New Scots: refugee integration strategy 2018 to 2022

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: