Distress signals: Unaccompanied young people's struggle for mental health care

Unaccompanied young people fleeing war, persecution and other struggles take a range of difficult journeys to arrive in the UK, frequently experiencing issues such as violence, family breakdown, bereavement, exploitation and torture. Following their arrival in the UK, unaccompanied young people can continue to face significant barriers in achieving stability. This can result in mental ill-health, or exacerbate existing mental health issues that unaccompanied young people may have already been struggling with.
In consultation with key stakeholders, including 10 unaccompanied young people and 10 mental health and advocacy professionals that support unaccompanied young people, this report provides an overview of what is currently known about the mental health needs of unaccompanied young people living in England and Wales. It explores the barriers unaccompanied young people face in accessing mental health support and in receiving a good standard of care, once they are engaged in mental health support services. It then considers best practice models in providing adaptable and sensitive mental health support to unaccompanied young people.
The headline findings from this report are the following:

• The effects of the traumatic events that young people have faced prior to their arrival in the UK can continue to affect them for substantial periods of time through a range of symptoms, such as flashbacks, sleep disturbances, memory impairment, anger and disruptive behaviour, self-harm and even suicide.
• Once young people are in the UK, their mental health can deteriorate if they face barriers in settling their lives and their long-term prospects.
• Self-harm and suicide pose a grave risk for these young people, especially if they are not receiving holistic support. More needs to be done to understand these risks and the network of support that would help to combat them.
• The strengths and difficulties questionnaire (SDQ) – which is the most commonly used tool for identifying an unaccompanied young person’s need for mental health support once they arrive into care – is not identifying their mental health needs adequately. Our data analysis has found that, in spite of the acute mental health issues that unaccompanied young people might be facing, the average SDQ total difficulties score for looked after unaccompanied young people is low and suggests they would have little need for mental health support.
• Lack of awareness and training among paediatricians, GPs, social workers and other professionals working closely with young people lead hinder identification of mental health need among unaccompanied young people.
• Language used to communicate with unaccompanied young people about their mental health needs is often inadequate. This is due to insufficient translation facilities within services and lack of education about mental health issues with the young people themselves. In order to ensure that young people can fully communicate their needs, extensive support is required even after they have been referred into mental health support.
• Immigration and asylum processes to regularise unaccompanied young people’s immigration status in the UK are creating stress and mental health difficulties among young people.
• The Government policies that have created the Hostile Environment have made it more difficult for young people to access NHS services and education. Cuts to legal aid are also creating additional barriers for unaccompanied young people, which can create further mental health distress.

We have identified a number of key recommendations for stakeholders on a national and local level to help support the needs of unaccompanied young people, to improve their mental health. This includes:

• More comprehensive tools for assessing mental health need.
• Services that are better connected with young people’s communities.
• Providing guardians to represent the best interests of all unaccompanied young people.
• More effective leadership within support services to ensure that all agencies are communicating about young people’s needs.
• Targeted training to improve awareness and identification of need among the professionals that are working most closely with young people.
• Creating centres of excellence to share learning and good practice.
• Ensuring that young people are linked in with high quality advocacy services.
• Providing a range of adaptable resources to allow young people to communicate their mental health needs.
• Improving complex and traumatising immigration and asylum processes.
• Ensuring that holistic support is also available for young people that are arriving to be reunited with family members through the Dublin III process.

We have provided examples of effective working, where relevant.
The task ahead in improving access to mental health support for unaccompanied young people is complex, but not impossible. Improving availability of services and identification of unaccompanied young people’s needs will also help to develop support for young people from other vulnerable backgrounds. The risks of not developing this support for unaccompanied young people can create potentially grave outcomes, but effective leadership and sensitivity will help to secure young people’s lives and futures.