Accredited Community Accredited Community Empowerment Course: Course: Empowerment Accredited Community Development and presentation of Empowerment Course:

research skills
by Ridwan Beshir

2011-2012

Acknowledgements
The Report provides findings and recommendations on the Eritrean community based on action research on needs assessment on the Mental Health Problems within Eritrean Refugees living in London aged 18-44 yrs. Thank-you for the E.O.U. for giving me this opportunity. I also want to thank for the participants, for Dr. Henock a psychiatrist in, Sega (counsellor), and also for my mentor Isha for the full courage and support.

Contents

Pages

Executive Summary Chapter 1: (i) Central aim (ii) The purpose of your research (iii) Literature review (iv) Methodology (v) Ethical considerations Chapter 2: Research findings Chapter 3: Discussion Chapter 4 (i) Conclusions (ii) Recommendations 17 17 18 19 11 12 13 15 10 9

(iii) The strengths and limitations of research Bibliography Appendices 21 20

Executive Summary
The Research examined the difficulties faced by the Eritrean refugees with M.H.P (Mental Health Problems) aged 18-44 yrs living in London. Focusing on the framework and care of these victim refugees and the impact on themselves, on their families and friends. This research found that the MHP for the Eritrean refugees started soon after they arrived in the UK due to a number of factors, for example a cultural clash, having problems adapting or switching on to the system of this country, lack of communication (which can be very difficult looking for employment and integration), being lonely or isolated, away from their loved ones, failure in achieving their expectations. All the above mentioned may cause the participants to have psychological distress, sleeplessness, anxiety disorder and depression which can lead to the early stage of MHPs. This is due to the fact that the early stage has not been handled properly until it was too late. I was heartened in this research by the courage, strength, openness braveness and willingness to come forward to discuss and be able to break the ice for this very sensitive and important issue by the participants and this cooperation has to be appreciated. The findings were not positive; the stigma and discrimination was deeply rooted not only hidden from the outside world but also from among their own community members until it was too late to seek a professional help. The stigma and discrimination attached to MHPs should be rooted out from the hearts and minds of this community and the society at large possibly by means of education. The findings also involved some other important points for example poverty, unresolved immigration statues, lack of information, lack of integration among their community and

the society contributed a great deal to the problem. The Government failure to invest more before MHPs become an issue but willing to invest after the victims have been diagnosed needs to be considered. Lack of proper housing puts a lot of strain and pressure on the participants. Not being able to engage fully in education due to lack of educational back ground also needs to be addressed. To reduce if not to control the MHPs needs the full involvement of decision makers is essential, for example, the NHS, local authorities, the community and community leaders. They need to come together in order to find out the best options which should benefit the service users. I strongly recommend that this kind of community research should be done professionally as this has never been done before in order to give a full awareness of early indications as well as long term solutions. The Eritrean community should be supported and provided with the necessary services they need morally and physically. It is also recommended that the service users have the opportunity to:1 Be taken seriously by mental health professionals 2 Access more self help initiatives to boost resilience 3 Access alternative therapies as well as greater social activities 4 Improve their personal skills 5 Have early intervention, community based preventive measures and cultural therapies are essential. 6 Have outreach this is a key tool in refugee communities to make contact with isolated individuals 7 And that More monitoring and research on vulnerable Eritrean refugees with MHPs should be undertaken across London ,because the vulnerability factors include

individual factors such as communication difficulties, low self esteem, difficult adapting to new situations or solving problems, academic failure, cultural isolation and discrimination contributed a high percentage to their MHP.

Introduction:- M.H.P.is a broad term and can be used to describe a range of emotional distress from difficulties that might be resolved by one visit to a G.P. through to a severe mental health illness treated by a psychiatrist for several years or more. Each of us needs to be aware of our own mental health and to understand that we all have mental health needs .Problems with mental health are common and it is estimated that one in four adults will experience a problem with our mental health in any year (MIND).

