My Lords, I rise to speak to Amendments 30A and 84A, but I also support the amendments from the noble Baroness, Lady Stroud, and I will explain why as I introduce these two amendments.
I first thank representatives from the Royal College of Psychiatrists and the Helen Bamber Foundation for their support of these amendments. The proposed new clause in Amendment 30A would make provision for the Secretary of State to
“commission a review of the processes and services”
that will be in place and their impact on
“the well-being of refugees and asylum seekers.”
We know a great deal more about the long-term impact of trauma on people’s mental and physical health, their memory and their ability to make sense of their experiences, adjust to a new situation, engage productively in work, advocate for themselves and avoid being retraumatised. The very system designed to protect them, whether by poor design or by poor execution, risks worsening the health of refugees and people seeking asylum, and increasing their vulnerability.
With respect to work, there is evidence that people with mental health problems of any sort who are out of work for more than six months have real difficulty getting back into work—ever. This is a really key, important point. Research by the Royal College of Psychiatrists has evidenced that people with significant mental illness, as well as those with evidence of torture or sexual or gender-based violence, are being detained despite their mental health-related vulnerabilities, and that their mental health is deteriorating further in immigration detention. This remains the case, despite the statutory guidance on adults at risk and associated caseworker guidance introduced by the Government in response to the highly critical Shaw report.
The health needs of refugees and those seeking asylum require close multidisciplinary working, continuity of care and a regular review of these processes to ensure that, unlike what happened in Napier barracks, these systems are working in the way intended. I urge the Minister to commit to a review of the processes and services in place with regard to the well-being of refugees and asylum seekers, carried out by a body with the necessary expertise.
10.15 pm
Amendment 84A proposes the need for a code of practice for professionals involved in the assessment and care of people seeking asylum, which ultimately aims to provide fairness, consistency and protection for people in these vulnerable situations. In seeking to require the Secretary of State to prepare and issue one or more codes of practice for the guidance of immigration officers, medical inspectors and other persons involved in the assessment and care of people seeking asylum, the objective is to regularise a process that at the moment displays somewhat haphazard approaches to the health and well-being of people in such vulnerable situations. Given the numerous agencies—public, independent and third sector—and a variety of sources of guidance, perhaps this is not surprising. The Home Office has a role in providing and maintaining a framework to ensure that its various agent bodies do not fail to assess and address the health and care needs of people arriving here, by whatever means, nor fail to assess, prevent or delay the development of health and care needs after their arrival.
Mental illness can influence the ability of asylum seekers to present their claims in a coherent way. The assessment of credibility is a fundamental aspect of the asylum decision-making process, whereby people seeking asylum are required to prove the existence of a well-founded fear of persecution if returned to their country of origin, based on any of the grounds prescribed
by law. The decision-making immigration officer needs information to make their decision, but they may be faced with a person with symptoms associated with mental health disorders and the mental health effects of trauma, such as memory loss, inability to express or even feel emotions, or profound guilt and shame at what they have experienced. It is vital that those interviewing them have a sufficient understanding of the effects of trauma on memory and disclosure and how to consider this when deciding the outcome of an asylum claim.
As I said in Committee, these are people with complex health needs. They are not just like any other patient in the NHS; they have had very difficult experiences and have difficult mental health needs. It is difficult for them to try to explain their trauma to the first interpreter or the first person assessing them that they meet. It can take years for people to be able to trust sufficiently. This is not just about having an assessment and a conversation; it is about a relationship of trust. It is intended through this amendment that the mental health, mental capacity and physical health of asylum seekers and refugees are assessed and considered properly on arrival and throughout the asylum claim processes, and that the treatment and care of asylum seekers and refugees is sufficient to ensure their health and well-being. Through this, they will be in a better position to engage with the asylum processes and later, if their claim is successful, to integrate.
The assessment and identification of mental health problems requires appropriately trained staff, as well as close multidisciplinary working. The treatment of mental illness requires multidisciplinary, holistic approaches and continuity of care. A code of practice would be of benefit both to professionals and to those seeking asylum, and I urge the Minister to accept this amendment.