25th September 2017 Blog

Refugee and migrant inclusion in community mental health project evaluation

Inequality • Mental health services • Racial equity •

Refugees and migrants experience poorer mental health outcomes compared to native-born populations. This can be due to traumatic experiences of persecution or dangerous journeys to the UK as well as stresses of adapting to a new environment including social isolation, language barriers, and various forms of discrimination.

They are also less likely to seek support for their mental health because of unfamiliarity and sometimes limited access to services or because they are simply too preoccupied with trying to adapt to life in a new country.

In some cases, this is compounded by stigma and culturally embedded understandings of mental health that do not resonate with bio-medical definitions of mental health conditions.

Active Lives, Healthy Minds

Active Lives, Healthy Minds is a community-based mental health and wellbeing project supporting refugees and migrants living in London. It is coordinated by Race on the Agenda (RotA) and delivered in partnership with several grassroots community organisations[1].

The project includes a range of social activities and support services. It aims to attract those that would not actively seek out support for their mental health for reasons outlined above.

Part of the project’s work includes mental health awareness workshops and supporting people to access specialist mental health services when they need them.

However, explicit mental health language is avoided in most activities in order to attract people who would not ordinarily approach health providers with a mental health concern or even recognise the difficulties they are experiencing as related to mental health.

Addressing structural inequalities

Much of the work contributes to mental health outcomes by addressing structural inequalities experienced by refugees and migrants in areas such as housing and access to welfare benefits, as well as social isolation faced by many new arrivals. This approach enables the partners to support the wellbeing of those whose mental health needs often go unnoticed.

Using avenues such as social activities and English language learning, the project supports people to increase independence in their day to day life and connect with others in similar circumstances, thereby reducing stress and social isolation.

English language learning, along with supporting people to resolve practical issues through one-to-one advocacy work, also contributes to their ability to engage independently with mainstream support services, including mental health services.

This goes a long way towards addressing the structural barriers facing refugees and migrants who are trying to access support for their mental health as well as other mainstream services

The approach taken by RotA and their project partners in promoting wellbeing and mental health recovery has the advantage of reaching people who would not normally access mental health services. However, this approach is difficult to evaluate using traditional methods.

A bespoke evaluation framework

The McPin Foundation is developing a bespoke evaluation framework that will allow RotA to capture project outcomes in a meaningful way.

Our initial consultation raised issues and challenges, which are not commonly faced in the evaluation of community mental health projects. How do you evaluate mental health outcomes when the project largely avoids using mental health language and does not assess its beneficiaries against eligibility criteria? How do you develop an evaluation framework that takes into account the mental health impacts of activities as diverse as English classes, mental health workshops, and benefits advice?

And most of all, how do you capture the impact this work has on the lives of people if they have very limited English language proficiency, as well as limited literacy in their native language, making the use of standardised questionnaires and surveys impossible?

Over the coming months, McPin will be developing an evaluation framework that will move away from standardised and often complex questionnaires that characterise project evaluation to accommodate the needs and strengths of people taking part in Active Lives, Healthy Minds. Look out for updates on how we get on.

[1] These are the Tamil Community Centre, Account Trust, Ilays Somali Community Organisation, and the Network of Eritrean Women.  The project’s primary focus is on people of Tamil, Nepalese, Somali, and Eritrean background.