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