The mental health needs of refugee torture survivors: exploring staff understandings

This study explored the issue of access to appropriate mental health care for
refugee torture survivors in the United Kingdom (UK). Despite survivors’ legal
entitlements, there are substantial concerns about their access to care. To
date, there has been little empirical investigation of the ways in which staff
who have contact with torture survivors understand and manage their mental
health needs. The focus of this study was on general practitioners’ (GPs’)
understandings of torture survivors’ mental health needs and their accounts of
how they respond. This is an important focus for exploration given GPs’ roles
as referrers, gatekeepers and future commissioners of services for this group.
This study involved individual in-depth interviews with eight GPs. Interviews
were analysed using thematic analysis informed by a critical realist
epistemology. Three main themes were identified.
Theme One encompassed participants’ talk about the challenges of assessing
and responding to torture survivors’ mental health needs. Challenges related
to GPs’ expertise and remit, their work context and the complexities of
working with a patient group with multiple needs and different cultural and
experiential backgrounds. Theme Two related to conceptualisations of torture
survivors’ mental health needs and associated solutions. Participants were
seen as drawing on competing social and medical models of distress.
Suggested interventions for this patient group were tied strongly to addressing
their multiple needs. The third theme related to medical practice within the
asylum context and its associated social and political discourses.
Based on the analysis, implications for future research, policy and practice are
considered. The research supports the position that torture survivors’ mental
health needs and their wider psychosocial needs cannot be separated if they
are to receive the most effective and suitable care.