Chapter 1:-Central Aim

It is important to understand that mental health problems are like any other illnesses, but lack of acceptance makes it different and difficult for many of us. For instance one of the main problems within my community is stigma attached to their MHPs, failure accepting the reality about mental health illness. The majority dont want to discuss their issues openly even if they do, they do not want to admit that they have been affected by this illness and indeed some of them undermine the seriousness of the illness at the early stage and, a further weak point, is that it is easier for them to speak and admit to the members from outside of their community (external) than from their own community (internal). This indicates how strong the stigma attached to the MHP issue. As a result this seriously affects the level of help and support they are willing to seek in order for them to recover.

As a member of this community I am concerned and hurt to see young Eritreans being affected and wasting their golden years and also of the instances where they end up taking their own lives which can be avoidable. It is also very sad for their families and friends. Part of my study is that I want these victims to understand and take advantages and use the services available to them. There is a need for them to be open it is crucial in order for them to be free from the stigma of MHPs and to help the community for the better results and create a promising and health community as well as a society, allowing a better chance of integration within the society. My concern is that this community is very polite preferring to suffer in silence rather than asking for handouts. Again this community is probably not adapted to or has not understood the system of this country and that is why they are more badly affected by these MHPs (more than the other migrant communities). Finally, mental health has become a more significant issue post-migration and there wasnt this kind of illness before.

(ii) The purpose of my research

Significance: - The purpose of this research is to study and raises awareness between the service users and the service providers related to the Eritrean community with M.H.P. The study will help to educate and raise awareness that the stigma and discrimination related to MHP shouldnt be a kind of cultural disease and should be eradicated from the peoples minds and that M.H.P.is one kind of mental health illness like any other illnesses .Because for some, the worry or thought of the stigma attached to the MHPs is more an issue, rather than the M.H.P. itself, my research is designed to find out why this community, particularly young men and women, have been affected. It is also to create a good relationship or bridge between the service users and service providers, and this research will serve as a base for future studies and for better findings and solutions for the victims. The current research was limited due to lack of funding and a lack of existing research on the topic to use as a literature review.

If I can be provided with a mandate I would like to work closely with my participants believing this idea will open a door for understanding the mental health issue and break the barriers of the psychological torture of stigma and discrimination attached to the MHPs.

(iii) Literature review

It is now over 20 years since the migration of Eritreans to the UK but unfortunately there is not any substantial research or study published regarding the MHPs, It seems it is hidden from the society but there have been a number of suicides from this, especially it seems, compared to other communities. I strongly recommend that a larger research is carried out for the future to help this community and to avoid more suicides.

Nothing in life to be feared it is only to be understood (Marie Curie).

Literature review from different community:-Coming from a collectivistic society, Somali refugees may experience trouble adjusting within Western, traditionally individualistic societies. Perception of their native land and misconceptions of the prospective host country have been suggested to predict level of readjustment, particularly for young Somali refugees (Rosseau et al, 1998). Upon entering a host country refugees may be subject to racism or discrimination (experiences likely at conflict with expectations of life in the host country) and may not have access to resources needed to construct a new life. Level of adaptation is a key factor in the wellbeing of refugee patients. Political, social, physical, and psychological factors prevent many refugees from adequately adapting to life in their host country. Specifically, residential mobility in the host country has been highlighted as a significant mental health risk in the current literature on Somali refugees (Mohamud et al, 2004; Palmer, 2006; Warfa et al, 2006). Residential status in the host country is often in flux due to socioeconomic factors. Difficulty finding employment, for example, often leads to additional residential moves following expatriation. Recent research within samples of Somali refugees has provided

preliminary evidence to suggest that frequency of change in residential status within the first five years in the host country is strongly related to depression even after controlling for age, gender, and area of residence (Mohamud et al., 2004). Research examining mediating factors in the development of psychopathology within a sample of Somali expatriates found overall educational history and employment status in the host country to be related to lower risk for anxiety, depression, and PTSD (Bhui et al., 2006). Previous research has indicated that loss of social status, such as vocational status, may be linked to increased levels of depression in older Somali male refugees (Silveira & Allebeck, 2001).

