BEREAVEMENT IN EXILE

1. BEREAVEMENT IN EXILE Anne Burghgraef, Senior Therapist Solace surviving exile and persecution

2. What is Solace? Solace is a mental health service for asylum seekers and refugees that has been operating since June 2006 Since 2000, asylum seekers have been dispersed throughout the UK, while previously they were based in London As Leeds was a dispersal area, a range of voluntary organizations were set up A study undertaken about 8 years ago involving both statutory and voluntary agencies, revealed that what was lacking was a specialist mental health facility, which was how Solace originated

3. OUTLINE * Introduction: * General Asylum Info Quiz * Case Study * Who are Asylum Seekers and Refugees? * Loss in Exile * External & Internal Pressures * What Helps?

4. ASYLUM QUIZ

5. CASE STUDY

6. WHY DO PEOPLE FLEE AND BECOME REFUGEES? Fear of death due to war (ethnic, civil, military) and or organized violence Abuses by the security forces or armed opposition groups (rape beating) Torture and inhumane treatment Unjust systems including detention without trial or unfair trials Death penalty Massacres or the threat of massacres

7. Political repression or religious intolerance Persecution because of ethnicity Gender based human rights abuses, honour killings, forced marriages, FGM

8. WHO ARE REFUGEES AND ASYLUM SEEKERS ? A refugee is a person who ��. owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion is outside the country of his nationality is unable, or owing to such fear, is unwilling to avail himself of the protection of that country. From the United Nations 1951 Convention relating to the status of refugees (Geneva Convention)

9. An Asylum Seeker is��.. someone who has made an application for protection under the terms of this Geneva Convention is waiting for a decision from the Home Office.

10. Top Ten Countries from which People flee to the UK Iran Eritrea Afghanistan China Somalia Zimbabwe Nigeria Pakistan Iraq Democratic Republic of the Congo

11. What do all refugees and asylum seekers have in common?

12. LOSS OF HOME

14. TRANSITION A refugee in transition is moving from a familiar place and way of being, where he/she could take for granted how things worked, where he/she was competent, and knew what to do to a place where virtually everything is alien and where you probably have no language to communicate.

15. LIMBO LAND

16. In pairs, spend 10 -15 minutes talking about what would being forced to flee from your home mean for you? What would you miss the most? Is there anything you would be glad to leave behind? What are the losses?

17. Family Friends Religion Community Political Affiliation Language(s) Personal identity Social Networks Social Status Employment Profession Culture Competence Beliefs/worldview Possessions Stability & Certainty Recognition Roles

18. EXTERNAL PRESSURES Limited financial resources Complex legal process Asylum seekers not permitted to paid work Isolation Learning a new language Cultural adaptation Little or no choice as to where you live Hostility due to lack of understanding Racism, stereotyping Negative media images

19. INTERNAL PRESSURES Coming to terms with potentially multiple losses Disorientation & confusion as you are confronted with too many changes at once Anxiety about the future including fear of return Acute and chronic uncertainty Worry about family left behind Culturally displaced - no sense of belonging

20. Deskilled as you need to learn the new �rules� and ways of doing things through Possible trauma related to experiences in the country of origin or during flight Early history, patterns of attachment Aftermath of experiencing or witnessing violence including torture and rape. Possible ambivalence to country of origin Disturbance of identity and worldview

21. QUESTIONS FOR CASES STUDY DISCUSSION 1) What is your reaction? How do you feel? 2) What are the issues you need to consider in working with this person? 3) What if anything would worry you if you were to work with this person? 4) How might you begin to work with this person?

22. PSYCHO-SOCIAL ASSESSMENT Anxiety Symptoms (hyper arousal intrusive thoughts, flashbacks, loss of appetite, sleep problems, panic attacks, shaking, involuntary movements) Physical Health (head & stomach aches, racing heart, muscle tension, weakness of limbs, dry mouth, sexual dysfunction) Cognitive Difficulties (short term memory, recollection, concentration, inability to think)

23. * Emotional Issues (grief & loss, depression, anxiety, numbness- feeling dead, self injury, suicidal, a range of different kind of fears, shame & guilt, passivity, lack of motivation) Family & Relationships (loneliness, dis-trust, conflict, problems with intimacy, sexual relationships, disempowerment as parents) Disorientation (confusion, hearing voices, loss of sense of self/identity, fear of going crazy, disassociation, seeing people you think you know)

24. WHAT HELPS? A relationship of trust & safety � a secure base Some preparation and country knowledge Advocacy and referral to advice and support agencies Psycho-education & normalizing anxiety symptoms as reactions to extreme events Coping strategies for distressing symptoms e.g. sleep difficulties Being open to the client�s own account of their experiences and needs and what will might help

25. Holding the feelings and bearing the losses in mind Sensitivity to the multi-dimensionality of refugee experiences (internal/external/past/present/future) Recognizing and respecting the differences in worldview between yourself and the person you are working with Hearing refugees stories and testimonies and bearing witness, constructing healing narratives Use of creative therapies eg art, storytelling as well as physical therapies Use of groups where possible