Expressions of distress by refugees and the implications for current notions of cultural competency

People who are forced to migrate grapple with traumatic experiences both in their home countries and within hostile political environments in host countries. This can often lead to psychological distress and mental health crises. In the UK context, there are multiple obstacles to seeking mental health support, including language barriers, problems with interpretation services, stigma around mental ill-health, dispersal and discontinuities of care. Cultural factors are highlighted as a main barrier for services to provide adequate mental health support. Debates exploring culturally specific idioms of psychosocial distress  suggest the urgent need to be informed about diverse ways of expressing mental health distress (e.g. Jannesari et al., 2022). This paper reframes this urgency and questions whether culture is a useful lens to address barriers of mental health support for refugee populations.



Methods

The Routes to Wellness project uses Experienced-Based Co-Design (EBCD) to develop a peer-support model to improve refugees’ mental wellbeing. This paper analysed the narratives of research participants based in two cities in England. Participants included people with lived experience of forced migration (n = 25) and service providers (n = 21). Their accounts covered stories about health access and contact with services.



Findings

Our findings suggest that there is a commonality in the drivers and expressions of mental distress in a diverse group of participants. These include sleeplessness, loneliness and alienation, anger and distress from experiences of racism and discrimination, stress and worries about the current asylum-seeking structure.



Based on a critique of the notion of cultural competency, this paper reflects on the desire to acquire and to know how forced migrants as people from different cultural backgrounds experience and express distress. It explores the balance between culturally sensitive approaches and the danger of generalised assumptions about specific ethnic/linguistic populations, with implications for clinical practice and community support interventions.