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Mental health morbidity among people subject to immigration detention in the UK: a feasibility study

Published online by Cambridge University Press:  22 June 2017

P. Sen ,
J. Arugnanaseelan ,
E. Connell ,
C. Katona ,
A. A. Khan ,
P. Moran ,
K. Robjant ,
K. Slade ,
J. Tan  and
K. Widyaratna
...Show all authors
P. Sen*
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
J. Arugnanaseelan
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
E. Connell
Affiliation:
Oxleas NHS Foundation Trust, London, UK
C. Katona
Affiliation:
Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF, UK
A. A. Khan
Affiliation:
Oxleas NHS Foundation Trust, London, UK
P. Moran
Affiliation:
Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol BS8 2BN, UK
K. Robjant
Affiliation:
Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF, UK
K. Slade
Affiliation:
Division of Psychology, Rm 4113 Chaucer Building, Nottingham Trent University, Nottingham, NG1 4BU, UK
J. Tan
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
K. Widyaratna
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
J. Youd
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
A. Forrester
Affiliation:
Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, 2.304 Jean McFarlane Building, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
*
*Address for correspondence: Dr P. Sen, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK. (Email: piyal@freeuk.com)
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Abstract

Aims.

The UK has one of the largest systems of immigration detention in Europe.. Those detained include asylum-seekers and foreign national prisoners, groups with a higher prevalence of mental health vulnerabilities compared with the general population. In light of little published research on the mental health status of detainees in immigration removal centres (IRCs), the primary aim of this study was to explore whether it was feasible to conduct psychiatric research in such a setting. A secondary aim was to compare the mental health of those seeking asylum with the rest of the detainees.

Methods.

Cross-sectional study with simple random sampling followed by opportunistic sampling. Exclusion criteria included inadequate knowledge of English and European Union nationality. Six validated tools were used to screen for mental health disorders including developmental disorders like Personality Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Autistic Spectrum Disorder (ASD) and Intellectual Disability, as well as for needs assessment. These were the MINI v6, SAPAS, AQ-10, ASRS, LDSQ and CANFOR. Demographic data were obtained using a participant demographic sheet. Researchers were trained in the use of the screening battery and inter-rater reliability assessed by joint ratings.

Results.

A total of 101 subjects were interviewed. Overall response rate was 39%. The most prevalent screened mental disorder was depression (52.5%), followed by personality disorder (34.7%) and post-traumatic stress disorder (20.8%). 21.8% were at moderate to high suicidal risk. 14.9 and 13.9% screened positive for ASD and ADHD, respectively. The greatest unmet needs were in the areas of intimate relationships (76.2%), psychological distress (72.3%) and sexual expression (71.3%). Overall presence of mental disorder was comparable with levels found in prisons. The numbers in each group were too small to carry out any further analysis.

Conclusion.

It is feasible to undertake a psychiatric morbidity survey in an IRC. Limitations of the study include potential selection bias, use of screening tools, use of single-site study, high refusal rates, the lack of interpreters and lack of women and children in study sample. Future studies should involve the in-reach team to recruit participants and should be run by a steering group consisting of clinicians from the IRC as well as academics.

Keywords

Discriminationepidemiologyhealth service researchmaltreatmentminority issues and cross-cultural psychiatry
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 6 , December 2018 , pp. 628 - 637
Copyright
Copyright © Cambridge University Press 2017 