(iv) Methodology
The study conducted using both traditions - qualitative and quantitative- in the process of data collection, analysis of the case study, and interviews and questionnaires.. A case study is a research tool which gives a broad idea of the study. It can be used to illustrate a point. An interview is a one to one or face to face research tool to explore more in private the issues of an individual. A questionnaire is a tool designed to collect information of more people and to explore their ideas. I chose to do questionnaires as it gives the participants the chance to express their view in detail and from an individual perspective and to gain more information in their own time. For the case study, as everyone has different issues to tell, it is important tool to go deep to find the main problems from individuals in private and to get all necessary information as much as I could. Although it was emotional for the participant and me, it was very important to find out the deep side of their problem and the cause of the problem and it gives light on how to tackle and help these individuals and the rest of the community from falling in to such a difficult situation by carefully studying and analyzing. The interview is one of the best tools to find out how they feel as individuals because, especially this community, they like to express their views and especially in this case because of fear that others might find out their problem and expose this to the public. Although this is

emotional, but they managed to express their views and get some relief by speaking out and by understanding this research will help other victims, it means they have been open to express their views for the sakes of themselves and their community.

By using all these three methods/ tools, it helps to find out what the main causes of this problem in the community are and the findings help to support other victims and previctims who are in danger too to help them. If not to prevent then to minimize and I believe this will be a solution for the long-term. The aim of the research was to identify and address difficulties and hardships faced by the young Eritrean refugees suffering from the MHP in London. First the literature review was undertaken about refugees mental wellbeing in London. All three of the tools allowed me to collect primary data. Exercising the three above mentioned methods, the overall findings were similar for example with stigma, discrimination, lack of enough support from the community and the government, lack of confidence and lack of communication. Thus the findings resulting from the tools triangulated. The strongest tool was the case study. It was very sad but interesting followed by the two interviews. It would have been better if the community have been educated more about my research project and more open. If I was going to do further research project, firstly I would print out leaflets in their language explaining the benefit of the community research and explain that by being open about their experiences, they may help to reduce and prevent further self harm or even suicide.

v) Ethical considerations
Prior to full research being carried out, full information and instruction was given to the participants. As this is a very sensitive topic I assured the participants regarding the confidentiality, as well as the purpose of this study and that the findings will benefit this community in obtaining the relevant and adequate services. As a result they agreed and

were willing to sign the consent form (see the appendices p.27) to be involved in the research. I believe I gathered the relevant information and data needed for my research at this stage.

Chapter 2: Research Findings

This research revealed that the number of those with MHPs increases over time due to unresolved immigration issues, poverty, housing problems, lack of communication/information and the inability to access support services as needed. The following were key findings for the study:A. Stigma related to MHP B. Lack of confidence C. Lack of information of facilities the necessary services. D. Discrimination related to MHP E. Unresolved immigration status such as uncertainty, a sense of impotence and perception of failure F. Lack of Government support G. Poor housing H. Unemployment Statistics from my research: In this study, 90% said they were unemployed. This is clearly a very serious issue for the participants and for Eritreans in general. It was not possible to find up to date statistics on employment levels amongst the community but it is seems to be the case that the majority of them are unemployed. It is clear that newer communities tend to have higher levels of unemployment. Amongst the Ethiopian population, for example, there is only 32% employment amongst the first generation. We can expect similar results for Eritreans (BBC, accessed 2012) Amongst this study group, 90% held no higher qualifications with many not even having basic qualifications. 90% of the participants were single parents / unmarried/ divorced. 85% said they felt lonely/ isolated. 75% felt they hadnt been treated well by the NHS or the local community.

