Vulnerable population-asylum seekers, refugees and migrants - lecture

Question 1

What is meant by a vulnerable group in healthcare?

Answer 1

‘Inclusion health groups’
Not usually well provided for by healthcare services, have poorer access, experiences and health outcomes
Includes Gypsy, Roma, rough sleepers, sex workers, prisoners etc

Question 2

Define migrants

Answer 2

No universally agreed definition
Heterogenous group including refugees, persons seeking asylum and documented and undocumented economic migrants

Question 3

What different groups fit into migrants?

Answer 3

International - born outside their country of residence
Refugees - born outside their country of residence, need of international protection
Economic - purely economic reasons/material improvements
Personal seeking asylum - request for sanctuary has yet to be processed
Internally displaced person - forced to flee home of habitual residence to avoid harm, no crossed an internationally recognized state border.

Question 4

What are the key differences between an asylum seeker and a refugee?

Answer 4

Asylum - flees home, arrived in another country, known to authorities, submit asylum application, legal right to stay whilst awaiting decision
Refugee - proven risk if return home, asylum claim accepted, permission to remain long term of indefinitely, right under UK international law for immediate family members to join them

Question 5

What are some key figures around refugees?

Answer 5

Half under 18yrs
75% hosted in low or middle income countries
70% hosted in neighbouring countries

Question 6

What are some key figures around asylum seekers in the UK?

Answer 6

75% wait more than 6 months for a decision
8% children without guardians
40% granted refugee status
Do not have the right to work - rely on state support
Housing provided - no choice on location - often hard to let council property
£45 pppw cash support - just over £6 a day for food, sanitation and clothing

Question 7

What countries have a large role in refugees?

Answer 7

Hosts - turkey, Iran, colombia, Germany, pakistan
Source - syria, ukraine afghanistan

Question 8

What is meant by migration?

Answer 8

Many reasons - economic, political, environmental and social
Forced - natural disaster, violence, famine
Voluntary (perceived) - labour, economic opportunities

Question 9

How does migration affect health?
Migration is a what of health?

Answer 9

Social determinant of health

Question 10

How does migration relate to mental health problems?

Answer 10

Trauma - poverty/conflict, stressful events before, during or after migration, loss of homes, livelihood, material belongings, communities and social support systems
Increased PTSD, depression, anxiety and suicidal thoughts.

Question 11

What health inequalities are migrants/refugees at risk of?

Answer 11

Infectious disease - overcroded, poor living conditions, poor hygiene services, missed vaccination
Preventable childhood diseases - Measles, Rubella - vaccines/nutrition
Inequalities in prevention - cancer screening services
Poorer oral health outcomes
Sexual and reproductive health - inc infant and maternal mortality.

Question 12

How does refugee/migrant status relate to COVID-19 risk?

Answer 12

Lack of social distancing through living and working conditions
Inc anxiety and depression
Lack of financial support, fear redundancy, separation
Often lack available healthcare or unsure about entitlement to health care.

Question 13

What are some common challenges of refugees and asylum seekers?

Answer 13

Poorly controlled chronic conditions
Mental health and specialist support
MAternity care - late presentation, FGM,
Untreated communicable disease - STIs, missing vaccines

Question 14

What is the HEE’s Female Genital Mutilation Programme?
e-FGM

Answer 14

Intro to FGM
Communication skills for with patients
Legal and safegaurding issues
Issues, presentation and management in children+ (young) women /around pregnancy
Psychological impact of FGM

Question 15

What are the barriers to accessing healthcare for migrants and refugees?

Answer 15

Language, health literacy, inadequate interpreting services
Difficulty navigating system e.g registering GP
Confusion about entitlement to care
Transport cost
Unknown consequences - fear of deportation
Lack of culturally appropriate services
Different health beliefs and practices
Trust/communication in health care providers
Experiences of discrimination

Question 16

What factors affect migrants health as they move to their country or origin to their destination?

Answer 16

Loss of social support
Xenephobia, discrimination
Educational attainment
Economic class
Seperation from cultural norms
Linguistic barriers
Lack of clean water and sanitation
Lack of safe, clean housing
Poor working conditions
Workers rights and policies
Legislation surrounding migrants access to health care.

Question 17

How does the WHO promote the health of refugees and migrants?

Answer 17

1. promote through short and long term public health interventions
2. continuity and quality of care - include OT and safety
3. Mainstream refugee/migrant sensitive health policies and legal/societal protection - intercountry, interagency and intersectorial
4. Tackle social determinants of health - Sustainable Development Goals
5. Inc health monitoring and health information services
6. EB health communication to tackle misconceptions about migrant and refugee health

Question 18

What is meant by individual trauma?

Answer 18

Results from(series of) event(s) or circumstances experienced by the individual as physically or emotionally harmsful/life threatening
Has long lasting adverse effects on the individuals functioning and mental, physical, social, emotional or spiritual well-being.

Question 19

How can trauma affect patients recieving care?

Answer 19

Unable to discuss health problems opening or fearful of examination.
Difficulty trusting health care professionals
HCP exposed to patient accounts can be emotionally affected - include burnout and vicarious trauma

Question 20

What is meant by trauma-informed care?

Answer 20

Recongises and responds to widespread impact of trauma on individuals and aims to create an environment that promotes healing and minimizes re-traumatization

Question 21

What are the key principles of trauma-informed care?

Answer 21

Safety - physical environment and clear communication
Trustworthiness and transparency
Peer support
Collaboration - shared decision-making
Empowerment
Cultural, history and gender sensitivity

Question 22

What is cultural competency?

Answer 22

Being able to interact with people from different cultures/different ethnicities in a way that is effective, respectful and values their own worth.
Lifelong process involves learning about yourself, others and developing social skills particularly around diversity.
This is important to learn about our own bias, and help reduce discrimination in the healthcare environment.

Question 23

What are the key components of cultural competency?

Answer 23

Self-awareness
Knowledge
Attitudes
Communication skills

Question 24

How to communicate effectively with diverse patients?

Answer 24

Avoid assumptions based on ethnicity
Use professional interpreters not family members
Ask open-ended questions to explore patients perspective
Be mindful of non-verbal communication differences

Question 25

What are the NHS entitlements for migrants?

Answer 25

Primary care - anyone can register with GP or receive services free of charge irrespective or migration status - no need to prove identity/adrress
Not ordinary residents charged at point of access to NHS services - not including Non-UK nationals with temporary leave to remain, refugees and their dependents, asylum seekers and their dependents, some refused asylum seekers, children’s in care of local authority, victims of human slavery/trafficking.
A&E is free, investigation, diagnosis/treatment of STIs and infectious disease, fertility services (not abortion or fertility), treatment from sexual violence, domestic violence or torture.
Are charged for NHS dental services as NHS nationals.