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References

Aas, KJ, Bosworth, M (2013). The Borders of Punishment: Migration, Citizenship and Social Exclusion. Oxford University Press: Oxford.Google Scholar
Allison, C, Auyeung, B, Baron-Cohen, S (2012). Toward brief ‘Red flags’ for autism screening: the short autism spectrum quotient and the short quantitative checklist in 1000 cases and 3000 controls. Journal of the American Academy of Child and Adolescent Psychiatry 51, 202–212.Google Scholar
Berger, D, Abbasi, K (2015). Refugees: time for moral leadership from the Western democracies. British Medical Journal 350, 7.Google Scholar
Birmingham, L, Mason, D, Grubin, D (1997). Health screening at first reception into prison. Journal of Forensic Psychiatry 8, 435–439.Google Scholar
Bosworth, M (2008). Immigration detention. Criminal Justice Matters 71, 24–25.Google Scholar
Bosworth, M (2012). Subjectivity and identity in detention: punishment and society in a global age. Theoretical Criminology 16, 123–140.Google Scholar
Brooke, D, Taylor, C, Gunn, J, Maden, A (1996). Point prevalence of mental disorder in unconvicted male prisoners in England and Wales. British Medical Journal 313, 1524–1527.Google Scholar
Brugha, T, Cooper, SA, McManus, S, Purdon, S, Smith, J, Scott, FJ, Spiers, N, Tyrer, F (2012). Estimating the Prevalence of Autism Spectrum Conditions in Adults: Extending the 2007 Adult Psychiatric Morbidity Survey. Retrieved 20 March 2017 from http://content.digital.nhs.uk/catalogue/PUB05061/esti-prev-auti-ext-07-psyc-morb-surv-rep.pdf.Google Scholar
Curtice, MJ, Exworthy, T (2010). FREDA: a human rights-based approach to healthcare. Psychiatrist 34, 150–156.Google Scholar
Das, D, Cherbuin, N, Butterworth, P, Anstey, KJ, Easteal, S (2012). A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults (ADHD Symptoms in middle-aged adults). PLoS ONE 7, e31500.Google Scholar
Department of Health, HM Prison Service, & The National Assembly of Wales (2001). Changing the Outlook: A Strategy for Developing and Modernising Mental Health Services in Prisons. Retrieved 20 March 2017 from http://webarchive.nationalarchives.gov.uk/20130107105354/ http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4034228.pdf.Google Scholar
Fazel, M, Wheeler, J, Danesh, J (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet 365, 1309–1314.Google Scholar
Fazio, RL, Pietz, CA, Denney, RL (2012). An estimate of the prevalence of autism-spectrum disorders in an incarcerated population. Open Access Journal of Forensic Psychology 4, 69–80.Google Scholar
Fok, M, Hotopf, M, Stewart, R, Hatch, S, Hayes, R, Moran, P (2013). Personality disorder and self-rated health: a population-based cross-sectional survey. Journal of Personality Disorders 28, 319–333.Google Scholar
Forrester, A, Valmaggia, L, Taylor, P (2016). Healthcare services in police custody in England and Wales: recent government U turn leaves police healthcare adrift from the NHS. British Medical Journal 353, i1994.Google Scholar
Forrester, A, Singh, J, Slade, K, Exworthy, T, Sen, P (2014). Mental health in- reach in an urban UK remand prison. International Journal of Prisoner Health 10, 155–163.Google Scholar
Ginsberg, Y, Hirvikoski, T, Lindefors, N (2010). Attention deficit hyperactivity disorder (ADHD) among longer-term prison inmates is a prevalent, persistent and disabling disorder. BMC Psychiatry 10, 112.Google Scholar
Grant-Peterkin, H, Schleicher, T, Fazel, M, Majid, S, Robjant, K, Smith, G, Katona, C (2014). Inadequate mental healthcare in immigration removal centres. British Medical Journal 349, g6627.Google Scholar
Griffiths, M (2013). Living with uncertainty: indefinite immigration detention. Journal of Legal Anthropology 1, 263–286.Google Scholar
