the upheavals of life as an asylum seeker. Referrals are from a number of different sources and include community workers, GPs, schools and social services.
Following an assessment, a range of treatment options may be considered e.g. family work, parent work, individual or group work for children and/or parents. When clients do not feel able to communicate comfortably in English interpreters are used. Consultations with schools and the professional network are important aspects of the work.
A refugee workshop, which offers support to those working with refugees and asylum seekers, meets weekly and a few places are available for non-Tavistock staff. Consultancy and training on clinical work and service development is available to statutory and voluntary sector workers.
Caring for Dispersed Asylum Seekers
Somali Community Outreach Project (Tavistock Clinic Refugee Services) The Somali Community Outreach Project, “Peace of Mind”, offers a service to the Somali community living in the London Borough of Camden. The project addresses the mental well being of children between 5 & 13 years of age and their families, and has been set up in partnership with the Somali Community Centre to offer a range of culturally sensitive services.
The project is funded by the Children’s Fund and will run until March 2004.
Aims • To offer Awareness Days to Somali parents on a range of issues including child development, parenting, the workings of the education system and the workings of the health system.
• To facilitate communication and establish a working partnership between parents and schools around the needs of individual children who are perceived as being difficult.
• To offer drop-in surgeries in community settings to parents and children who wish to talk about their worries and concerns.
• To offer a range of culturally sensitive counselling provision to parents and children including individual work, family work and group work.
• To undertake development work with existing statutory and voluntary agencies, raising their awareness of the needs of the community with a view to improving access.
ANNEX A The Department of Health Asylum Seeker Co-ordination Team The Department’s Asylum Seeker Co-ordination Team is responsible for coordinating policy relating to the healthcare of asylum seekers and refugees. This includes working across the Department of Health and other government departments and with health workers and service planners in the field. In particular we work with the Home Office to ensure that health and social care requirements are considered at all stages of the asylum process, both in terms of existing policy and future plans.
Find out more by going to the Department of Health asylum seeker web page www.doh.gov.uk/asylumseekers
Asylum Seeker Team, Department of Health, Room 5W 56, Quarry House, Quarry Hill, Leeds.
Tel: 0113 2546605 Fax: 0113 2545481 E-mail: Justine.Osborne@doh.gsi.gov.uk ANNEX B Key Definitions & Documentation This section contains both definitions commonly used in reference to refugees and information on the most common documents issued to asylum seekers, refugees and those with leave to remain by the Home Office and the Immigration Service.
1951 United Nations Convention relating to the status of Refugees The convention was drafted in the context of an estimated 30 million refugees inside post war Europe, and only applied to European nationals. In 1967, a UN protocol extended the convention to cover anybody, anywhere in the world. Currently, 136 countries have signed up to the UN convention on refugees and are committed to
certain duties, including:
• Non-refoulement (not returning someone to a country where s/he would be in danger);
• Protection (having a system in place to protect refugees);
• Equal rights (to award recognised refugees the same rights as other members of society).
The interpretation of these duties varies from country to country.
Asylum seeker A person who has made an application for refugee status in line with Immigration Rules and the guidance set out in the Refugee Convention (the Refugee Convention is a general phrase used to cover the 1951 Convention and its 1967 Protocol). Once a person’s asylum application has been assessed by the Home Office, they are given a
decision. This could be:
1. Person granted asylum
A person will be granted asylum if they meet the requirements of paragraph 334 of the Immigration Rules. In general terms, where a person is able to demonstrate a fear of persecution, if returned to their country, for reasons of race, religion, nationality, membership of a particular social group or political opinion and the person doesn’t fall to be excluded from the provisions of the Refugee Convention, they will be granted asylum. A grant of asylum means that a person has been recognised as a refugee. A person granted asylum since July 1998 will have been granted Indefinite Leave to Remain (otherwise known as settlement) at the same time as the decision to recognise them as a refugee.
A person’s application is rejected. When a person is refused refugee status they will either have a suspensive or a non-suspensive right of appeal (some may choose not to appeal). If someone has a non-suspensive appeal they will be required to return to their own country in order to exercise that right of appeal. This applies to 17 countries at the moment. However, most will have a suspensive right of appeal, meaning their removal is suspended until they have exhausted all appeal rights. Some people, on appealing, may be given granted asylum or otherwise.
Caring for Dispersed Asylum Seekers A person who no longer has any appeal rights in the UK will be removed or expected to leave the UK. If they do not leave, they will be an over-stayer.
Sometimes, although a person has exhausted their appeal routes, it is not possible for them to return to their country – for example, if there is no safe route in existence or if the person is in the late stages of pregnancy. Such people can apply for section 4 or ‘hard case’ support, which comprises full board accommodation, usually outside of London. Support continues until the person can safely return to their country of origin.
3. Person given humanitarian protection status This will be granted to a person who has failed to demonstrate a claim for asylum but is able to demonstrate that
if returned, they would face a serious threat to life or person (subject to certain exclusions) arising from:
Humanitarian status is given for up to three years, after which the person can apply for settlement.
