We are all migrants – the only question is when
UCD research into mental health needs of migrants in Dublin yielded ‘surprising, reassuring and disturbing’ results
Syrian Kurd Salah ad-Din lifts his 7-month-old daughter Hiro Belo as they wait at the main bus station in Istanbul, Turkey, September 15th. Photograph: REUTERS/Murad Sezer
As Ireland contemplates its response to the wave of migration facing Europe, it’s worth reflecting on lessons learned from the wave of inward migration Ireland experienced in the late 1990s and early 2000s.
Between 1995 and 2000, about 250,000 people migrated into Ireland. By 2001, the aggregate figure for refugees and migrants over this period represented 5-7 per cent of the entire population.
It is convenient to use the term “migrants” for people who migrate, but they are, first and foremost, people. Like most people, the vast majority seek simply to settle down and live their lives. Many who emigrated into Ireland over past decades have quietly settled in and are now citizens here.
Some, however, experienced significant psychological problems. In order to explore this further, our research group in UCD examined the mental health needs of migrants seeking mental health services in Dublin’s inner city. Our findings are surprising, reassuring and disturbing all at the same time, and offer particular perspectives on the current wave of migration in Europe. First, we found that “migrants” are an astonishingly diverse group. One of our studies, led by Dr Fiona Wilson, focused on 64 migrants who had mental health concerns and found that they originated in 35 different countries and had 29 different mother tongues. Their circumstances varied widely. Some had far more in common with the Irish- born population than with “fellow migrants”. There is no protypical “migrant”.
Second, we found that rates of involuntary psychiatric admission are no higher among migrants compared with Irish- born people. Ireland’s rates of involuntary psychiatric admission are now generally low anyway, compared with other countries (such as England), but in many other countries (including England) migrants and ethnic minorities experience increased rates of involuntary admission. Our studies show this is not the case here.
Traumatic eventsThird, there is a significantly elevated rate of post-traumatic psychological problems among migrants compared with Irish- born people. We found 80 per cent of migrants who came to our mental health service experienced at least one traumatic event prior to arrival, most commonly the murder of a family member or friend, beatings or lack of food or water. The rate was even higher (94 per cent) among forced migrants, who constitute the majority of the current wave of migrants in Europe.
More than 50 per cent of the forced migrants we interviewed experienced torture prior to arriving in Ireland and 47 per cent had post-traumatic stress disorder, compared with just 6 per cent of Irish-born mental health service users.
Our findings confirm that migrants are a highly diverse group, do not experience elevated rates of psychiatric detention compared to Irish-born people and have increased rates of post-traumatic psychological problems. It is important, however, not to over-pathologise human distress or inappropriately medicalise suffering. Enforced counselling of people whom we imagine to be traumatised (but might not be) is actively harmful. What is needed in the first instance is practical support: decent accommodation, medical care, English classes and time for recuperation. Families should be kept together.
The importance of free, efficient wifi cannot be overstated, to allow migrants to contact family and friends, keep track of developments and maintain a sense of control. Access to the internet is now a key intervention for the psychological wellbeing of displaced persons.
Most people cope with trauma by talking with family and friends, or through religious or community supports. For those whose resources are overwhelmed, counselling should be available, with an open door policy rather than forced engagement. For a minority, psychiatric treatment may be needed.
Maintaining dignity is central. The opening words of the Universal Declaration of Human Rights state that “recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world”. Dignity is a key concept in human rights and there is no human right that is not connected with dignity.
Dignity results from the match between a person’s circumstances and his or her capabilities: a person experiences dignity if he or she is in circumstances that permit exercise of his or her capabilities. Mental health care supports dignity by enhancing psychological wellbeing and improving capabilities. Improving circumstances is a broader undertaking but is equally important for the protection of dignity and wellbeing among migrants.
Psychological wellbeingSome lessons from our recent history are clear. Enforced dispersal impairs psychological wellbeing and undermines dignity; relocation should be arranged collaboratively with migrants and host communities. Enforced idleness is an unnatural circumstance that is uniquely corrosive of dignity and wellbeing; people need to be engaged in meaningful activity and allowed to work. Most migrants have robust psychological health, but for those who have difficulty, support services need to be prompt, pragmatic and appropriate.
In the past, we Irish were commonly the migrants. Today, it is Syrians and others. In the future, it will be us again. We are all migrants; it is only a matter of when.
Brendan Kelly is associate clinical professor of psychiatry at UCD and author of Dignity, Mental Health and Human Rights (Ashgate, 2015)