Hallas, P, Hansen, A, Stæhr, M, Munk-Andersen, E, Jorgensen, H (2007). Length of stay in asylum centres and mental health in asylum seekers: a retrospective study from Denmark. BMC Public Health 7, 288.Google Scholar
Heeren, M, Mueller, J, Ehlert, U, Schnyder, U, Copiery, N, Maier, T (2012). Mental health of asylum seekers: a cross- sectional study of psychiatric disorders. BMC Psychiatry 12, 114.Google Scholar
Herald Scotland (2015). 28-day Immigration Detention Time Limit Rejected by Government. Retrieved 20 March 2017 from http://www.heraldscotland.com/news/homenews/14115795.28_day_immigration_detention_time_limit_rejected_by_Government/.Google Scholar
Home Office (2015). Mental Health Issues in Immigration Removal Centres: Tavistock Institute Review. Retrieved 20 March 2017 from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/402205/tavistock_response.pdf.Google Scholar
Keller, AS, Rosenfeld, B, Trinh-Shevrin, C, Meserve, C, Sachs, E, Leviss, JA, Singer, E, Smith, H, Wilkinson, J, Kim, G, Allden, K, Ford, D (2003). Mental health of detained asylum seekers. Lancet 362, 1721–1723.Google Scholar
Kessler, RC, Adler, L, Ames, M, Demler, O, Faraone, S, Hiripi, E, Howes, MJ, Jin, R, Secnik, K, Spencer, T, Ustun, TB, Walters, EE (2005). The World Health Organization adult ADHD self- report scale (ASRS): a short screening scale for use in the general population. Psychological Medicine 35, 245–256.Google Scholar
Lawlor, D, Sher, M, Stateva, M (2015). Mental Health Issues in Immigration Removal Centres. Tavistock Institute Review. Retrieved 20 March 2017 from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/402204/tavistock_institute_report_final.pdf.Google Scholar
McCarthy, J, Underwood, L, Hayward, H, Chaplin, E, Forrester, A, Mills, R, Murphy, D (2015). Autism spectrum disorder and mental health problems among prisoners. European Psychiatry 30(Suppl. 1), 864.Google Scholar
McGinley, A, Trude, A (2012). Positive Duty of Care? The Mental Health Crisis in Immigration Detention. A Brief Paper by the Mental Health in Immigration Detention Project. Retrieved 30 November 2015 from aviddetention.org.uk.Google Scholar
McKenzie, K, Paxton, D (2006). Promoting access to services: the development of a new screening tool. Learning Disability Practice 9, 17.Google Scholar
McKenzie, K, Michie, A, Murray, A, Hales, C (2012). Screening for offenders with an intellectual disability: the validity of the learning disability screening questionnaire. Research in Developmental Disabilities 33, 791–795.Google Scholar
Momartin, S, Steel, Z, Coello, M, Aroche, J, Silove, DM, Brooks, R (2006). A comparison of the mental health of refugees with temporary versus permanent protection visas. Medical Journal of Australia 185, 357–361.Google Scholar
Moran, P, Leese, M, Lee, T, Walters, P, Thornicroft, G, Mann, A (2003). Standardised assessment of personality – abbreviated scale (SAPAS): preliminary validation of a brief screen for personality disorder. British Journal of Psychiatry 183, 228–232.Google Scholar
Nielsen, F, Ziegenbein, M, Sieberer, M (2014). Prevalence of borderline personality disorder in immigrants in a psychiatric inpatient setting. Australian and New Zealand Journal of Psychiatry 48, 488–488.Google Scholar
Pascual, JC, Malagón, A, Córcoles, D, Ginés, JM, Soler, J, García-Ribera, C, Pérez, V, Bulbena, A (2008). Immigrants and borderline personality disorder at a psychiatric emergency service. British Journal of Psychiatry 193, 471–476.Google Scholar
Pickles, H, Hartree, N (2013). Transferring healthcare for immigration detainees in England to the NHS. British Medical Journal 346, 6.Google Scholar
Pluck, G, Brooker, C (2014). Epidemiological survey of suicide ideation and acts and other deliberate self-harm among offenders in the community under supervision of the Probation Service in England and Wales. Criminal Behaviour and Mental Health 24, 358–364.Google Scholar
Prison Reform Trust (2014). Prison: The Facts. Bromley Briefings Summer.Google Scholar
