During our week as interns at the Helen Bamber foundation we got to observe and engage in their work. We got to see the services they provide and the importance of how they are organised. The following text is about what we learned about them. This week we got a lot of insight in how this charity works and what they offer to their clients. They work in a unique way with integrated care that stands out from the public offer in both the UK and Norway. The HBF works with asylum seekers who are victims of torture, gender-based violence, trafficking and or violence based on their sexual orientation. They coordinate multiple areas of expertise to provide the comprehensive help this group needs. They help to provide accommodation, financial and legal support and they offer physical, psychological and social care.
HBF uses integrated care in the treatment of asylum seekers with complex mental health problems. There is often a lot of stigma connected to having mental health problems, especially in immigrant communities. By giving other forms of support as well as treatment, one builds trust between the HBF and the client. With the stigma that comes with mental health, and many people thinking it isn’t something that can be helped, many often don’t seek treatment for their problems. Stable housing and getting help with their asylum appeals are however something that most people see as desired and necessary. By giving assistance when it comes to housing and residency status the HBF does three things. One, they help their clients gain the stability and safety in their day to day lives necessary for effective treatment. Two, gives people other, less socially stigmatised reasons to seek help. Three, strengthens the trust that the clients have to the HBF and their therapist, making it easier to share the traumas that they are harbouring.
The many positives of integrated care are very clear, but there are some challenges lying ahead if one wants to expand the number of people that are cared for under this model. HBF offices aren’t too big so it isn’t too hard to go and talk to someone who is working with the same client as you, just with a different aspect such as legal help. The problem comes when one wants to expand. The HBF has many formal mechanisms to try to keep the different parts of their work connected and working in unison, working with as whole of a picture of the client as they can get. They have their complex cases meeting, where they look at clients that are having problems of different types, informing and seeking guidance from the rest of the team on what can be done outside their own field of work. They also have the care plan meeting, where they discuss their approach to clients, what types of help they need and how to give them that help. Both these meetings serve the function of trying to work against fragmentation. The HBF has also recently hired a case coordinator whose work it is to see that the different departments are working well together and that problems are handled at the different levels they need to be.
To become a client at HBF you need to be referred on their webpage. You can refer yourself or someone you know can refer you. If they think you fit their profile you will get invited to a interview where they will get an idea off what you need from them. Later the team will get together to assess whether they are able to help you. Whom they can take on as clients is largely determined by their capacity. When someone becomes a client at HBF they start with an interview following a care plan meeting with all the different departments. They consider the urgency and need of the different areas of each client and plan what the following actions should be. This differs from client to client. When they evaluate, they use a scale from low too high to consider urgency. If elements of a client care are considered as “High urgency” it means that decisive resolving actions must be taken.
They offer every client the possibility to be reviewed every six months to see how everything is going. This conversation is an important gateway to all the other services they provide. They follow up on how everything is going with the client and use the urgency scale. This is a good place to get much needed information for the HBF to offer the best services. Here they evaluate with the client everything from how their accommodation is, how their legal process is going. If they are happy with the help they are given, if they are attending community group and what their everyday is like. This is also where they talk to the client about if they want and are ready to start trauma focused therapy. We had the opportunity to join in on one of the sixth month reviews. Many of their clients have been through difficult situations where they have been exploited and therefore given them reason to lose trust in other people. HBF can build that trust which is important so they can help their clients the best they can. Because HBF helps their clients with their materialistic needs they also get trusted with helping their psychological needs. This can be difficult also because it is a lot of stigma around mental illness in a lot of immigrant environments.
The HBF offers trauma focused therapy to help their clients which is struggling with psychological illness. During our stay we were told that the NHS was experiencing cuts in their funding for mental health services. As a result, there are long wait times for treatment. The treatment given by the NHS may not necessarily be long-term and may not meet all the needs of the clients, such as those who come to HBF. Many of the HBFs clients are victims of multiple traumatic experiences they often have complex presentations (such as complex PTSD), and thus need far more care and treatment than most. Some of HBFs clients may also struggle to access appropriate care from the NHS due to their immigration status.
