Understanding the experiences of female migrants living in Kent, Surrey and Sussex, by Patrick Nyikavaranda.

Patrick is a second-year doctoral researcher based in the Primary Care and Public Health Department at Brighton and Sussex Medical School. 

Part of his NIHR Applied Research Collaboration Kent Surrey and Sussex (ARC KSS) funded PhD aims are to understand the experiences of female migrants living in Kent, Surrey and Sussex when accessing or contemplating accessing mental health support. Additionally, Patrick aims to co-design mental health interventions or guidance that will be meaningful and effective for migrant females. 

In this brief blog, Patrick discusses the synthesis of gathering evidence around some of the challenges migrant females encounter when accessing primary care support and what may help them access support. 

"I have been fortunate enough to have a glorious and supportive supervision team, which is composed of four magnificent supervisors: Professor Carrie Llewellyn, Dr Marija Pantelic, Dr Priyamvada Paudyal, and Dr Christina Jones. In another world, it may have proven a nightmare having four supervisors rather than the three most of my colleagues have but, in my case, it has worked out well. If anything, my supervisors’ experiences, expertise and differing opinions fit in perfectly like a jigsaw puzzle (that has been placed right for me and only for me) to what my passions, interests and focus are in to. As a researcher with a primary focus on mental health and migrants, my supervisors have helped me expand my knowledge base, as well as encouraged me to develop my research and teaching skills. I have been fortunate enough to have been involved, alongside my now number one fellow researcher, Alice Tunks, in regular Primary and Community Care (PCC) Theme Working Group meetings and the more intimate PCC PhD Working Group Meetings facilitated by Dr Sam Fraser, ARC KSS Implementation Manager for Primary and Community Care and Dr Deborah Ikhile, the Post-Doctoral Research Fellow in Primary and Community Care.

"The following summary is based on a collective review, which it is hoped will stimulate interest in female migrant studies in Kent, Surrey, and Sussex and beyond. 

"The current Covid-19 pandemic has exposed previous and ongoing health inequalities in vulnerable populations. Females make up the largest population of workers in high-risk environments for infections, with early estimates accounting for 71.6% of infections of the Covid-19 virus. Job losses have increased childcare responsibilities and increased risk of domestic abuse and exploitation have been more pronounced in-migrant female populations. It is well known that forcibly displaced migrants, including refugees and asylum seekers, are at a high risk of developing mental health conditions.

"A systematic review was conducted to investigate barriers within Europe to access and support in primary care and the community for migrant females. Additionally, the review aimed to conceptualise research considerations around female migrants by taking a broadly feminist view, mainly on gender, power, and representation.

"The main findings affecting migrant females included:

  • Accessing appropriate support information: Information given to migrant females on the identification of mental health disorders and where to seek support in their community was often limited. Older, migrant females faced barriers in accessing information through technology and having to rely on mainly younger male members to access information using modern technologies.
  • Cultural Barriers: Broadly included language, religion, and cultural intersectionality. Some female migrants were reluctant to seek support for their mental health because of language difficulties. Cultural and religious beliefs and practices were often mixed in studies, highlighting this as a barrier in practical help-seeking and support provision.
  • Stigma: Cited as a barrier from an individual, community, and structural levels. Individuals were often reluctant to seek support due to shame, whereas some had a reluctance to do so because their community saw accessing mental health support because of weakness or of spiritual forces. Health professionals too, had some stigmatising views to migrant populations, with some assuming symptoms of mental health distress were often exaggerated.
  • Structural Issues: Time restraints and long waiting lists were cited as barriers to access and adequate support.

"Facilitators were not often mentioned in the studies, however, services offering culturally appropriate, gender-sensitive support were seen as the most likely to be accessed by migrant females. The General Practitioner (GP) was seen as the most likely to be accessed for mental health support outside of secondary care.

"Broad issues raised in the studies from a feminist perspective mainly focused on gender and power imbalances. Moreover, gender issues were at times excused as cultural issues without considering the impact this had in relating experiences by female migrants, including separation of participants based on gender, yet not considering the impact a different gender of the researcher may still have had on the quality of experiences in the culturally appropriate context. Furthermore, interviewing female participants in the presence of male family members was considered culturally appropriate. However, representation and recording experiences of genuine female migrants in a context representing loss of power and choice of words was never fully visited in studies. Intersections of gender, ethnicity and migrant status were areas the studies could have had a greater focus on.

"Future primary research may seek an understanding of experiences of access and mental health pathways for newly arrived female migrants by adapting feminist approaches to the research. The study has several implications for policy, including, the need to evidence and consider feminist issues in migrant research, which informs policy. Commissioners may seek to fund local evidence-based studies and projects aimed at redressing the inequalities of traditional services. Models of support based on the study may be adapted in providing adequate access and support for other minority and often neglected groups. 

"Based on this review, my next steps on the PhD project will aim to understand referral, access, support and mental health outcomes for female migrants in KSS with the hope of co-producing interventions and support that is accessible, appropriate and effective in supporting mental health conditions. As part of wider ambitions, this project will seek to develop models of research and support nationally, starting from a regional approach with a focus on Feminist Participatory Action Research."

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