Procter, NG, De Leo, D, Newman, L (2013). Suicide and self-harm prevention for people in immigration detention. Medical Journal of Australia 11, 730–732.Google Scholar
Ramsbotham, D (1996). Patient or prisoner? A new strategy for health care in prisons. HM Inspectorate of Prisons for England and Wales. HMSO.Google Scholar
Rivlin, A, Hawton, K, Marzano, L, Fazel, S (2010). Psychiatric disorders in male prisoners who made near- lethal suicide attempts: case-control study. British Journal of Psychiatry 197, 313–319.Google Scholar
Robinson, L, Spencer, MD, Thomson, LDG, Stanfield, AC, Owens, DGC, Hall, J, Johnstone, EC (2012). Evaluation of a screening instrument for autism spectrum disorders in prisoners (autism spectrum disorders in prisoners). PLoS ONE 7, e36078.Google Scholar
Robjant, K, Hassan, R, Katona, C (2009 a). Mental health implications of detaining asylum seekers: systematic review. British Journal of Psychiatry 194, 306–312.Google Scholar
Robjant, K, Robbins, I, Senior, V (2009 b). Psychological distress amongst immigration detainees: a cross-sectional questionnaire study. British Journal of Clinical Psychology 48, 275–286.Google Scholar
Royal College of Psychiatrists (2013). Position Statement on Detention of People with Mental Disorders in Immigration Removal Centres. Retrieved 20th March 2017 from http://www.rcpsych.ac.uk/pdf/Satisfactory20Treatment20in20Detention20document20March202014%20edit.pdf.Google Scholar
Sen, P (2016). The mental health needs of asylum-seekers and refugees-challenges and solutions. British Journal of Psychiatry International 13, 30–32.Google Scholar
Sen, P, Exworthy, T, Forrester, A (2014). Mental health care for foreign national prisoners in England and Wales. Journal of Mental Health 23, 333–339.Google Scholar
Shaw, S (2016). Review into the Welfare in Detention of Vulnerable Persons: A Report to the Home Office.Google Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59 (Suppl. 20), 22–33.Google Scholar
Singleton, N (1998). Psychiatric Morbidity Among Prisoners in England and Wales. Stationery Office: London.Google Scholar
Steel, Z, Silove, D, Brooks, R, Momartin, S, Alzuhairi, B, Susljik, I (2006). Impact of immigration detention and temporary protection on the mental health of refugees. British Journal of Psychiatry 188, 58.Google Scholar
Stumpf, J (2006). The crimmigration crisis: immigrants, crime, and sovereign power. American University Law Review 56, 367–419.Google Scholar
Taylor, D (2016). Suicide Attempts at UK Immigration Removal Centres at All-time high. The Guardian, 4th April, 2016. Retrieved 25 March 2017 from https://www.theguardian.com/uk-news/2016/apr/04/suicide-attempts-uk-immigration-removal-centres-all-time-high-home-office-figures.Google Scholar
Teather, S (2015). The Report of the Inquiry into the Use of Immigration Detention in the United Kingdom. Retrieved 20 March 2017 from https://detentioninquiry.files.wordpress.com/2015/03/immigration-detention-inquiry-report.pdf.Google Scholar
Thomas, SDM, Slade, M, Mccrone, P, Harty, M, Parrott, J, Thornicroft, G, Leese, M (2008). The reliability and validity of the forensic Camberwell Assessment of Need (CANFOR): a needs assessment for forensic mental health service users. International Journal of Methods in Psychiatric Research 17, 111–120.Google Scholar
Tyrer, P, Merson, S, Onyett, S, Johnson, T (1994). The effect of personality disorder on clinical outcome, social networks and adjustment: a controlled clinical trial of psychiatric emergencies. Psychological Medicine 24, 731–740.Google Scholar
UK Home Office (2015). Immigration statistics, July to September 2015.Google Scholar
Wilsher, D (2011). Immigration Detention: Law, History and Politics. Cambridge University Press: Cambridge.Google Scholar
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