I am a mental health worker in the public system, providing practical support and psychological therapy to refugees and asylum seekers with Post Traumatic Stress Disorder (PTSD). The vast majority of the people seen at the services I work in have been tortured or have gone through similarly horrific experiences, such as having a family member killed in front of them and being threatened with being killed themselves. Interestingly, we’ve rarely had a client put into immigration detention. I would guess that this is due to it typically taking many years for people to get to the ‘right’ service for them within the mental health system. This is even more so for our clients, who may be isolated by language barriers, lack of knowledge of the health care system, stigma about seeking mental health help and numerous other issues.
So earlier this year when one of my clients was detained, it was interesting to watch how everyone in my team was taken aback by this occurring, especially knowing that this client was a torture survivor. Over the next couple of months, they supported me so that I could support my client through his confusing and dark days of again – for the third time in barely a year— being in immigration detention. For him, like so many others, his detention had no time limit other than the theoretical ‘deadline’ of when the Home Office would organise his deportation, or if he was fortunate enough, the day he would to be granted bail.
Detaining and holding people who have come through such horrific experiences, who have been through so much to get to this country in search of safety, often simply re-traumatises them. This can worsen their mental health, impede their chances of a decent recovery which would enable them to lead a productive adult life, and keep them literally re-living the horror that caused them to flee in the first place.
Research into the mental health of immigration detainees supports this. A review of studies of detainees (in the UK, Australia and the US) found consistently high levels of mental health distress among detainees, particularly depression, anxiety, post-traumatic stress, suicidal ideations and self-harm. Findings indicated this was particularly the case for people who were already struggling with mental health difficulties prior to detention. Additionally, the more time spent in detention, the higher the distress. Once released, individuals’ mental health symptoms tended to improve; however, those having longer detention periods had worse outcomes even years later. Other research (in the Netherlands, which has a similar asylum process to the UK) found that the longer the asylum process – which often brings more chances of being detained – the higher the risk of having psychological/psychiatric problems; and that an extended asylum process was a stronger indicator of mental health difficulties than previous traumatic experiences.
Ironically, then, the current immigration process and immigration detention parts of ‘the system’ impact unhelpfully on many other parts of ‘the system’. People often do end up getting their asylum or some sort of leave to remain granted, which means they could move on to work and all the things thought of as being ‘a good citizen’. But that then doesn’t always happen. The damage is done. Some people in these circumstances end up under the care of many physical and mental health services within the health care part of ‘the system’ or within charitable organisations, who rely on government and/or community-generated funds to exist. Staff members, and people’s crucial but rarely-recognised carers, spend significant time trying to help ex-detainees put back together the shattered pieces of their lives. This would be easier, shorter, and less costly in terms of money, effort, time, energy and resources if people were extended a better sense of safety throughout their asylum process. Detention on the basis of immigration status does just the opposite of this, raising the costs on all fronts to everyone, worst of all to the person seeking one of the most basic of human needs: safety.
When my client was detained, I felt pretty powerless to do much, other than to ring regularly, try to let him know when I’d ring again, and write to the Home Office as persuasively as possible about what it is like to have PTSD and be detained. To do this, I had to use not only my knowledge about mental health conditions, but also my understanding of this individual person based on what they had shared with me and my colleagues about their experiences. Hearing his story inspired me to write about him. As with any experience, as cliché as it may be, putting yourself in the other person’s shoes helps gain a better understanding of the situation, so I wrote this narration from my client’s point of view, based on what he told me.
I come from a country with an unstable government, terrorist groups and security forces, all of whom, along with the military, are in a constant wrestle of taking the top spot in the country. I am young, barely into my twenties, but before I even got to 20 I had been imprisoned and tortured two long periods of time. Some of the torture was so maliciously and intentionally done that although it causes me persistent physical pain, the doctors here have determined that if they try to fix it, I would risk further and irreparable damage. But those are just the physical scars. No wonder, when I eventually had an assessment with the trauma service, they determined I also had Post Traumatic Stress Disorder (PTSD).