4. Person given discretionary leave to remain
This will be granted to an applicant who:
Discretionary leave to remain is given for up to three years, after which a renewal application can be made for up to three years. After 6 years, settlement can be applied for.
5. Person given exceptional leave to remain (pre-April 2003 only) Exceptional leave would have been granted where a person was able to demonstrate compelling compassionate or humanitarian reasons why they should not be removed from the United Kingdom. Exceptional leave to remain was replaced by humanitarian protection status and discretionary leave to remain on April 1st 2003, though persons given a decision before April 1st 2003 could be in the UK under this status. Exceptional leave to remain was given for up to 4 years.
Documentation ARC: Application Registration Card. This is issued by the Immigration Service to a person who has made a formal application for asylum in the UK. This will replace SAL1/SAL2 and contains a photograph of the asylum seeker, details such as their name and a chip containing biometrics information. Where it is not possible to issue an ARC card the asylum seeker will receive a SAL form.
Caring for Dispersed Asylum Seekers
SAL1: The Standard Acknowledgement Letter or ‘SAL’, is given to a person who has claimed asylum at a port of entry. It confirms that a claim for asylum has been made and that the person is currently awaiting an initial decision. It is issued if an immigration officer is satisfied with an asylum seeker’s identity documents and that the person should be given Temporary Admission. The SAL can be used as an identity document in establishing entitlement to a range of services.
SAL2: The SAL2 Standard Acknowledgement Letter is given to a person who has claimed asylum after entry into the UK. It confirms that a claim for asylum has been made and that the person is currently awaiting an initial decision. The SAL can be used as an identity document.
In some instances a SAL1 can be replaced with a SAL2, if for example, a child subsequently joins the main applicant. However, this person is still considered an “on arrival” applicant.
IS96: A document notifying a person that they have been granted ‘Temporary Admission’. It is given at the port of entry. If the person was not able to satisfy the immigration officer of their identity they may only be issued with an IS96. Since April 1998 an asylum seeker should have been given a SAL even if they did not have documentary proof of their identity. Thus if someone has a SAL1 they should also have an IS96. If they have a SAL2 they would not normally be expected to have an IS96.
GEN19: A document indicating that an individual has been granted ELR in the UK. Since July 1998 a grant of ELR has consisted of four years leave to remain, after which an application for ‘indefinite leave to remain’ can be made.
ANNEX C Resources HARP – www.harpweb.org.uk The Health of Asylum Seekers and Refugee Portal is a key source of information for health professionals working with asylum seekers. This web site is supported by the Department of Health. Information currently available
Other Guidance Health staff who are working with asylum seekers and refugees are also recommended to read ‘Meeting the Health Needs of Refugees and Asylum Seekers in the UK’ by Angela Burnett and Yohannes Fassil. This is a resource pack aimed at both clinicians and service planners.
The pack contains a wealth of information on detailed aspects of healthcare not provided here – from dermatology to dental problems, along with background information on the asylum process and discussion of related issues such as legal support, schooling/education and tracing missing family members. Many practical suggestions and models of good practice are given throughout. Wording at 4.13, 4.14, 4.16, 4.17 and 4.32 draws on this resource pack. A second edition is currently being prepared and will be available later in 2003. Comments for contribution can be sent to firstname.lastname@example.org The pack is available at http://www.london.nhs.uk/newsmedia/publications/Asylum_Refugee.pdf
Medical cases (includes requests for............................ 0208 6330181 or 0208 6330180 accommodation changes on medical grounds) Re-location requests on non-medical grounds and................. 0208 6330120 or 0208 6330113 adding/removing dependants from support claims Cases where asylum seekers receiving NASS support................ 0208 6330286 or 0208 6330289 are hospitalised (in order for NASS to reassess support during hospitalisation)
ANNEX D Providing Advice and Information for Asylum Seekers Advice and information needs to be provided to asylum seekers in ways and formats that are effective and appropriate.
Check list for providing information to asylum seekers
• There are many different organisations which asylum seekers and refugees rely on for help as they progress through the asylum procedure in the UK. Make sure you explain whether an organisation is part of the Government or not and whether it is involved in deciding on asylum applications. Rather than saying “The Home Office” or “The Department of Health”, it can help to be specific about the positions of people your readers are likely to encounter when they access your services. Asylum seekers can be very wary of any Government officials, even if they are not related to the Home Office.
• Don’t forget to include relevant contact details and contact numbers and mention whether they have interpreting facilities available.
• When translating your information, be clear about what refugee languages are relevant.
Refugee flows into the UK change constantly and sometimes it may be more appropriate to translate into a dialect rather than a standard language.
• Some asylum seekers are illiterate, so you need to think about providing information in different formats, such as audio or in special software formats which allows people to hear information via computer.
Welcome Packs A number of local councils have produced a ‘Welcome Pack’ for NASS dispersed asylum seekers. These packs
provide information on the following:
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