No Solace For Asylum Seekers
The stereotypes that surround asylum seekers and refugees are well known, though of course not everyone believes them. Asylum seekers face potential discrimination in many aspects of their day-to-day lives, particularly from people who believe they are “fake” refugees, seeking benefits to which they are not entitled.
Media portrayal of asylum seekers and refugees has, in the past, occasionally also been unfair, but it is unclear whether this portrayal is the cause or the result of general discrimination towards the group.
According to the National Consultative Committee on Racism and Interculturalism (NCCRI), asylum seekers are housed in full-board accommodation in certain areas of the country and are not grouped together according to choice, religion or country of origin.
A common myth is that asylum seekers and refugees are given free housing and comfortable financial benefits. Adults receive an allowance of €19.10 per week, and children get €9.60. They are not, as has been reported, given money to buy cars, mobile phones, expensive clothing or alcohol.
The number of asylum seekers actually entering the country is also much lower than most people realise. Between 2001 and 2005, just 2 per cent of the 1,946,200 people seeking asylum in Europe came to Ireland. Applications have steadily declined since 2002.
Asylum seekers have traditionally had difficulties accessing healthcare, particularly GP, community and mental health services. This problem peaked when the numbers of refugees were at their highest a few years ago, but has not improved much since then.
Treating asylum seekers is no doubt a difficult area for GPs, especially when language barriers, an already increasing patient workload and cultural differences are taken into account. However, many GPs still do so, taking on what can be a difficult workload, and giving their extra time and effort.
Unfortunately, many GPs don’t do this, which can lead to an uneven spread of asylum seekers in certain areas, and a vulnerable patient group not getting the care they may need.
The language barrier, always perceived to be the biggest difficulty for GPs in treating asylum seekers, and non-nationals in general, is still a big problem. The Health Service Executive’s (HSE) interpretation services are not being used as much as they could be, and even with that service, the process can be confusing, time-consuming and unstructured.
Research conducted by Anne MacFarlane at the Department of General Practice at National University of Ireland Galway shows that many GPs have negative experiences of telephone interpretation services. She, along with colleagues in the department, asked 17 GPs and 26 asylum seekers in Galway about their experiences.
The GPs said contacting the interpretation service was time-consuming, and made the consultation with the patient longer. Many didn’t know how to source the service. None of the patients were attending a GP that used the interpretation service.
Many GPs also said they were concerned about discussing personal information with their patient in front of various family members, often present to translate for their mother, father or child.
The GPs also said, however, that communication problems with asylum seekers and refugees were much greater when they first started attending general practices, and that now communication is only a problem in difficult cases.
An unpublished survey of general practice service utilisation by asylum seekers compared to Irish citizens, again conducted by Ms MacFarlane at NUI Galway, showed that the asylum seekers studied had more consultations with GPs compared to Irish-born patients. They also had a five-fold higher chance of being diagnosed with psychiatric illnesses, particularly anxiety, and the research showed that there is a need for direct referrals to psychologists.
The impact of government-provided basic direct accommodation on asylum seekers, who are not permitted to work and who have no access to adult education or training, has been studied in other countries like the UK, where it caused depression and mental health problems.
Irish mental health experts have agreed with this. Dr Pat Bracken, a consultant psychiatrist in Cork, has spoken out about the issue in the past, saying the direct provision accommodation system could do as much long-term damage to asylum seekers’ mental health as the traumas that they left their country to escape.
The Irish College of General Practitioners (ICGP) has done major work in this area, publishing an extensive information pack in 2003, written by Dr Philip Crowley.
The college’s ‘GP Care in a Multicultural Society’ project ended in 2006, although the ICGP still supports GPs in this area.
Dr Hans Pieper, a GP in Galway, is the country’s first (and only) Fellow in Asylum Seeker and Refugee Healthcare. He works in NUI Galway and has just published an information pack for GPs, an updated version of the 2003 document, with more information on addressing the language barriers and the legal processes for asylum seekers.
The document was written from a Galway perspective, but some sections, particularly advice on writing medico-legal reports in cases where a GP is asked to do so for asylum seekers who may have been tortured, are relevant to all GPs. It is available on the website www.nuigalway.ie/dgp