We attended the complex cases meeting and it showed us how important it is that the organisation works like this. Every department is represented by the staff that is involved in the help with the specific client cases. These cases are the most difficult and complex in the sense that this care is usually reserved for hard to treat clients. In meetings they communicate what difficulties they are having and consul with each other on how to solve it in a good way. The people that work at HBF have different backgrounds and educations that make them see things from different perspectives. This is very useful when someone in the team is struggling to find a solution that helps the clients. HBF cooperates with different organisations. There are a lot of the clients of HBF that also are in contact with other organisations or systems and therefore it is important for them to also communicate if there is something that needs to be coordinated. Also, if there is something HBF does not provide they are in contact with organisations that can for example The Red Cross with does family tracing. This is something a lot of their clients wants.
The social health of immigrants is important. They are vulnerable to isolation due to multiple reasons such as not being in contact witch their families and friends, different culture, language barriers, struggling with mental illness and many other reasons. The community groups that HBF offers every week is very important for their client’s wellbeing. They have many different ones so there is something for everyone. We got to join in on one of the groups and could see up close the positive impact these groups can have. We did some relaxation exercises, arts and games. One of the assistant psychologists was sitting in a corner so clients could come talk to her privately if they wanted to. The community group give the clients the opportunity to relax and socialize in a safe environment. There were multiple volunteers that tried to make everybody feel seen and included. This group is a good opportunity for the clients to meet people in the same situation and build relations.
The main need for a charity doing the work that the HBF currently does comes in connection with the UK asylum system. The HBF uses their expertise from working with victims of torture and trafficking to write medical legal reports that bears witness to their stories of what they have experienced. This is useful for their clients in the court because things might be difficult to say, and it explains why some parts of the story might be repressed. Thus, very difficult to talk about in the adversarial context of a cross examination. One of the practices that the HBF has been working to end has been the Detained-Fast Track (DFT) procedure for asylum seekers. This procedure has been suspended since July 2015 after legal challenges and critiques levelled at it from the HBF and other charities and foundations working in the same field. When a claim was considered suitable for DFT the asylum seeker would be placed in detention immediately. On paper the reason for having the DFT was to expedite the process of appeals and getting the asylum claim processed faster. Throughout the appeals process the person would be detained, something that was very detrimental for people with the types of mental health problems the HBF helps.
The medical legal report is one of the most important ways the HBF helps their clients in their meetings with the UK Home Office. The medical legal report is written by medical personnel for the non-medical professionals that will read it, typically to inform a court decision. It includes a point for point biography of the asylum seekers life, focusing on the traumatic events that are the cause of them needing asylum. Based on this biography and psych assessments, an expectation of the claimant's presentation in court is presented. Explaining based on their mental state how one should expect them to present in court. It also includes the medical professional's opinion on the fitness of the claimants in connection with detention, giving through testimony. It also includes the medical personnel opinion on the consequences of deportation, both based on safety and for example in the cases of PTSD the availability of treatment in the home country. Also, if the PTSD triggers are for example connected with places and or smells that would be impossible to avoid in the case of deportation.
This charity is small and get its funding from different grants. They decline support from the government because they disagree in the way they treat asylum seekers and are often debating this. Without the financial support and the volunteering, they would not be able to offer what they are. Whilst the HBF doesn’t accept money from the UK government as a matter of principle they are still very willing to help both the NHS and other government services better themselves in their treatment of asylum seekers who have been exploited. They help with training of staff that are in direct contact with this group. They help people to better know how to help people that they meet that might be victims of trafficking. They also try to spread their method of integrated care that the HBF uses to help their clients into other parts of the support apparatus in the UK.
We want to thank the Helen Bamber Foundation for showing us their organisation and for the great and necessary work they do.