Other findings Mental health issues post-migration:- Many of the participants reported that when they had arrived in the UK, they had been in good mental and physical health but the problems started in the UK due to unresolved immigration issues, culture gaps and the issues listed below. A participant said:

Before I was a beautiful fit lady but now I am mentally and physically not fit and became over weight as I am always in doors because I am un employed with no regular exercise as a result I hated to go out and socialize. I know people will laugh at me as a result I prefer to stay at home day and night

The other key issues are as follows: Stigma:- Stigma attached to MHP was the main issue behind the MHP itself especially within this community and preventing the participants from building their future. The participants expressed their concerns over the stigma they faced in particular within their own community. This is because they felt they are not considered mentally fit and felt not accepted by their families as well as others. As a result this lead to isolation and loneliness. Lack of socializing with the wider community also remains a problem related to the stigma and discrimination. One of my participants said: I prefer to die rather than asking any help from my community they believed that the bad words would spread easily among their community and would be more stigmatized. Lack of confidence:-The majority of the participants have no self esteem to fight for their rights, possibly due to lack of adequate knowledge and information of facilities for the necessary services and they had not been able to read and understand English language properly one of the participants said: I wasnt be able to gain enough education during my young age and now I am paying high price I blame myself for the failure for missing the golden opportunity Discrimination:- Most of the participants felt being discriminated not only because of their MHPs but also due to lack of communication as one participants said: I was considered as a second class during the treatment not only because of my skin color but due to my language barriers ,the staff tried to undermine me and psychologically been affected. Keating and Robertson (2002) said that the mainstream MH Services have a history of failing Afro Black Caribbean communities and that there has been little

change in recent years. They argue that there circles of fear which mean that black service users dont engage with services, subsequently they argue that because of the understandable reluctance to engage, black people are subjected to more restraining procedures in order to gain control over situations perceived as dangerous. Many service users reported to them a fear that involvement with Mental Health Services would lead to their death Unresolved Immigration statues Contributed to their severe MHPs; being unable to know their current situation and not be able to predict their future. One participant said I came from the war torn country seeking for safe heaven and sanctuary instead I am now considered as a criminal staying without statues, no employment, living on vouchers for years I do not know how long more this will take it is like living in an open prison. To be an asylum seeker is not a crime Lack of Government support Although the government provides support, participants reported that it did not meet their individual needs, for example not been able to provide adequate cultural therapy (mother tongue therapy) and not been able to solve accommodation problems. A participant said The government is not willing to invest at the early stage but prefer to invest at the latter stage heavily. Poor housing:- A number of respondents noted that being mentally not fit and to share with strangers and to stay in hostels is not ideal or not easy. Unemployment:- Please see the statistics above. The refusal of employment also has a serious impact in their life. This causes poverty and means that integration is difficult.

The NHS role towards the migrants on mental health issues:- Eritrean refugees with MHPs living in London felt that there was a lack of information on facilities to access the services, for instance how and where to get the appropriate information, lack of one to one counseling cultural therapy( mother tongue). The participant said In this country if you cant look after yourself no one will care about you, once diagnosed there is no cure, no help, no good future so it is better to die. The results also showed that there were barriers especially for the Eritrean community accessing the medical services due to bad networking , not knowing how and where to get adequate information, and language barriers because sometimes no interpreters available . One of the participants saidI have been sectioned without a proper MH checks and found

myself having difficulties to communicate and advocate for myself and have been told to take medication which made my MHP worst and had a very bad side effects on me.

The overall study regarding migrants with mental health conditions found that there is a wide spread ignorance especially in the NHS sector this is due to either an unwillingness amongst professionals to deal with the problems or simply an insufficiency of materials and human resources to help those suffering whose cultural frameworks are different from those of majority groups. The study also found that there exists insufficient links between service users and service providers meaning that culturally aware trauma services for refugees with the NHS is negligible.

