Understanding the role of place in refugee mental health to inform policy

Refugees embarking on their journey to establish new lives in Global North countries often find themselves navigating a convoluted process characterised by limited choices regarding their place of residence. This lack of agency becomes particularly pronounced for asylum seekers, who are vulnerable due to their uncertain legal status but, even those who are granted refugee status, frequently experience relocations at short notice, which can disrupt their newly acquired sense of stability.  

Central to the recent changes in UK immigration policy is the rhetoric surrounding ‘safe and legal routes,’ encompassing asylum pathways such as family reunification, community sponsorship, and resettlement schemes. Although these pathways seemingly assure a path to refuge in the UK, the discourse of ‘safe and legal routes’ has served as a justification for the UK’s intensified border control, resulting in restricted access to safe places of living for those in dire need of sanctuary.

Paradoxically, it seems the initiatives advertised to provide secure and stable living environments for refugees have resulted in inherent residential instability. For example, a closer look at specific resettlement schemes, such as the ‘Afghan Citizen Resettlement Scheme,’ ‘Ukraine Family Scheme,’ and ‘Homes for Ukraine,’ shows that, despite the initial promise, these initiatives have faced hurdles concerning longevity, financial viability, social integration, and living conditions.

The dissonance between the intended objectives of these schemes and their actual outcomes raises questions about their effectiveness in ensuring the wellbeing and mental health of those they aim to support. And if they are considering the impact of factors such as place as much as they should.

Importance of place: insight from research

In our research and through our network we are studying the importance of place in refugee mental health with the aim of informing decision makers and providing insight into future policies. Recently we reviewed existing research on the relationship between place and refugee mental health which revealed some critical findings in the light of current policy.

Importantly the physical and material characteristics of the environment can significantly influence mental health and wellbeing. Safe and socially meaningful environments can have therapeutic effects, reduce loneliness, and mitigate homesickness, depression and trauma which has been embedded from experiences before migration. In contrast, ill-equipped facilities, isolated and unwelcoming environments hinder good mental health and wellbeing.

A poignant case in point is the recent proposal to house asylum seekers on the Bibby Stockholm barge. Despite legitimate concerns regarding fire safety and other factors, a small number of individuals were relocated from hotels to the barge, only to be evacuated shortly thereafter due to the detection of Legionella traces in the water system. This indicates an under estimation by decision makers of how important it is for refugee mental health to be placed in a safe, welcoming and well-equipped environment without health hazards.

Place-specific social determinants of refugee mental health including employment opportunities, location of residence, and meaningful daily activities contribute to mental health and perceived quality of life. In contrast, residential instability and mobility amplify the risk of poor mental health outcomes, particularly affecting vulnerable groups such as women and children. Sadly, the temporary accommodation of Afghan refugees in hotels and the uncertainties surrounding Ukrainian resettlement schemes have led to experiences of transience and insecurity. More long-term strategic thought is needed to prevent these outcomes and the consequences they have for refugee mental health.

Long-term integration strategies for refugees, that are embedded within local environments, are of key importance. Likewise, refugees benefit from settling in areas with access to their cultural communities. Ethnic density and diversity in conjunction with refugee support networks play pivotal roles in how settlement locations shape everyday life. Current dispersal policy can relocate asylum seekers away from their social networks and to relatively isolated areas with low rates of ethnic diversity which can result in isolation and discrimination during the crucial time of settlement.

Lastly, neighbourhood violence and disorder affect refugee mental health. Exposure to physical and verbal violence and threats to safety and personal integrity due to factors such as discrimination can increase the likelihood of post-migration trauma. The current socio-political climate and anti-immigration sentiments add further complexity to these findings.

Enabling voices to be heard and actions to be taken

The insights garnered from our scoping review highlight the urgent need for further research and evidence to address the challenges posed by immigration policies and their impact on refugees' mental health and wellbeing. This is not merely an academic exercise and the implications of these findings can be seen in many of the current policies which need addressing.

Already our research is helping those working in this field to provide evidence to support their proposals and initiatives. As a legal organiser at a charity that supports asylum seekers and refugees recently stated about Bibby Stockholm:

“I think now that the Home Office has implemented full dispersal policy the issue is not just about the barge, but the way people are moved around everywhere and there's nothing in the policy to consider this and I think more research and evidence around this would be really important going forward.”

Our scoping review has informed their witness statement against the use of Bibby Stockholm barge to house asylum seekers but much more needs to and can be done.

Acknowledging the central role of place in refugees' experiences, past traumas, and future prospects is essential. As we attempt to move forward, considering the centrality of place for refugees becomes crucial to envisioning a future where their agency is respected, their hardships acknowledged with empathy, and their lives are dignified.