Traumatised migrants deserve adequate care
Europe is experiencing unprecedented mass migration stemming from the unsettled state of many African and Asian countries.
According to the Minister for Justice, the relocation of some 40,000 of the 150,000 who are fleeing war and poverty into the Mediterranean region, will begin later this year. Ireland has pledged to accept around 600 of these in September as part of this process.
Even in the past weeks the crisis has deepened as many have made their way to Calais from which they are trying to make the short crossing on foot, via the Tunnel to England. Most of these migrants have fled by boat from their home countries and many face death as they are trafficked in unsafe crafts out of Africa, mainly to Italy and Greece. Some 700 drowned in April as they fled from Libya to Italy.
It is absolutely, morally right that we should provide assistance to people in such circumstances and at one point in the 90s and noughties we were accepting 12,000 per year.
Regrettably, many of these people suffer with psychiatric illness. There are a number of reasons why migrants have an increased risk of a range of mental illnesses, including depression, anxiety, post-traumatic stress disorder (PTSD) and psychoses such as schizophrenia.
There are few stressors in life as enormous as the experience of migration. It is a psycho-social process of change and loss. The losses may include loss of family and friends, relinquishment of one's job and of one's status, termination of contact with the person's ethnic group and often the loss of one's language.
The changes the person has to undergo involves not simply moving to a new country and adapting to a new population with its own attitudes and habits, but coping with the reception and legal process in the host country, usually in an unfamiliar tongue.
Considering the three stages of migration - planning, migration and adaptation to life in a new country - it is obvious that each step has its own danger points.
When an individual decides to immigrate for work or education, the move is planned. With asylum-seeking migrants, this usual organisation is unlikely since the decision to leave often happens suddenly when a community is under siege.
There may be a sudden rupturing of the family and community with little optimism of ever returning, particularly when the person is leeing from persecution.
There may be events such as attacks, torture or witnessing these that ignite the decision to flee and that also increase the risk of traumatic stress.
On the other hand, if there is mass migration, the fact of having the support of one's ethnic group may provide some buffer at that point.
The journey is often long and hazardous, with many experiencing malnutrition or physical illness en route and with little by way of medical help available. Some may witness the death of those they have befriended while travelling and hunger and cold are further difficulties.
These problems may then be compounded by difficulties faced in the host country including problems with documentation, difficulties finding employment and experiencing racism.
A further and less-obvious stressor for new arrivals relates to the type of culture. Migrants' sense of alienation and estrangement may be heightened if they have lost their cultural identity and are forced to acculturate into the values and language of the majority community.
This may occur when individuals have moved from a socio-centric to an ego-centric culture. In other words, relocating from societies where the community ties are very strong to those where the focus is on the individual may be extremely burdensome.
Those who maintain links with their own ethnic, religious and linguistic group are protected but the host country also has a key role in recognising the need for this vulnerable group to have a continuing connectedness to their own culture while also welcoming them to the local community.
Depression, PTSD, suicide and psychosis have all been shown to be higher in migrants. The recent pattern of migration, however, seems to be uniquely traumatising by comparison with other population movements in modern times.
The multiple and severe stressors that migrants are exposed to pursue in search of a better life has been called Chronic and Multiple Stress Syndrome (the Ulysses Syndrome) in likeness to the odyssey of the mythical Greek character in his long voyage through the Mediterranean.
Most psychiatrists in Ireland have dealt with such complex traumas in recent years and we have learned as we went along. Perhaps the time has come for some forward planning by the Departments of Justice and of Health so that we can be adequately equipped, in terms of our training and our resources, to provide the treatments that these displaced individuals so desperately need.
Our mental health services are grossly under-resourced and will crumble if we are not suitably resourced to deal with the influx of severely traumatised people that is about to begin.
Health & Living