Mental health policy and practice across Europe: an overview

Care of asylum seekers and refugees 357
service providers themselves and examine the institutional contexts in which
services are provided (Watters 2002).
This chapter will proceed with an overview of migrants and refugees in the
European context. Refugees will initially be identified as a particular type of
migrant and attention will be given to the relationship between refugees and
undocumented migrants. As part of this background, statistical information
on refugees in Europe will be presented and discussed, drawing attention to
the significant differences that exist between refugee numbers in southern and
northern Europe. The second section of the chapter will focus on the mental
health needs of refugees, drawing on evidence of the mental health problems
experienced by this group and debates concerning diagnosis. This section
will include an examination of refugees’ mental health in the post-migration
context and evidence linking post-migration experiences with mental illness.
The third section will focus on the provision of mental health services for
refugees within Europe. This section will draw on work on good practices in
the mental health of refugees and will comment in particular on developments
in four European countries – the United Kingdom, the Netherlands, Spain
and Portugal – before drawing more general conclusions regarding the position
in Europe as a whole and the potential for disseminating good practice in
this area.
Migrants and refugees in a European context
The period between the middle of the twentieth century and the present time
has been referred to as the ‘age of migration’. Commentators have noted
that while historically people have crossed borders and settled in other lands
since time immemorial, the scale, global scope and social and economic consequences
of migration in the present age is unprecedented (Castles and Miller
2003). Of course, migration may occur for a variety of reasons. Historically,
millions of people have left their countries of origin or moved to different
regions to pursue a better life in other lands. The driving force behind this may
have been religious or political persecution or economic deprivation, or it may
have been a perception that a better standard of living was achievable elsewhere.
The interrelationship between factors that drive people from their
home countries and those that attract them to new ones is typically referred
to as ‘push/pull’, and the analysis of migration frequently focuses on this
interrelationship (Hollingfield 2000).
Castles and Miller (2003) have identified five ‘tendencies’ that characterize
migration in the early twenty-first century. The first is the ‘globalization of
migration’ in that migration affects a wide diversity of ‘receiving’ countries at the
same time. It is also globalized in the sense that countries of immigration may
receive a very wide diversity of migrants from different economic, social and
cultural backgrounds. Secondly, there is an acceleration of migration in that
migration has grown in volume in all the regions of the world. This is not to say
that certain types of migration cannot reduce from time to time. For example, at
the time of writing, there has been a notable decrease in the number of asylum
seekers entering the industrialized world (UNHCR 2004). However, as will be