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Bilal Hassam

Refugee mental health is also a matter of national security

'More than 60 percent will go through serious mental distress' writes Dr Hassam [Getty]

Date of publication: 2 July, 2020

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Comment: The Glasgow and Reading attacks highlight that we must provide mental health services to asylum seekers instead of seeing unwell people as potential terrorists, writes Dr Bilal Hassam.
Within a week, Britain has seen two barbaric violent stabbing attacks. Both perpetrators were asylum seekers. Both had mental health issues. Instead of fuelling the fires of anti-refugee sentiment, these tragic incidents should remind us of the critical importance of mental health among the most vulnerable in our society.

I've been working with refugees through the humanitarian charity Penny Appeal since 2014. With the compounded challenges of fleeing for their lives and trying to rebuild a new one in the UK, often the mental well-being, especially that of younger refugees, is neglected. 

We are all too familiar with the profile of violent attackers that feature a history of mental health problems and so it is essential that we seek to understand exactly what drives people to commit these atrocities. That is the only way we can stop more of them happening in the future. 

A particular barrier to understanding these mental health issues is when the perpetrator is of Muslim heritage (even if, like the Reading attacker, they had converted to Christianity), and the incident is classed as a terror attack. Working with psychiatric inpatients has shown me that those suffering from psychoses or delusions will express them in the language and imagery of their own culture - this could cause them to be perceived as dangerous terrorists, instead of being considered just dangerously unwell.

These tragic incidents should remind us of the critical importance of mental health among the most vulnerable in our society

Although the Reading attack was classed as a terror attack and the Glasgow incident wasn't, many will view the attacks as one and the same, simply because both perpetrators had similar backgrounds; they were refugees. The fact that both perpetrators were already in close contact with the authorities suggests that the current system simply isn't working. 

It follows that the mental health of violent attackers, rather than their racial identity - whether they are Middle Eastern refugees or white far-right activists - may be the more important factor for us to focus on. Research has shown an association between depression and anxiety and holding extremist attitudes. This cuts across across communities, with increased immigration leading to an increase in terrorism not from new arrivals but from "homegrown" far-right extremists.

This may seem obvious, but to many it isn't: Someone who is mentally well is extremely unlikely to engage in a violent attack. This makes providing effective mental health care not only the right thing to do, but the safe thing to do.

That's not to view those with mental health issues as a threat, nor go down the dangerous path of securitising our health service. Rather we must do the opposite: provide appropriate mental health services instead of seeing mentally unwell people as potential terrorists. This is essential if we are to avoid the potentially fatal consequences of failing those who are mentally vulnerable.

Read more: Coronavirus forced us to imagine a world without detention centres. They should remain shut forever 

Currently, provision is severely lacking, despite the scale of the problem. Asylum seekers are five times more likely to have mental health issues than the general population, and more than 60 percent will go through serious mental distress. 

This increased vulnerability to mental health stresses is partly down to traumatic experiences before migration, but is also explained by the trauma sometimes faced by refugees in their host countries. The conditions in the Glasgow hotel, and how they affect those with mental health issues, have already been raised as a point of concern.

What this tells us is that we need to care much more for refugees and asylum seekers than we currently do, and this includes increasing access to mental health care provision. While the NHS is open to refugees and asylum seekers with active applications, migrants are often incorrectly refused treatment and are less likely to receive mental health support than the general population.

The issues also lie beyond healthcare provision. The stigma of mental illness means that migrants who are struggling find it hard to ask for help. Rates of somatisation, where mental health problems take the form of physical symptoms without a physical origin, are high among refugees and asylum seekers, and are often misdiagnosed. This means that the true reality of refugee mental health is likely to be much graver than we know.

The true reality of refugee mental health is likely to be much graver than we know

Refugee communities are not going to disappear - if anything, with ongoing protracted conflicts around the world and new and increasing "push factors" like Covid-19 and climate change, arrivals in Europe are likely to increase.

It goes without saying that the actions of a few should not define the whole. Now more than ever, we must protect our refugee communities from the ghosts of their pasts. We must work to increase access to the services they need to rebuild their lives, and ensure their presence on our island is welcomed and not a reason to recreate the very violence from which they are fleeing.


Dr Bilal Hassam is a medical Doctor and Senior Executive at humanitarian charity Penny Appeal.

Follow him on Twitter: @bilalhassam


Opinions expressed in this article remain those of the author and do not necessarily represent those of The New Arab, its editorial board or staff.

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