Mental health policy and practice across Europe: an overview

366 Mental health policy and practice
but also by the opportunities offered within the prevailing policies on asylum
and immigration. Commenting on the situation in France, Fassin has pointed
to a significant decrease over the past ten years in the number of claims for
refugee status being accepted while, at the same time, there has been a sevenfold
increase in the number of people receiving leave to remain on the basis of
humanitarian concerns relating to ill health (Fassin 2001). One of the few routes
to legitimacy available is through ill health. Fassin concludes from this that
‘Thus greater importance is ascribed to the suffering body than to the threatened
body, and the right to life is being displaced from the political to the
humanitarian arena’ (p. 4). Elsewhere, this argument has been extended to refer
to a process of ‘strategic categorization’ wherein medical professionals may
highlight refugees’ health problems as they provide one of a limited range of
‘avenues of access’ to health and social care benefits (Watters 2001b). This is not
to imply that professionals are wilfully exaggerating the mental health problems
faced by some refugees. It is rather to suggest that, in a context where a
refugee may have a range of problems relating to health, mental health and
social care, some of these may enhance the refugee’s case and may be duly
emphasized. It is thus important that researchers examining the mental health
of refugees in Europe are aware of the social and legal context of diagnosis and
treatment.
Mental health services for refugees in Europe
In undertaking an examination of the mental health care of refugees in Europe
one is immediately struck by the difficulties in mapping the field. In some
countries with large, or relatively large, numbers of asylum seekers and refugees,
mental health services are closely integrated into the systems established for
processing asylum claimants. In others, there is very little planning or management
and considerable variation in the quantity and quality of care from city
to city, region to region. Many of the problems in mental health care provision
are common to those experienced by migrant and settled minority
ethnic communities across Europe. Six characteristics of these services are: a
lack of monitoring and evaluation; a ‘bottom up’ unplanned approach resulting
in considerable variability in service availability and quality; an absence of
consultation with service users; poor access to appropriate counselling services;
presence of racial discrimination in some services; and poor quality and
quantity of staff training (Watters 2002).
It is useful to consider these features in the light of international recommendations
for service provision in this area. The 2001 World Health Report
highlights the specific needs of refugees and internally displaced persons. They
are identified as a vulnerable group with ‘special mental health needs’. The
report identifies the importance of a holistic approach in stipulating that mental
health policy ‘must deal with housing, employment, shelter, clothing and
food, as well as the psychological and emotional effects of experiencing war,
dislocation and the loss of loved ones’. The report adds that in this area, ‘community
intervention should be the basis for policy action’ (WHO 2001: 83). An
earlier manual produced by the World Health Organization (WHO), and which