New Scots: refugee integration strategy 2018 to 2022

The New Scots refugee integration strategy sets out an approach to support the vision of a welcoming Scotland.

Health and Wellbeing

" Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."

Article 25 (1) Universal Declaration of Human Rights

The right to health is a human rights issue, encompassing not only the right to healthcare, but also to other determining factors of health such as education, employment, income and housing. Good health is critical to social participation and engagement in activities like volunteering, employment and education. [87]

The Scottish Government has been clear that everyone, who is resident in Scotland, is entitled to access health care on the same basis. This includes all refugees, asylum seekers and people whose claim for asylum has been refused. Refugees and asylum seekers living in Scotland are entitled to register with a GP, to access emergency health services, to register with a dentist and to have eye tests. They can access specialist healthcare, as any other patient can, often through a GP referral. This includes maternity care, mental health services and any other services for specific conditions. All public health services have a Public Sector Equality Duty that requires them to ensure that the services provided are fit for purpose and meet the needs of all members of society. However, some refugees and asylum seekers continue to face barriers to accessing services for a range of reasons.

Many refugees and asylum seekers arrive in Scotland with physical and mental health problems associated with the reason they have had to seek asylum. This includes gender based violence, sexual violence, torture, experience of war and other degrading treatment. The experience of seeking asylum, incidents of racism or prejudice and the challenge of understanding and exercising rights can exacerbate existing health problems or create new ones.

National Health and Wellbeing Outcomes set out high-level statements of the ambition for health and social care in Scotland. [88] The outcomes are intended to improve the quality and consistency of care provision across Scotland, so that service users and carers have a similar experience, regardless of the Health Board or local authority area they live in, while allowing for local approaches to service delivery. The outcomes are grounded in a human rights approach, which recognises that we should all be free to live with dignity and to participate equally in our communities.

A human rights approach to health emphasises the importance of empowering people to know and claim their rights, to participate in decisions that affect them, and to maintain and improve their wellbeing independently. This includes equipping people with the knowledge and skills to understand their wellbeing, to use the health service and other public services effectively and to look after themselves in a way which works for them. The health literacy action plan, Making it Easy, [89] supported everyone in Scotland, including refugees and asylum seekers, to have the confidence, knowledge, understanding and skills to live well with any health condition. The refreshed health literacy action plan, Making it Easier, [90] will support improved navigation of the health and care system, building on the progress made under Making it Easy.

Integration Authorities [91] across Scotland are planning, innovating and working with health and social care staff, communities and the third and independent sectors to ensure person-centred and responsive approaches in the design of care and support locally. By sharing knowledge and experience, they are finding out what works best for people, what delivers best value to communities and sharing the routes and pathways to those outcomes.

Mental ill health is one of the major public health challenges in Scotland. Around one in four people is estimated to be affected by mental illness in any one year. [92] Improving mental health for everyone is a priority for the Scottish Government. Scotland's Mental Health Strategy 2017 – 2027 [93] recognises the impact that trauma and discrimination can have on mental wellbeing. This includes specific traumatic events, as well as experiences of social isolation, uncertainty and inequality. There may also be specific issues around access to services and support for those living in remote and rural communities. The mental health strategy sets out an ambition to " prevent and treat mental health problems with the same commitment, passion and drive as we do with physical health problems." The mental health strategy presents opportunities for the New Scots strategy, in relation to specific needs around trauma and the development of early intervention approaches that better support the needs of refugees and asylum seekers.

The National Trauma Training Framework [94] has been developed by NHS Education for Scotland to support the strategic planning and delivery of training for people working across Scotland who have contact with survivors of trauma.

Although refugees may have vulnerabilities, they are also resilient and often provide significant support to one another, including through informal caring. The Carers (Scotland) Act 2016 [95] recognises the significant role of carers and requires services to have processes in place to identify carers and their needs. There are also examples of peer support projects, which can promote positive health messages. [96]

Key issues identified through New Scots engagement

A great deal of feedback was received during the New Scots engagement that took place during Summer 2017, and a more detailed analysis of this will be published in 2018. However, some of the broad themes raised, which are relevant to health and wellbeing, include:

1. Health literacy and understanding of rights and entitlements. This includes access to specialist services, but also broader health and wellbeing support available through public services and the third sector.

2. Understanding of health and wellbeing needs and experiences by service providers to enable them to meet the needs of refugees and asylum seekers. This includes increased awareness and training on trauma informed practice, as well as broader issues such as the impact of social isolation and racism.

3. Communication when accessing health and social care services. Language and access to interpretation services was a recurring theme, as was the need for empathetic responses from staff. Staff training in communication between services and joint working was also highlighted.

Objectives and Actions

Objectives and actions for each theme contribute to the overarching New Scots outcomes. New Scots is designed to be a dynamic strategy, which is able to adapt to new and emerging issues. New actions will be developed during implementation. The following initial actions set out the work related to health and wellbeing, which will be progressed in the first instance:

New Scots Outcome

Objective: what we want to achieve

Action: what we will do

2. Refugees and asylum seekers understand their rights, responsibilities and entitlements, and are able to exercise them to pursue full and independent lives.

Refugees and asylum seekers are able to look after and improve their own health and wellbeing.

Work with NHS 24 and health and social care partnerships to improve the availability of information about people's rights and entitlements and how to access services. Ensure this work is linked into Making it Easier – the refreshed health literacy action plan.

Increase participation of refugees and asylum seekers in local and national health forums and strategy groups.

Extend opportunities for refugees and asylum seekers to benefit from peer support to improve their knowledge of health care systems and health improvement strategies, including those that have a positive impact on mental health and wellbeing.

3. Refugees and asylum seekers are able to access well-coordinated services, which recognise and meet their rights and needs.

Refugees and asylum seekers, who use health and social care services, have positive experiences of those services, and have their dignity respected.

Continue to identify and disseminate evidence about the health needs of refugees and asylum seekers, to support services in carrying out Health Inequalities Impact Assessments, and to meet their public sector equality duty.

Ensure complaints procedures are accessible to all refugees and asylum seekers.

Services are more responsive to the needs of refugees and asylum seekers.

Ensure sufficient guidance and training for health and social care staff on the issues faced by asylum seekers, in line with the recommendation of the Equalities and Human Rights Committee's report, Hidden Lives – New Beginnings.

Ensure trauma informed practice is embedded into health services and other service provision.

Share best practice and quality guidance for interpreting services used within health and social care to improve practice by health and social care staff.

4. Policy, strategic planning and legislation, which have an impact on refugees and asylum seekers, are informed by their rights, needs and aspirations.

Relevant policy, strategic planning and legislation are informed by the underlying social factors, which impact refugee and asylum seeker health and wellbeing.

Work to identify data that monitors the mental health and wellbeing of refugees and asylum seekers, and its impact on integration, to improve data usage and inform relevant strategies.

Identify research priorities to provide further evidence of the impact of social factors on health and wellbeing of refugees and asylum seekers.

Continue to identify and disseminate evidence about the health needs of refugees and asylum seekers to inform planning of health and social care services.

Respond to consultation and engagement opportunities to ensure policy and practice associated with wider social factors is informed by refugee and asylum seeker health needs and rights.


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