MD(Res) Scholarship 2020: Lauren Warterman; King's College London
Project Title: From Immigration Detention Centres into the Community: Health, Coping and Unmet Needs of Formerly Detained Migrants
Start Date: February 2020
Supervisors and Mentors: Dr Rosie Mayston, Professor Martin Price, Professor Cornelius Katona, Dr Jessica Potter, Dr Andrew Forrester
Summary of the Research:
The UK detains three times more people in Immigration Removal Centres (IRCs) than any other European country, whilst they await deportation or permission to remain in the country. Detention in IRCs is known to cause severe health consequences for asylum seekers and other migrants, a population of people already vulnerable to psychiatric illness and with complex physical health needs. Nearly two-thirds of those detained are subsequently released into the community, often suddenly. National bodies and government commissioned reports have expressed grave concerns about the lack of safe continuity of care after release. Little research has explored the experiences of people following release from immigration detention into the community.
To explore migrants’ experiences of the transition from detention to release, including: physical and mental health, barriers to and facilitators of healthcare access, perceived support, social stressors, and coping.
To identify unmet health and social needs during this transition period.
To explore which healthcare or charity sector services were deemed beneficial by recipients, and what additional supports may be beneficial.
To explore the barriers and facilitators to providing effective care, including continuity of care, from the perspectives of policy-makers, service providers, frontline healthcare and charity sector staff and ex-detainees.
To make recommendations for policy development to improve continuity of healthcare and psychosocial support following release from IRCs, and for further research in this field.
1) A systematic review and narrative synthesis of qualitative research will be conducted, exploring how immigration detention contributes towards psychological symptoms and mental illness in migrants.
2) Qualitative research interviews with migrants previously detained in UK IRCs will explore their experiences of transition from detention to release into the community and their views about how their health and social needs might be better supported during this time. Interviews and focus groups with charitable sector workers, healthcare workers and service providers will review the challenges that arise when supporting ex-detainees’ health and social needs. The data collected will be analysed to identify emerging themes.
3) Additionally, an audit of IRC healthcare records will be conducted, with a particular focus on mental health screening and planning for continuity of care.
4) The findings from the above three studies will be synthesised and presented to a panel of stakeholders, including experts by experience.
5) We will then use Theory of Change workshops - an approach that connects key stakeholders to identify priority outcomes and pathways to achieving these.
6) Findings from the qualitative research and recommendations from these workshops will be disseminated to stakeholders via presentations, articles and reports. Parliamentary dissemination will be a priority.
Patient and Public Involvement:
This research has been co-developed and will be delivered with active stakeholder involvement. At every stage we are collaborating with experts by experience from campaigning group Freed Voices who have previously experienced detention in IRCs. One expert by experience is a co-applicant and will be involved in interviewing participants and data analysis. In response to stakeholder input, the aims were refined with greater focus on post-detention continuity of care, an issue considered critical.
I am an ST4 in General Adult Psychiatry on the Maudsley Training Programme and an NIHR Academic Clinical Fellow. I am undertaking a part-time MD(Res) programme as I am equally passionate about both clinical work in psychiatry and research. I am particularly interested in investigating how the health inequalities experienced by refugee and migrant populations might be reduced, in the UK and other high-income countries, especially for those who have been detained in immigration detention centres. Little previous research has focused on migrants’ experiences of continuity of health and social care following release from immigration detention, or on the barriers to providing effective continuity of care. Therefore, I have been developing a research project that will investigate and explore the impact of immigration detention on the mental health and wellbeing of migrants, both during detention and during the transition period following release from detention, with a goal of discovering ways in which migrants’ health could be better supported. I have been awarded the Lindsay Bequest and Reid Trust Award 2019 by the Royal College of Physicians of Edinburgh to help to fund this research.
For many years, I have been volunteering with charities which support asylum seekers and migrants, which has also enabled me to foster important professional relationships with experts working in the field and with members of the public who are experts by experience. I volunteer at the Asylum Seeker Drop-In in London (where I lead the medical service) and have also written medico-legal reports for asylum seekers to support them with their asylum claims. I am a member of the European Federation of Psychiatric Trainees (EFPT) ‘Psychiatry Across Borders’ working group and of the RCPsych’s Working Group on the Health of Refugees and Asylum Seekers. I have recently published articles in the British Medical Journal and British Journal of Psychiatry Bulletin providing advice to NHS staff about how to assess and treat asylum seekers and undocumented migrants. For more information about my previous work, please visit https://orcid.org/0000-0002-9963-4008
I am fortunate to be supervised and mentored by a fantastic team of experts in forensic psychiatry, anthropology, epidemiology, migrant health and mixed methods research, and to be working with some amazing experts by experience. I am delighted to have been awarded the Mental Health Research UK MD(Res) award to support me with conducting this work and developing my research expertise.
Progress Report year1, 2021
I have continued to work closely with experts by experience in planning the research. I have also made some progress with the plans for my systematic review and with my thesis, such as learning about the differences between systematic review methodologies and I have written a few thousand words on the evidence behind some of these methodologies and which factors led me to chose one methodology over the other. I have found that writing sections of my thesis as I go, rather than leaving these until the end, is a more efficient and effective way of working. I have finalised the plan for the methodology and registered the project on POSPERO.
I have also applied for and taken up other roles that will contribute significantly to my academic learning. This month, I became the Praxis Section Editor of the BJPsych Bulletin Journal. I was also successful in an application for an HEE-funded Population Health Fellowship which will last for one year part-time and provide me with training in public/population health skills. These skills will be extremely useful for my MD(Res) research project. I am continuing to work with the Royal College of Psychiatrists (RCPsych) Working Group for the Health of Asylum Seekers and Refugees, and we published a Position Statement on behalf of the Royal College on the use and consequences of immigration detention. I am also involved in organising an RCPsych study day on asylum seeker mental health which will take place this October 2021.
I have attended a number of virtual courses, hosted by LISS and by King’s College London. These included courses on academic writing, public and patient engagement, creating impact, social media skills, philosophy of the social sciences, law and society, research budget costings and Freedom of Information requests.
I would like again to thank Mental Health Research UK and all their donors for their support.