UNACCOMPANIED MINORS’ AND THEIR CARERS’ PERCEPTIONS OF MENTAL HEALTH INTERVENTIONS AND SERVICE PROVISION
4.1. THEME 1: ENGAGEMENT
4.1.1. Trust
It is not uncommon for young people to disengage with interventions or show some form of resistance to mental health care (O’Reilly & Parker, 2013). This was found to
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be more marked among unaccompanied refugees as their lack of trust appeared to be a significant factor that enhanced disengagement. Young persons struggled significantly in trusting any professionals, including mental health clinicians. They also found it difficult to trust people in general, and felt that they might be in trouble or place themselves in an unsafe position if they trusted doctors or other professionals, and shared too much information. Young persons perceived that, even when they did trust somebody, there was no help available; so they preferred to solve problems themselves rather than relying on others.
“…… doctor don’t even know what’s wrong with me, doctor just…….. write down this report and they give me tablet the same……. This doctor, I (do) not trust him, I’m not safe.” Young person 8
“There’s not many people he can trust. He’s openly told me that he can’t trust people.” Carer 14
“Yeah, because I didn’t say to anything about my problem, I didn’t tell it to anybody, you know, because I don’t trust anybody. Because I trust that, you know, like when somebody I trust…….. they give me trouble”. Young person 9
According to most of the young persons’ views, mental health professionals let them down, did not help them or even hurt them when trusted. Their main focus while discussing the issues around trust, therefore, seemed to be the professionals’
untrustworthiness. Some carers, however, stated that the young persons need to
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work through their personal difficulties with trust, before they relax and are ready to establish a meaningful relationship with the clinician, so that an effective intervention can take place. They commented that this process often requires adequate time.
“I’m not sure if the boys ever relaxed into, you know, it’s almost like there were certain vulnerabilities for you to relax enough for somebody to help you get beyond your ailments, and I don’t think they allow themselves to relax to that extent.” Carer 1
“I just was thinking I was sort of getting a level of trust, but then you realise you still, they’ve got their own systems and their own issues to resolve, and it takes a while.” Carer 2
It appeared that one of the main reasons for the young people not trusting the clinicians or any other professionals was their fear of this information being fed back to the Home Office, thus leading to them being deported back to their country of origin. This perception discouraged them from disclosing any information that has the potential to compromise their asylum application.
“I was thinking, if I said everything to my solicitor, maybe they’ll put me in jail.
Maybe they’ll put me in prison and then after sometime immigration refuse me…….. Maybe, you don’t know about government. You don’t know, maybe they can take it.” Young person 9
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“No, because I’m scared, these people there, but I’m scared maybe these people like altogether they (will) put me in Afghanistan, I don’t know.”
Young person 15
“…… (he’s) thinking that information he provides the Westcotes [name of child mental health service] will go to the immigration people, and go back to his
country where he’s in danger. And people will know where he is as well.”
Carer 16
“In his mind he thinks, right, are you going to tell them that I’ve said something different to what I said before? See, so ‘coz he knows police, Home Office and solicitor……. they think, hold on, if I say a lot of things here, they may be used against me which is why they may not share stuff…. there’s a lot of issues that are turned round and then they end up believing, thinking, oh so you’re working in cahoots with them……. so that I can be deported back to my country.” Carer 7
The young persons’ trepidation due to their unfamiliarity with the administrative system, culture and society at large appears to have been adding to their mistrust in the clinicians. This fear of the unknown is reflected in statements like “you don’t know about government. You don’t know, maybe they can take it.” Subsequently, a carer’s obligation to pass on certain information, which can be misinterpreted or distorted, forms the ground for further consolidation of this mistrust. Participants also talked about a certain degree of suspiciousness by young persons towards professionals, which seemed to be a direct consequence of their struggle for survival
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over the years. They thus often doubted professionals’ intentions to engage them in conversation and to collect information, which ranged from passing on the information to another organization, to having financial gains. Young persons’
mistrust of people in authority possibly also originated from their upbringing in the country of origin and their experiences during the journey, where many may have actually been persecuted by authority figures representing the establishment.
“I’m not a celebrity, I’m not a hero, I’m not anyone, I’m just an ordinary person;
why are there here so many cameras? When I came here for a check up and I came to a medical place and a medical place with cameras and everything, like you know, what’s going on in here? Make the person really, really, really paranoid, like is there anything going on between these people and other organisations?” Young person 16
“I did lots of interviews, it’s nothing. They want to work for their job to get the money, that’s it.” Young person 13
“Mind you, like I said, our children are not brought up the way your children are brought up in this country, your Western children are very confident. A lot of them have very good understanding of what authorities are there for. Our children don’t know that. Our children fear people in position of authority all the time. Our children are suspicious of people of authority all the time.”
Carer 4
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As drawn from earlier quotes, young people found it difficult to trust and engage with the clinicians because of their unfamiliarity with systems, but also with individuals. A young person expressed his reluctance to share details of his intimate personal life story with someone he was not familiar with. Carers stated that it was difficult for the young persons to trust clinicians without having adequate time to establish a relationship, get to know them and understand how the systems work, especially in an environment that looked formal, with people taking notes of their account.
“If I knew, then yeah, then I’d be able to tell them, then I can talk to them. But I don’t know them; they didn’t show me anything…… If you never know them, you’ve never been there, it’s very hard, very difficult to go there and talk about yourself and life.” Young person 13
“And I think, that’s the whole thing about these young people, that they don’t know, and they haven’t got relationship, they don’t want to open up. ‘Coz they need to build that trust.” Carer 5
“Going to an unfamiliar place with people who they don’t know, and who are writing things down and it seemed quite formal, I can imagine would be, if you didn’t know what their agenda was, would be quite difficult…… why would they trust their word that they’re not going to tell others. And some psychologists to be fair and psychiatrists do go for specific assessments to help their case and things like that.” Carer 13
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“He was frightened. He thought he’s in trouble, you understand, because….
something he wrote first of all in his college... And he did, he wrote that same thing again in at the Centre Project. So he thought they were telling him off, when he first went to CAMHS……. So the first two sessions, M (CAMHS clinician) and the psychologist had with A (young person), was him defending himself: no, I didn’t want to do anything to anybody.” Carer 4
The carers here show remarkable insight into the young person’s world, their difficulties in trusting professionals and the possible underlying reasons. The young persons’ struggle in trusting the clinicians seemed to be more prevalent among those who had less contact with CAMHS. Being interviewed and assessed by unfamiliar representatives of unknown government departments without much preparation in familiarizing and rapport building are clear hindering factors in the formation of trust.
Conducting such interactions in a formal and official manner can be reminiscent of their earlier experiences of being interrogated for the purpose of ascertaining their continual right to remain in this country. This, in turn, triggers the young persons’
defences against the perceived threat, hence their lack of engagement.
The lack of trust in the clinician can have far reaching implications in the outcome of the intervention. Without establishing a trusting therapeutic relationship, young people would be more likely to drop out. It can also be hypothesized that their basic necessities of survival, including asylum application, take precedence at that stage over other seemingly less important needs such as help for their mental health difficulties.
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