Below is a case study to illustrate some of the difficulties faced by the research participants and how the complexity of their lives can be overwhelming and where the intervention to date has not worked:

Case Study:- Selam ( name has been changed for confidential reason ) arrived in the
UK in late 1990 with her 3 children aged 3, 5 and 6, but without her husband in a good spirit and mentally healthy, but no enough educational back-ground . Shortly after arrival she got divorced and as a result she has been confused, felt lonely, grew increasingly isolated from family/friend and started to get depressed. She has not been able to discuss her issues with anybody, mainly from fear of stigma and discrimination. A s a result, she couldnt seek the appropriate medical/professional help and advice and the matter got worse: she started to have panic attacks, sleeplessness and anxiety. This led to serious depression. She has since been diagnosed with a mental health problem. She did believe in mental health problems but was not willing to accept or admit the reality, fearing not only stigma and discrimination but also fearing the children might be taken away by the authority so she forced herself to hide her mental wellbeing from the outside world and chose to suffer in silence until it is too late and has recently been hospitalized. This has even created more stress. In addition, one of her sons has been to prison and life is getting tougher over time. She tried counseling a few times but it didnt help her and she preferred more religious and traditional methods. Over all her life is not moving forward and she believes there is no future for her at all.

Chapter 3: Discussion
The Eritrean refugees are migrants like any other migrants and should be treated equally like everybody else. They should have access to interpreters and bilingual health advocates. This is crucial because most of the service users have difficulties to express themselves. Before the participants arrive in the UK, their expectation and hopes were very high in seeking a better and stable life. However the hopes and expectations evaporated and faced with unexpected difficulties and with a completely different system for example cultural differences, lack of communications, lack of confidence, language barriers, confusion and nowhere to turn for help meant they faced many complex challenges. According to my study, about 90% of the participants are single or single parents no fully engaged in education or employment which is even more frustrating and puts more stress and burdens on the victims and this time very hard to move on with their daily lives. Lack of regular exercise and not been able to socializing caused the victims more stress and they put on more weight. As a researcher I believe that unless and until the stigma, discrimination, poverty and lack of education have been dealt and fundamentally addressed and resolved the life of these refugees with MHPs will always be a barrier for the integration, prosperity not only that the participants will always face a very challenging life ahead of them and will always remain burden not just for themselves but also for their family, friends and for the society as well. I have also learned from service users that living in this society with a mental illness carry both stigma and the potential for discrimination and isolation. These can add to distress and as experiences for service users. Acceptance by others is a central to their wellbeing. Being accepted by others helped in development of acceptance within themselves. For some service users, discrimination on mental health ground is an extra burden on top of discrimination relating to race, ethnicity, culture, gender and sexual orientation. Unresolved immigration has a very negative effect on mental health. Decisions can take a long time meaning many do not know the future. They are not able to work or study and this means they do not interact with wider society. This needs to be taken into account

before their mental health deteriorates into something far more serious. The Eritrean refugees with mental illness should be treated as active survivors rather than passive victims in terms of cultural consideration It would be better if the NHS framework designed to meet the needs of the individuals by creating a good environment, for example consultation prior to the medication about the treatment and the side effects clearly using interpreters/advocates... It is also essential to consider contacting family members, social support and links with community groups, religious leaders and those who are active in problem solving, but also it is not very safe to assuming that community resources are adequate to deal with the major problems they face, therefore it is essential in primary and secondary health care.

Chapter 4
(i) Conclusions

Refugees and resettlement experience combine to produce a set of social, cultural, economic and psychological challenges for refugees which may affect integration, mental and physical health and access to health and social care. This community faces multiple forms of disadvantage which affects mental health and lack of help seeking behaviour due to cultural expectations and norms, lack of access and engagement with western treatments. Most significant was the concern about the increasing rate of suicide among this group.

