AbstractThe right to asylum is a fundamental and historical right that, in the contemporary Western world, is rooted in colonial policies. This right is gradually being eroded, especially in the EU and UK, through the granting of fewer rights and entitlements, use of illegal migrant push backs, and criminalisation of migrants. The increased legal, social and economic restrictions on people seeking asylum links with, and produces, mental health risk factors around economic deprivation, a lack of social support, and insecure housing. Accordingly, studies have shown that people seeking asylum have high rates of mental health problems.
Given the colonial influence on modern migration policies, I adopt a postcolonial lens throughout this thesis. A postcolonial lens suggests that researchers working with sanctuary seekers could usefully explore the manifestations, experiences and impacts of racism and discrimination, as well as how researchers can pathologise participants. With this context and these warnings in mind, I set out to understand what affects Iranian and Afghan mental health during the asylum process. The questions addressed by this PhD and the methods used to investigate them are as follows:
Question 1: To what extent are postmigration social environmental factors associated with mental disorders in people seeking asylum? Method: A systematic review with narrative synthesis.
Question 2: How should researchers work with migrants, migrant organisations, and migrant communities? Method: An ethnography of three participatory action research projects with Iranian and Afghan community groups.
Question 3: How does the UK asylum process affect the mental health of Iranians and Afghans? Method: Walking and in-depth qualitative interviews with Iranian and Afghan people who have sought asylum, those who work with them on migration or mental health issues, and community members.
Systematic review results identified 7,004 unique records, 49 of which were eligible for inclusion. Findings demonstrated an association between discrimination and mental health problems among people seeking asylum, as well as between general postmigration stressors and mental health problems. The review produced a typology of postmigration social environmental risk factors that informed the topic guide for qualitative interviews and could be used to direct further research on the mental health of people seeking asylum.
Analysis of ethnographic data produced three major thematic categories. The first concerned how researchers should negotiate differences between their values and the values of participant communities, in the process navigating cultural misconceptions and empowering quieter voices. The second focussed on identifying sources of power within migrant organisations and using this to produce effective collaborations. The final theme examined the difficulties of enacting participatory action research (PAR) principles, and the importance of equity rather than equality within the PAR process.
Internal oppressions embedded in the Iranian and Afghan communities disrupt the ability to conduct inclusive research. Moreover, collaborating migrant organisations were structured very hierarchically, impeding the participatory process and inviting me, as a researcher, to replicate harmful power dynamics. The ethnography also produced six practical lessons learnt for future research that mapped onto themes, including on being conscious of the nuances of migrant identities, offering participants a choice of research approach, and ensuring that ethical procedures are culturally accessible. These findings guided the approach and working relationship with qualitative interview collaborators, resulting in more reciprocal arrangements moulded to benefit partners. They also encouraged a focus on disseminating and implementing findings in collaboration with interested participants.
Qualitative interviews produced three major sets of themes around how Iranians and Afghans conceptualise mental health, asylum process factors affecting their mental health, and the mental health support and coping strategies they adopt. Mental health problems could be seen as a personal weakness and shame, described through metaphor and acculturation issues, and were often embodied. These conceptualisations helped contextualise findings around the effects of the asylum process on mental health. Deprofessionalisation through an inability to work was associated with resultant loss of identity, though education could act as a mental health protective factor. The perceived life-freezing and future-destroying waiting inherent to the asylum process was linked to a loss of dignity and a fearful uncertainty.
Moreover, people’s financial precarity and poverty, often involving a lack of money for everyday needs such as food, led to feelings of worthlessness and humiliation. In terms of treatment and coping, participants often drew on their internal resilience and resourcefulness to keep going through the gruelling asylum process. There was also a desire to proactively counter the stagnation of the asylum process, in particular by volunteering. Few sanctuary seekers, especially Afghans, accessed formal mental health services. This was partly due to a lack of English language ability, but also due to a limited practitioner understanding of Afghan and Iranian conceptions of mental health. Those who did access formal services, felt that therapists could be more direct and practical in the mental health advice they gave.
Synthesis of findings highlighted several ways in which mental health was negatively affected during the asylum process. Firstly, sanctuary seekers are silenced through discrimination and marginalisation. Sanctuary seeker experiences during the asylum process were characterised by neglect and exclusion alongside targeted discrimination. Secondly, identity is devastated through the minoritisation and deprivation sanctuary seekers experience during the asylum process. Sanctuary seekers underwent a process of minoritisation once they arrived, accelerated by Home Office restrictions on access to employment, education, and welfare. Sanctuary seekers reported they did not have enough money for their everyday needs, including for food, and were unable to provide for themselves being denied the right to work. Thirdly, as a consequence of the pervasive Home Office discourse of distrust, disbelief and orientalism, participants reported feeling attacked, threatened, disbelieved and re- traumatised by the asylum interview and, resultantly, betrayed by the institution and process they had anticipated would protect and support them. Fourthly, participants had few stable physical spaces in which to feel safe and recover either from these experiences or from the experiences that preceded their arrival in the UK.
The Iranian and Afghan diasporas provided practical support in response to sanctuary seekers’ need for community networks and support. However, they were less effective at providing the emotional solidarity needed to manage mental health during the asylum process. Synthesis of findings and critical appraisal of the completed work identified three findings related to migration and mental health researcher practice, processes and frameworks. First, was that a reliance on Western mental health concepts obscures learning from other cultures.
Iranians and Afghans viewed mental health problems as a personal weakness and, relatedly, there was shame attached to mental health problems. Thus, using Western mental health terms during research could be counterproductive. Second, was that the legal term “asylum seeker” does not meaningfully describe participant experiences, and was actively rejected by some participants. I offer a new conceptual framework, based on the term “sanctuary seeker” and a move away from Home Office discourse. The framework offers a means of categorising migrants that is grounded in people’s experiences as an alternative to using the legal and discursive category ‘asylum seeker’ in defining study populations. Finally, the thesis suggests that researchers working with sanctuary seekers must negotiate the balance between respecting and challenging diaspora values. In aiming to build relationships with community collaborators and produce mutually beneficial work, researchers should explore and recognise community ethical values.
|Date of Award
|1 May 2022
|Sian Oram (Supervisor) & Stephani Hatch (Supervisor)