Traumatic Stress Clinic (TSC) The Refugee Team 73 Charlotte Street W1T 4PL London

1. Traumatic Stress Clinic (TSC)The Refugee Team73 Charlotte StreetW1T 4PLLondon

2. Traumatic Stress Clinic (TSC) (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

3. Who are we? • NHS outpatient service for adults • 3 clinical teams • Adult team • Refugee team • Veterans service (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

4. Refugee team • Clinical and Counselling Psychologists • Group Analyst • Clinical Psychology Trainees • Administrative Staff • Honorary Staff (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

5. What We Do • Individual and group treatments for trauma • Training & Consultation • Research • Lobbying and Human Rights Advocacy (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

6. Our client population • Refugees and asylum seekers from all over the world • 140 open cases • Wide range of languages • Work carried out with interpreters • We cover Camden, Islington, City and Hackney. Tower Hamlet, and Westminster (in addition NCA’s referrals) (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

7. Definitions Under international law, the 1951 UN convention relating to refugees defines a ‘refugee’ as someone who: • has a well-founded fear of persecution for reasons of race, religion, nationality, membership of a particular social group, or political opinion; • is outside the country they belong to or normally reside in, and • is unable or unwilling to return home for fear of persecution. Whilst someone is waiting for their application to be considered, they are known as an 'asylum seeker'. People who are not recognised as refugees commonly referred to as “failed asylum seekers”. Does not necessarily mean they are not refugees, rather they have not been recognised by the country in question. Refused asylum seeker is more accurate. (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

8. Country of Origin (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

9. NUMBER OF OPEN CASES REFUGEE TEAM 139 (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

10. Age range of Refugee clients at Traumatic Stress Clinic (n= 139) (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

11. What is PTSD? • Criterion A The person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. The person’s response involved intense fear, helplessness or horror.

12. Unwanted Thoughts, Memories, Nightmares Or Flashbacks Trying Not To Think About It Numbed Feelings The Event Feeling Edgy (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

13. Re-experiencing symptoms • Intrusive memories • Distressing dreams • Acting/feeling as if the event reoccurs • Psychological distress at exposure to cues • Physiological reactivity on exposure to cues (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

14. Avoidance & numbing symptoms • Avoidance of thoughts, feelings, conversations about the event • Avoidance of activities, places or people • Inability to recall impt aspects of trauma • Feelings of detachment / estrangement • Feeling numb • Forgetting (a dissociative amnesia) (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

15. Hyperarousal symptoms • Difficulty falling or staying asleep • Irritability or outbursts of anger • Difficulty concentrating • Hypervigilance • Exaggerated startle response (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

16. Treatment: A phased model approach • Why a phased model? • Complex and multiple needs - Psychosocial needs - complex traumatic stress reactions • Needs change over time • Respect needs of client • Model not linear (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

17. Phased Model of Intervention Establish safety and trust Trauma focused therapy Re- integration Phase One Phase Two Phase Three (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

18. Phase 1 - Establishing Safety and Trust Aims: • Stabilizing the individual: management of crisis, dealing with legal and social needs, eg. advocacy work, professional report writing, referral for health related problems, reducing social isolation, linking with relevant organisations • Restoring a sense of control: psycho-education, normalization, symptom management, recognize strength and resilience • Developing a trusting therapeutic alliance: clarify roles and rights, validation and recognition of atrocities, advocacy in support of basic human rights, respect client’s needs and background, guidance and gentle pressure can be helpful (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

19. Phase 2 – Trauma Focused Therapy Aims: • To develop a coherent detailed narrative of the traumatic experiences & create a sense of meaning within a historical & social context • To deal with peri-traumatic emotional (and possibly physical) responses such as shame, guilt, anger & humiliation. • To allow the memories to be processed so that they stop intruding into the person’s mind & symptoms are reduced. • Overall aim is to reduce the emotional impact on current life by helping clients to place the events in the past (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

20. Phase 3 - Reintegration Aims: • Creating a future by helping the individual rebuild their life and relationships in the present • Developing a sense of future goals/ aspirations • Moving on with traumatic experiences integrated into life story • Establishing a sense of reconnection with others & pre-trauma identity • Developing trust in a wider context • Rebuilding set of beliefs & a new life in a new country (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

21. The Catalyst Fund • The fund is used to buy equipment for group and individual clients to be able to implement symptom management strategies taught within sessions. Examples of this are Mp3 players for playing relaxation exercises and tools (stress balls, oils etc) for grounding strategies that help people cope with dissociation, flashbacks and nightmares. (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

22. On occasion clients attend the service at initial assessment or during treatment in crisis with immediate essential needs. The fund is used to address immediate needs of clients in the interim period between identifying such a need and locating sustainable ways of addressing needs (e.g. emergency food and clothing, small funds to acquire essential white goods, bedding or furniture from charitable organizations) where no statutory funding is available. (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

23. Parents with young children who are socially isolated sometimes have difficulty attending the 10 session psycho-education group on a weekly basis due to lack of childcare. This has prevented some people from attending the group and benefiting from the treatment we can offer. The grant enabled us to pay for childcare for few hours a week whilst the client is attending their therapy sessions, where it has not been possible to arrange childcare through statutory services. (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

24. Example Cases Case1 • A client who has severe post-traumatic stress disorder (PTSD) and major depression (MDD) with suicidal ideation, following imprisonment when at a demonstration in DRC. He was held without charge, or any legal process, for several months, during which time he was repeatedly tortured and raped, and witnessed the torture and death of other prisoners. He is currently waiting for a decision on his asylum status from the Home Office, and is managing financially on supermarket vouchers. The grant enabled him to buy essential items (toiletries) and equipment to support him with his English lessons at College. He has now successfully completed three terms of ESOL classes and his spoken English has improved significantly. His confidence has grown to such an extent that he has now signed up to do voluntary work in an English-speaking setting. (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

25. Case 2 • A young woman refugee from DRC who has severe PTSD and MDD as a result of multiple traumatic events and losses in her home country. She arrived in the UK as an unaccompanied minor and she waited 5 years before the Home Office recently granted her ILR.  The client is in treatment at the TSC and she has made significant progress.  However the prolonged wait for her asylum decision had made it difficult for her to move on with her life and has exacerbated her depression.  She is now a single mother with a one year old son who has a number of medical problems. Prior to obtaining a decision on her asylum status she was unable to find work as employers were reluctant to employ an asylum seeker. On her limited benefits, she was unable to adequately provide for herself and her son’s basic needs during the very cold winter period. We gave her a grant to pay for food, heating, clothes and bedding for her baby. (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust

26. (c) Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care Trust