The research highlighted some important points:1 The stigma and discrimination was the main concern for the mental health of Eritrean refugees. Sadly for many users of services, discrimination on M.H grounds adds to and compounds discrimination based on race, culture, gender and sexual orientation. These findings are more than feelings of some service users and are all well documented in M.H. Research and knowledge. 2 Unresolved Immigration issues. Fear of detention and/ or forced return are common among the Eritrean refugees and is one of the main factor for their MHPs, destitution is also an issue. Multiple loss and powerlessness, uncertainty about the future compromises mental health. 3 Lack of communication and language barriers: due to lack of English language communication skills, the participants felt they were unable to achieve much

progress in their lives. This worsens mental health conditions. 4 Cultural clash: this is a very serious issue. Prior to arriving, Eritreans did not expect such a cultural shock. It takes time to adapt and this drags them backwards, meaning once again it is very hard to progress. 5 Unemployment (leading to poverty) has a great effect on their mental health: some of the participants had expectations of financial support (for themselves and to help their parents back home) but when this fails, this becomes another serious problem. 6 Poor housing Many new arrivals stayed in hostels or temporary accommodation making it very hard to cope and adapt with complete strangers.

(ii) Recommendations
The report contains numerous recommendations some of which are highlighted,in terms of the role of service providers and individuals with mental well being. The study also indicated that within this community there is a lack of sufficient knowledge about the health services and other public services available for them. As a result, there have been more incidences of self harming and even suicides. A number of young victims have admitted to receiving mental health support across the capital, therefore this community needs a professional and well organized body or team to take this issues seriously and deal accordingly. There is also a need to lend a basic advice, give moral support and guidance. For instance poverty and poor housing can impact negatively on mental health. Again by improving these services victims with MHP would be improved. Tradition and faith healers could also be part of the solution, counseling should be conducted in their mother tongue using cultural therapy and access to bilingual health advocates. It is important to have a formal link between community organizations and clinical services which may include employing trained refugees with mental health qualifications in the NHS sector or other services dealing with MHPs. The following points are also recommended.

1 Seeking professional help on the right time to help them boost their selfesteem, improving personal skills and resilience. 2 Being around people-socializing

3 Greater awareness of current services and activities 4 Being involved and keeping busy 5 Keep healthy physically ( exercise, yoga and other mediations) 6 Service providers to provide facilities and activities in central locations and to meet and consult more with Eritrean community 7 Peer to peer support (mentoring within Eritrean community and wider community) 8 Community-based ESOL 9 More training, with translators if necessary, to understand UK employment systems 10 Professionals need to be better equipped to support community where mental health is a stigma (in identifying and treating) 11 The Eritrean community needs to understand the reality of mental health as an issue in the community The government or the Department of Health, Social Services including housing, immigration Department, Education and Employment should work hand in hand for the better of service users. Most importantly the Health and Well Being Boards must intervene and actively engage in this important issues in order to save the community.

(iii) The strengths and limitations of research

The main problems and challenges on this study was the theme of the topic itself, because mentioning MHP is the most sensitive issue especially within the Eritrean community. Not many people are even willing to mention, let alone to discuss openly the topic, mainly for the fear of being stigmatized and discriminated against. After assuring the participants and clearly explaining the aim, confidentiality and that the outcome will make a change and benefit the participants and the rest of the community for now and for the future, I tackled this issue. The fact is that there is no or little research on this topic was both a strength and a weakness in my research. The strength is that I am doing something no one has done before and this will help build a greater understanding and awareness of my community. And a weakness is because I have very little secondary evidence to refer to and help guide my research. The research tools were a strong part of my research, particularly the case study as a means of exploring more ideas and views of the communitys suffering. The interviews were also useful as it allowed participants to talk privately about issues they do not trust many others to speak about. The questionnaire allowed me to explore broad issues. I would use these again. I would make them longer to gain even more information. In the future, it would be better to get more funding to be able to print leaflets to inform of the study but also to educate about mental health. Then we could use these findings to further advocate to the government or NHS for more funding and help. More time and more people to help would also help to build the study. It would also be better to offer financial help to participants to take part, e.g. travel, childcare. It would be ideal if this research could be turned into a book or published more widely so that more people become aware of this issue.