They determined this by the nightmares and flashbacks I had about my experiences in my home country, threatened, locked up, tortured and that happening more than once. I eventually made the heart-breaking decision to leave my female relatives, whom I love and for whom I am supposed to provide and protect, to seek safety. I found none in a nearby country, although I even had legal papers to stay there. But I knew no one, had no way to get a foothold there, and that country was only marginally more stable than my own, meaning it could easily and without warning become even more like my own. I found little solace after making the long, difficult journey to Europe. Again, only strangers, now with little ability to communicate. No support because I ‘wasn’t supposed to be there’, and ultimately more traumas. Further struggles meant I finally made it to the UK, where I have some family members. Perhaps this will make me more legitimate? But no. I am faced with a harsh system which repeatedly implies, and sometimes says, they do not believe my story, I shouldn’t be here, I should at least go back to the first European country I set foot in because those are the international rules. I’m so confused, so angry.
So I find myself in the immigration system, having to check in weekly at a centre so they can keep tabs on me, like I’m on probation for having committed a crime that puts the public at risk. I hear what they tell me when they coldly read me the rules – they may take me into detention at any time, especially as they’ve already rejected my first asylum application, even having acknowledged that I was a victim of torture.
But they don’t understand. The anxiety, growing to panic, growing to terror, at the idea of being detained again. How do I know how long I’ll be there? How do I know when I can get out and yet again try to start my life? How do I know I won’t be tortured again? The answer to all of these, of course, is that I don’t know. So here, in this place where I’ve finally arrived, with some hope of arriving at safety, I find that I am again in a place of total uncertainty and lack of safety – physically, emotionally, mentally.
They don’t understand what the flashbacks and the nightmares are like. These are not ‘remembering a bad time’ or ‘having a bad dream’. In these moments, which stretch like hours and days, I am completely back there. In the cell. Being threatened. Being harmed. Having my body and dignity treated like some moldable pile of mud. I smell the sick odour of the cell and of the guard who would come to get me. I hear the screams of other prisoners, the slam of the doors. I feel the pressure, the pain, the shock on my back, my knee, my head. I see my own body being manipulated in front of me. All as if it was actually happening, again, all these months and years later, here, now, for yet another time.
The staff at the trauma service had explained to me that this is a key part of what makes trauma develop into PTSD. Sometimes during a traumatic event, the brain doesn’t take in everything like it needs to, it doesn’t process things in the normal way, because it’s going through something unusual or shocking. So it’s left with an incomplete memory of the experience, like a puzzle missing some pieces. Some of these missing pieces are the ones that put on labels like ‘where this happened’ and ‘when this happened’. So it doesn’t know that the torture is over and done. It doesn’t know that I’m out of danger. Any signs, big or small, that something or someone in my environment could be a risk to me, sets off all the warning alarms that I’m in real danger again. Then come all those feelings of panic, of needing to flee; and sometimes it pulls me back into living my terrifying memories again, because it doesn’t know I’m in a different country, it’s a different day, time, year, that I’m not being locked up for the purpose of being tortured.
Is it really a surprise then that, despite myself, despite trying to comfort myself and to steel myself as best I can, I repeatedly experience that anxiety that grows to terror, every time I have to go sign my name in that office? Of course I sometimes go late. Of course I sometimes leave even though they’ve said they want to meet with me. Of course I sometimes just don’t go there at all. It makes me feel like a coward, which makes me feel even more angry, but sometimes it’s like voluntarily torturing myself. So I just don’t go.
And then it was this, ironically, that got me detained. The workers at the office decided I was so difficult and such a troublemaker, I guess, for not obeying all of their rules, that they did in fact lock me up one day when I went to sign on. And just like my detention and torture in my beloved homeland, this happened more than once. Is it any wonder that my ‘trauma symptoms’, as the people at the psychology service call them, didn’t go away? They all stayed, stuck. And that when I was in detention, when they called me on the phone, that they sounded worried and expressed concern and even wrote letters saying that I was getting worse?
Author: Christine Coho
Christine is a mental health worker in the public system. She provides practical support and psychological therapy to refugees and asylum seekers with Post Traumatic Stress Disorder (PTSD).