A new review highlights key factors in preventing post-settlement psychological distress in unaccompanied refugee minors.

The review, published in Child: Care, Health and Development, investigated existing research into the different factors affecting mental health outcomes in unaccompanied refugee minors (URMs). A URM is defined as any young person under the age of 18 who has been separated from both parents and is an asylum seeker, recognised refugee or other displaced person.

Recent data from the UN Refugee Agency (UNHCR) show that there is a total of 68.5 million forcibly displaced people worldwide. This includes 25.4 million refugees, over half of whom are under 18. The review highlights that, particularly in a European context, existing treatment services cannot currently support the often-complex mental health needs of incoming unaccompanied child refugees. As such, it is necessary to understand which preventive measures are the most effective and have the potential to reduce the need for treatment.

Here, we break down the review’s main recommendations for improving mental health outcomes for young, unaccompanied refugees: 

1) Down with detention centres; up with high-quality social support

Six of the studies included in the review found a link between higher support settings, such as foster care, and lower psychological distress in URMs. Of these, three found that such living arrangements were associated with fewer PTSD symptoms. A fourth study, focussing on the relationship between highly-restrictive reception environments and emotional problems, found that girls were more likely to experience negative mental health outcomes.

The findings also explore the quality and type of social support. The studies suggest that enabling unaccompanied young refugees to mix freely with children of similar ages and backgrounds reduces psychological distress. In addition, they highlight the importance of supportive adults in facilitating initial conversations around anxiety, trauma and depression. On this basis, the review stresses the importance of avoiding placing URMs in detention or reception centres for any period of time.

 2) Ensure easy access to mental health services

Research focussing on mental health services found a significant gap in the numbers of URMs requiring and accessing support; one study indicated that 60% reported needing professional mental health care, with only 12% having ever received any. Just one-third of URMs had their mental health needs recognised by guardians or caregivers.

In addition, one study found that, in England, URMs requiring mental health support were more likely to be referred by social services rather than by a GP in comparison with accompanied children. A separate investigation also indicated that they were less likely to receive trauma-focussed interventions, cognitive therapy and anxiety management than accompanied refugee minors.

The review suggests that there is room to educate both URMs and their guardians, foster carers and social workers about how to recognise symptoms of psychological distress, and which services might be able to provide them with appropriate support. Improved screening could also help to identify URMs who are dealing with mental health issues, and lead to more timely referrals for treatment.

3) Address the research gap

The review states that there is “a dearth of studies on treatment for unaccompanied young refugees”, and that its own conclusions are limited by the lack of availability of high-quality research in this area. There is a particular need to investigate mental health outcomes for URMs who require psychological therapies, and also the more impaired sub-group who may benefit from drug treatments for PTSD or depression. More work also needs to be done to investigate to what extent unaccompanied young refugees are able to access different pathways to mental health services.

Co-author Dr Matthew Hodes commented: "Sadly, it looks as if young refugees, including URMs, will continue to migrate to European and other countries to escape highly adverse environments afflicted by organised violence and poverty."

"Ongoing cross-disciplinary and multi-agency collaboration is required to identify the best approaches to the prevention of psychological distress amongst URMs."

‘Prevention of psychological distress and promotion of resilience amongst unaccompanied refugee minors in resettlement countries’ by Ritu Mitra and Matthew Hodes is published in Child: Care, Health and Development.

Image: DFID - UK Department for International Development [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)]