In this piece, Rachel Jenkins, the Mental Health & Wellbeing Manager at Refugee Women Connect, explains how to introduce culturally aware and trauma-informed care to support migrant women’s mental health.
by Rachel Jenkins
Picture image: Matthew Ball @Unsplash
In the series “The state of migrant women mental health,” we have exposed the barriers that migrant women, particularly asylum seekers and refugees, face in accessing mental health services.
While the challenges will be hard to dismantle due to systemic inequality and policies like the Nationality and Borders Bill and the recent Illegal Immigration Bill it is not enough to simply point out the barriers without reflecting on how to improve these services.
In this article, we will explore structural and practical changes that can be made, and who needs to be involved in facilitating these changes.
In Part I, we looked at how organisations can implement informed, culturally appropriate, and trauma-informed mental health support to migrants, and why this is so important.
Today, we will focus on some of the smaller practicalities that are often overlooked when considering how best to support migrant women.
Without breaking down the practical barriers that women face in accessing mental health support, it is difficult to engage migrant women, as they may be unable to actually access this support even when offered in an appropriate and trauma-informed way. But what do we mean by trauma-informed, and why is this so important to embed into our services?
Trauma-informed organisations understand the impact trauma has on individuals, not just on service users, but staff as well, and they are committed to helping staff to access options for their recovery.
Trauma-informed organisations
Another important solution to best support migrant women’s mental health is to check whether we as institutions are trauma-informed for our staff. Providing mental health support is a difficult job. Most of us have experienced some trauma in our lives, so we are all likely to be re-triggered at some point in our work.
Trauma-informed organisations understand the impact trauma has on individuals, not just on service users, but staff as well, and they are committed to helping staff to access options for their recovery. Organisations should allow for things like mental health days and flexible working patterns, and foster an environment where staff feel comfortable saying when they are not doing well or need additional support.
Trauma-informed organisations know the signs and symptoms of trauma and can identify staff, volunteers, and service users who are struggling with trauma. Once identified, staff, volunteers, and service users are given additional support through procedures and policies that are flexible and can be adapted to the specific needs of the individual person.
All managers should have training in trauma-informed practice and offer their teams access to mental health support, as well as reflective peer supervision, and team bonding opportunities that staff can attend if they choose to.
More importantly, staff need to know that when they disclose sensitive information, this information will be treated with care and respect that is holistic and not just an HR exercise that ticks the box of what an organisation should do.
Another aspect of trauma-informed care is to try to ensure no one is actively re-traumatised. This can be difficult if you are a mental health professional, especially one who works with clients who have experienced trauma. Regularly listening to discloses of sexual violence, domestic violence, abuse, and death have a profound impact on the listener – especially if that listener has experienced any of those in their own lives.
Being aware of the symptoms of re-traumatisation and offering reflective peer supervision and regular debriefs are crucial to ensuring people are not experiencing re-traumatisation, or if they are, that it is identified early, and that additional ongoing support is given to that professional.
People tend to provide the culture of care that they experience as employees. If we are overworked, unmotivated, and feel stressed when going into our work as mental health professionals, we are not going to be in the right state of mind to be truly present for our clients.
If we are encouraged at work and have healthy work/life boundaries, we are going to be in a better position to encourage our clients and motivate people to make healthy choices for themselves. Managing the well-being of staff, volunteers, and service users should be a priority for every organisation.
If we are overworked, unmotivated, and feel stressed when going into our work as mental health professionals, we are not going to be in the right state of mind to be truly present for our clients.
Mental health professionals within organisations should be directly involved in not only supporting staff, volunteers, or service users when they do need additional support, but should also be involved in writing, implementing, and monitoring policies relating to wellbeing in order to ensure they remain trauma-informed in theory and in practice.
For more information on how to implement trauma-informed approaches in any organisation, here is a good place to start.
Improving how we work with interpreters
The next area where we need to implement culturally relevant and trauma-informed solutions is in how we work with interpreters. It can be very hard to find interpreters at the moment that you need them, especially if you want a woman interpreter with a language that is harder to find an interpreter for already.
Sometimes we rush this process because we are extremely busy because we feel pressure from another professional to do an intake, or because we know they are in crisis, but not taking into consideration several factors is a mistake.
We need to be careful about who we choose as interpreters, and they should never be friends or family members of the client. We should always take into consideration whether they want to speak to a woman or a man, but also consider other culturally relevant factors. For example, regional dialects should be considered to ensure the information being interpreted is going to be accurate.
Depending on the client, maybe they are seeking asylum because of religious persecution and do not want an interpreter from a particular religion interpreting for them because they are afraid that this could help identify them or create a bias with the interpreter or make them feel unsafe.
All of these can be solved by having an initial conversation with your client about their preferences for interpreters. We should not be afraid to request a new interpreter if we or the client are unhappy with the interpreter.
Interpreters for mental health sessions are also booked through general interpreting services, which means we are asking interpreters with potentially no experience working with trauma or people with mental health needs to enable mental health conversations to happen. Since that is the case, we need to find ways to offer training around the needs of our client groups to interpreting services so that they can better understand the needs of our clients and what our clients are likely to talk about in sessions.
How can we provide trauma training for interpreters so they feel confident being exposed to things that may come up in sessions?
Then, to be trauma-informed, we need to consider the mental health of the interpreters, too. This is almost never discussed, but consider how much trauma interpreters are exposed to, often with no warning, and not often with the right training. What if we re-traumatise the interpreter accidentally? How can we begin sessions with interpreters by warning them of what might be disclosed and giving them the chance to turn down interpreting for the session if they know it might be harmful to them? How can we provide trauma training for interpreters so they feel confident being exposed to things that may come up in sessions? These are easy to implement when training staff on how to work with interpreters, and again, would benefit from more partnerships between organisations using interpreters and the interpreters themselves.
We also need to consider how we advise each other on how to work better with interpreters when providing mental health support in team meetings and in reflective supervision. We should be incorporating cases that involve working with interpreters into regular reflective supervision so that we have a chance to talk about how difficult it can be to facilitate mental health support for a client while also having to think about the interpreter, as well as ourselves. This would help us feel more confident, learn from mistakes, and get advice from colleagues on how to improve providing mental health support while using interpreters.
Lastly, knowing the difficulties around working with interpreters highlights another barrier that requires a solution – the length of time we give clients who need interpreters. This goes not only for mental health professionals, but for GPs, midwives, and any other healthcare appointment.
We need to double the length of time we would give to someone who does not require an interpreter, as we know it can take time to get everyone settled in a room, or if using a phone interpreter, to get everyone connected and to make introductions. It then takes time to interpret, to think about what the person is saying, and then change it into another language, all while making sure it is accurate to the best of your ability.
We cannot rush clients into disclosing mental health needs and we cannot rush interpreters into explaining what those needs are. Again, it is our responsibility to change for our clients, not the other way around.
Allowances for babies and children at appointments
Another barrier that requires a solution is how we allow babies and children to attend appointments. This one is very much about making things equitable as well, as women are much more likely to be negatively impacted by rules that state they cannot bring babies or children to appointments.
It is not appropriate for children to attend medical or mental health sessions with their caregivers, as this could allow them to hear inappropriate, worrying, or even traumatising information. Babies, while incapable of understanding what is being talked about, may start crying, which will then have an impact on whether the caregiver is able to talk about their support needs. However, to simply make it a rule that babies and children cannot attend appointments, allowances need to be made. We must recognise that not all migrants have the same level of support networks available to lean on for childcare support.
It is not appropriate for children to attend medical or mental health sessions with their caregivers, as this could allow them to hear inappropriate, worrying, or even traumatising information.
Depending on the size and budget of the organisation, there are different solutions available. For example, it may be possible to provide an on-site creche in another room so that children and babies can be looked after safely while caregivers can focus on getting the support they need.
If a creche is not feasible, it may be possible to offer a phone consultation at a time that suits the caregiver during the child’s school hours or during a baby’s nap time, for example. This also requires offering some flexibility, as things come up with children and babies that are unavoidable. Instead of having a rule that if you must cancel your appointment late then it is a strike against you, offer a new time and be understanding. It is clear when a client is taking advantage of the flexibility and when they do not have other options available to them.
Could we offer face-to-face sessions during term time and then phone sessions during school holidays, when it might be harder for someone to travel with multiple children or when they do not have childcare options? Could we offer to meet them at a partner organisation for a mental health session, where there is a creche if the organisation can guarantee a confidential and safe space?
This is another opportunity for better partnerships between statutory services and voluntary services – voluntary services supporting migrants often already have childcare sorted as they are aware of what a barrier it can be – and many would be more than happy to allow a mental health professional or specialist support to see a client in a drop-in service if it meant that person was going to access the service they need.
In Part III we will focus on the importance of close working relationships between charities and statutory services providing mental health support and the importance of services being led by Experts by Experience.
Lastly, we will examine why collective action on the part of mental health practitioners is crucial in the current political climate if we truly want to ensure migrant women are able to access vital health services.
