Royal College of Psychiatrists stresses governments have a moral obligation to ensure all immigration legislation protects those with mental illness
A significant new report published today by the Royal College of Psychiatrists (RCPsych) addresses the profound implications of asylum legislation introduced by the previous Conservative government, in particular, the Nationality and Borders Act 2022, the Illegal Migration Act 2023, and the Safety of Rwanda Act 2024.
The 98-page report, Protecting the mental health of people seeking sanctuary in the UK's evolving legislative landscape, can be downloaded here.
RCPsych said: "The report is aimed at all stakeholders who are involved in, or whose decisions affect, the care of asylum seekers – including the government, NHS Trusts and clinicians. Each of these stakeholders will need to make changes to ensure the mental health of asylum seekers is better protected, which is why the report offers practical and actionable recommendations for each."
As the report notes, asylum seekers and refugees frequently face deeply traumatic experiences, which increases the risk that they might develop a mental illness such as anxiety, depression or post-traumatic stress disorder.
Serious concerns are raised over the previous Conservative government's asylum legislation from 2022 to 2024, which ultimately saw the criminalisation of seeking asylum and will likely have far-reaching consequences for the mental health of asylum seekers and for broader mental health services.
"At a time of increased hostility towards migrants and the criminalisation of asylum, this legislation paves the way for extended periods of immigration limbo, the expansion of immigration detention and quasi-detention accommodation, serious limitations on appeal rights, and the forceful removal of those arriving in the UK via irregular routes. Evidence suggests that these factors will contribute to significant deterioration in the mental health of those affected," the report highlights.
RCPsych stresses that governments have a moral and ethical obligation to ensure all immigration legislation explicitly protects and supports those with mental illness, and the current government must carry out a review of all current relevant legislation in terms of its potential impact on mental health before considering making any further changes to law.
Dr Lade Smith CBE, President of RCPsych, said: "A robust immigration policy can still be guided by human kindness, that is fair and compassionate. The Labour government has an opportunity to ensure its new immigration legislation and policies explicitly protect people seeking sanctuary who have mental illness while maintaining the public's confidence in border control."
For an overview of RCPsych's most important observations on the impact of asylum legislation on mental health, the executive summary helpfully lists the report's key findings as follows:
Language and rhetoric
Consultation with experts by lived experience highlighted the importance of language and rhetoric in this area. Hostile language, or language which refers simply to immigration status or route of arrival, can contribute to feelings of dehumanisation and stigma, and is vital in building trust and a context of safety for people seeking sanctuary.
Forcible removals
The new government has announced that they will not send any people seeking sanctuary to Rwanda. They have not, however, committed to repealing the IMA [Illegal Migration Act 2023], leaving open the possibility that in the future there may be inadmissibility provisions enforced and 'safe third country' agreements made with other countries. Evidence gathered by organisations working with individuals who received Rwanda removal notices suggests that mental health difficulties were exacerbated, fear, uncertainty and confusion were triggered, and that the risk of self-harm and suicide was increased. Many of the individuals selected for removal showed evidence of serious mental illness, and/or having survived trafficking and torture. Any policy which involves forcible removal of people seeking sanctuary to another country is likely to have similar effects and would be highly concerning on both health and humanitarian grounds.
Offshoring
The new government has announced that all current asylum claims will now be processed in the UK, however, it has not ruled out the possibility of processing those claims offshore rather than in the UK in the future. Offshoring is the process of people being held in, or forcibly removed to, offshore locations or other countries, where their claims will be processed. This policy has been used in Australia, where extensive research evidence indicates that such a policy can compromise human rights and health, with high rates of post traumatic stress disorder (PTSD), depression, self-harm and suicidality amongst those held offshore.
Limited appeals rights
Under the IMA, the appeals rights available to stop forced removals are significantly limited, with appeals only permitted on the grounds that removal would cause "serious and irreversible harm." It is not yet clear how these provisions might be used given the new government's stated intentions to not send anyone to Rwanda. However, if used in any future policies, these limits to appeal rights would disproportionately impact those with mental health difficulties, who would find it more difficult to marshal the required evidence. Furthermore, as mental health clinicians we know that it can be almost impossible to predict the trajectory of mental health at an individual level, as would be required in these cases, despite evidence at a population level that traumatic life events can cause impacts that are both serious and potentially life-long.
Fast-track processes
The NABA [Nationality and Borders Act 2022] introduced new tight deadlines for providing evidence, with penalties for missing deadlines such that less weight is given to any 'late' evidence. There are significant potential problems associated with accelerated procedures, which remain concerning given the new government's stated intentions to develop new fast-track procedures to process asylum claims. Fast-track procedures and tight deadlines may hinder comprehensive evaluations of asylum claims, including psychiatric assessment and, as previously mentioned, those with existing mental health difficulties are likely to disproportionately find it difficult to gather the evidence, including medico-legal reports, required. Given the ambiguity around what constitutes acceptable reasons for providing evidence late, it is not clear how grounds related to mental health will be interpreted by decision-makers. People with mental health difficulties or histories of trauma are at particular risk of enforced return to their countries of origin despite significant vulnerabilities that would have come to light were their claims to have been assessed in a more appropriate time period. For context, a previous iteration of fast-track procedures, the 'detained fast track' policy, was described as "structurally unfair and unjust" and was ultimately found to be unlawful by the High Court in 2015.
Immigration limbo
Long periods of immigration limbo are characterised by uncertainty, fear of detention or forced removal and even destitution. Provisions in the IMA increase these periods in limbo, although it is unclear how this might change with the new government's proposals. During the long asylum process, people seeking sanctuary are isolated from the wider community in a variety of ways, including through lack of access to work or education, restrictions on housing and benefits, poor standards of accommodation, expectations of regular Home Office reporting, and barriers to accessing healthcare. Offering longitudinal support for mental health difficulties can be very challenging due to relocation or detention at short notice, leading to lack of continuity or follow-up. Because of the ongoing uncertainty that individuals face, this context does not allow for the psychological safety required for recovery from trauma and can leave clinicians morally injured when unable to offer much-needed therapies.
Immigration detention
The UK is the only European country in which there is no maximum time limit on immigration detention. The IMA introduced detention as a fundamental part of the removal process and gives powers to detain for as long as the Secretary of State considers "reasonably necessary" to examine their case or remove them. We highlight evidence and a 2021 RCPsych Report into the harms of immigration detention, showing considerable adverse effects on mental health. Mental healthcare in detention is poor overall, with little provision of appropriate screening, assessment, monitoring or treatment. Inadequate staff recruitment and retention, lack of private clinic space and inadequate funding all contribute to poor healthcare.
Hotel accommodation and quasi-detention facilities
The use of hotel accommodation and large-scale quasi-detention facilities has been concerning, and evidence suggests that physical and social isolation are common, as well as re-traumatisation through the often military or prison-like nature of the buildings, sleep deprivation and restriction and surveillance of residents' movements. The Bibby Stockholm barge, for example, was frightening for individuals who could not swim and who had made dangerous journeys across the sea. Several such facilities have been closed due to health and safety concerns. It is important to ensure that future asylum accommodation is fit for purpose and does not exacerbate mental health problems.