Return of vulnerable persons

1. Return of vulnerable persons Belgian Immigration Office Coordinating psychologist of Detention Centers Maïlys Dereymaeker The project is co-financed by European Return Fund and Estonian Ministry of Interior

2. Content • Introduction • Belgiandetention centers + Mission • Monitoring humane return of (vulnerable) persons: our best practices: - Humane policy - Implementing humane policy: Staffandprojects => Extra Care project => Special Needs project - Conclusionandrisks • Psychological impact

3. BelgianDetention Centers • Directoratefor Control at the Territoryand Border Control • 5 Detention centers - different target groups • Mission: Detention of irregular migrants in a humane mannerin order to achieve their return within the shortest period possible or the provision of access to the territory whenever this proves necessary and when stipulated by the regulations, in respect of the existing regulatory, legal and international determinations and standards.

4. Monitoring humane return in detention centers – Humane policy • Systematicdetectionandsignalisation of specificproblems or vulnerabilities • ‘Made tomeasure’ care and assistance: duringdetention, during return andafter return • Close follow-up by the administrative services who are responsiblefor organising return

5. Implementation of humane policy: Staff • In eachcenter: => A director (+ assistant-managers) => A multidisciplinary professional staff: • Medical service: physiciansand nurses • Clinicalpsychologist • Social team: educators, socialassistants, teacher • … • Coordinating clinicalpsychologistfor overall monitoring

6. Implementation of humane policy: developing projects on humane return • Motivationforcreatingspecificprojects: • Difficultiestoprovide adequate andcontinuous care and assistance forresidentswithpsychomedicalproblemsand / or extreme behaviouralproblems • Difficultiestoorganise a return for these residents • Projects: • Extra Care project (since 2009) • Special Needs project (since 2009)

7. Extra Care project: Our intentions • A more adequate approach in detention centers • An improvedcoordination/ communication / information flow between centers andadministrative services responsiblefor organising return • A systematically signalisation of ‘Extra Care’ residents • An improvedcoordination / communication / information flow withexternal partners

8. Extra Care: 1. Approach detention centers – Internal • Collective approach of groups of residents vs a customized approach of eachindividual Extra Care resident • Training ourstaff members • Extra Care Information Sheets • Introducingregularmultidisciplinary meetings on Extra Care residents

9. Extra Care: 1. Approach detention centers – External admissions • Existing collaboration with hospitals nearby • Development of a systematic co-operation with psychiatric institutions nearby: Temporary transfer (a priori max. 14 days):  On the advice of our psychologist + doctor  (Indication of) diagnostics/ adaptation of medication / assessment on possibilities for return (specific needs during return… Person remains “detained” – costs of psychiatric admission paid by Immigration Office

10. Extra Care: 2. + 3. Coordination / Information flow and Signalisation • Creating a common Immigration Office database – Detention Centers and administrative services responsible for return • Extra Care list (EZA) => Residents who need Extra Care are listed in the database on the advice of our multidisciplinary teams in the detention centers • Extra Care: residents with medical and / or psychological problems / vulnerabilities, behavioural problems + residents who need extra monitoring, e.g. residents on hunger strike, residents with a special needs file, …

11. Picture NAME

13. Extra Care: 2. + 3. Coordination / Information flow and Signalisation • Introducingregularmultidisciplinary meetings on Extra Care residents in the detention centers • Introducing weekly meetings on Extra Care residentswithadministrative services who are responsiblefor organising the return • Prioritising these cases (case management): => Outcome is variable: fast identification and return, temporary or long term placement in a hospital / psychiatric institution, to end the decision of detention, or sometimes also temporary right to stay

14. Extra Care: 4. Coordination / Information flow and Signalisation • Collaboration with Social-Psychological team of the Federal Police of our national airport (continuity of ‘made to measure’ care and assistance): • Training of police escorts • Information flow to the Social-Psychological team of the police • Development of a joint approach

15. Special Needs project: Aim and target group • Aim project: Providing financial support for the organisation of ‘made tomeasure’ care and assistance of vulnerable persons with regard to their forced return (during detention, during return and after return). • Target group (vulnerable persons): • Non accompanied Minors (+ Aged-out minors) • Persons withspecificneeds (psychological or physical) • Pregnant women • Elderly persons • Persons whoneed a ‘made tomeasure’ follow-up forotherreasons

16. Special Needs project: during detention • Duringdetention: • Urgent psychiatricadmissions of residents • Purchase of medication or othernecessities (such as wheelchair, hearing device, …) • (Training forstaff of detention centers withregardtovulnerable persons)

17. Special Needs project: during return • During return: • Assistance of a physician, a specialist, a (psychiatric) nurse, a psychologist, a confidant, a liaison officer • Up to the airport of arrival (e.g. when pick-up by family) or up to the arrival of the returnee at his / her home, …

18. Special Needs project: After return • After return: Post-arrival assistance and / or reintegrationtrajectories made tomeasure the needs of vulnerable persons: • Reintegrationperiod is limitedto 12 monthsafter return • Based on estimatedexpenses a maximum budget is fixed • Medical follow-up (e.g. residential or ambulatorypsychiatric follow-up, follow-up of generalmedical treatment, appointmentswithspecialists), … • Other follow-up…

19. Special Needs project: After return Monitoring after return: • Monitoring bylocal partner (check of invoicesafterappointments etc., assist the returneewith his appointments, …) • Monitoring by liaison officers of BelgianImmigration Office General remark: Finding family / relatives (informal care givers) of the returneeandinvolvingthem in the return process is important for the durability of the follow-up

20. Conclusion and risks • Organising the return of vulnerable persons in generaland more specific of persons with a psychiatric disorder, is a very complex process • Risks: - Finding no local partner in home land / No family (dependance on returnee) - Loss of information / Bad communication - (Interpretation of the) behaviour of the returnee - Dependance on goodwill of authorities + local partner - …

21. Psychological impact on returnees • In general, whendetained in a detention center: • Differentpsychologicalprocesses come at a crosssection and are meeting eachother: migration process, asylumprocess, detentionprocess and return process… • Specificcontext of detention • Specificcontext of different cultures and living in a group All have a impact on the mental health of our (sometimesalreadypsychologicalvulnerable) residents

22. Psychological impact on returnees • In our experience: General psychological impact related to procedure: - General complaints of (acute) distress and tension - Difficulties adapting to detention - Difficulties facing a (forced) return - Feeling angry (because of the procedure) - Feeling depressed and fearful…

23. Group sessions

24. Psychological impact on returnees • In our experience: Psychologically vulnerable persons: • Are in a very emotional state (high emotional distress) • Have a vulnerable personality structure or low IQ • Decompensate / establish a great psychological suffering (presence of a psychiatric disorder)

25. Individual sessions with psychologist

26. Psychological impact on staff • In our experience: • Adaptation period(learningtocopewith extreme behaviours, …) • Working in a veryspecific context => match or not? • Developing a follow-up forourstaffwithregardto the specific stress level of working in this context: creatingStress Teams (STEAM) as a part of this

27. Stress Teams (STEAM) • Selecting teams of volunteers who own certain competences to care for their collegues after a crisis • Different levels of follow-up: STEAMmembers, coordinator (psychologist of the center), supervising team • Training by an expert in trauma and crisis psychology • Actions of STEAM: after a big crisis (possible traumatising), loss of collegues or residents

28. Questions? Thankyouforlistening!!