Bibliography

Mind: www.mind.org.uk
BBC: How Different Immigrant Groups Perform [http://news.bbc.co.uk/1/shared/spl/hi/uk/05/born_abroad/economics/html/overview. stm} Accessed 2012. Bentley and Owen (2008), Somali refugees mental health cultural profile (http://ethnomed.org/clinical/mental-health/somali-refugee-mental-health-cultural-profile) Bhui, K., Abdi, A., Abdi, M., Pereira, S., Dualeh, M., Robertson, D., et al. (2003). Traumatic events, migration characteristics and psychiatric symptoms among Somali refugees-preliminary communication. Soc Psychiatry Psychiatric Epidemiol, 38(1), 35-43.

Palmer, D (2007) An Exploration into the Impact of the Resettlement Experience, Traditional Health Beliefs and Customs on Mental Ill-Health and Suicide Rates in the Ethiopian Community in London, International Journal of Migration, Health and Social Care Volume 3 Issue 1, Migration and refugee communities forum , Pavilion Journal, Brighton (http://www.ethsa.co.uk/researchonethiopia.pdf) Mohamud, S., Bhui, K., Craig, T., Warfa, N., Stansfeld, S., Curtis, S., et al. (2004). Residential mobility and mental health: A cross-sectional study of Somali refugees in London. Ethnicity & Health, 9, S80-S81. Rousseau, C., Said, T. M., Gagne, M. J., & Bibeau, G. (1998). Between myth and madness: the pre-migration dream of leaving among young Somali refugees. Cult Med Psychiatry, 22(4), 385-411.

Silveira, E., & Allebeck, P. (2001). Migration, ageing and mental health: An ethnographic study on perceptions of life satisfaction, anxiety and depression in older Somali men in east London. International Journal of Social Welfare, 10(4), 309-320.

Appendices Questionnaire:1. Gender. Male...... Female-----.

2 Age.

18-25...... 25-35..... 35-40..... 40+.....

3 How long have you been in the UK?

Under 5 yrs------ 5-10yrs--- 10-15yrs----- 15-20yrs------

20+yrs---.

4 What is your Employment State? Voluntary------Unemployed--------.

Part time------ Full time------

5. How old were you when you arrived in the UK? Under 15yrs----. 16-24yrs----. 25-34yrs------. 35-44yrs-------.

6. What is your current Immigration Status? Exceptional leave to remain------. Indefinite leave to remain...... Asylum seekers.... Full Refugee Status-------. Un-decided------.

Dont know--------. Others...... 7. Are you married or single? Married...... Single......

8. Do you have family/friends in London? Yes lots ------. Yes few..... None-------.

9. If the answer is yes for the above question Do you socialise? Yes-----. No-----.

10. If the answer is No Why not?

Do you think this affects your mental wellbeing? Yes------. No----. 11. Do you take part or engage any activity with the following groups? Community Group-----. Religious Group-----. Youth Group-----. Networking .....Others---. 12.If yes how often? Once a week----. Continuously----. Not at all-----. 13. If none why not? Once a month ------.

14. Do you ever feel Isolated or Lonely?

Yes---. No---.

15. If yes why ? Stigma----. Lack of confidence----. Lack of communication----. Language barrier.....You think you Wouldnt benefit----. Others---. 16. Do you attend any of the following services? Social services---. Counseling.... Community Group---.Religious

Activities---.

Others---.

17. If yes briefly explain about the services you receive?

18. If not why do you think it is difficult to access the services? Lack of interpreters---. Lack of transportation---. Lack of information ---. Others..... 19. Have you accessed the NHS? Regarding your mental wellbeing? Yes---. No---.

20. If Yes how do you rate the services? Excellent.... Good---. Bad---. Undecided---.

21. Have you experienced any discrimination? Yes---. No---.

22. If yes can you briefly explain about the discrimination you experience?

23.And how did you manage to overcome the problem?

24. If you receive any of the services mentioned What do you recommend to improve them?

25. Please feel free to comment about Eritrean refugees with the mental well being in London..

INTERVIEW1.: Maza ( name has been changed for confidential reason ) a 40 years old arrived in to the UK in 1996 with her 4children aged 1, 2, 3 and 7.. After a few years her husband joined them, but there was just very little understanding between them and the husband was very hard to accept the cultural differences , getting jealous and started to be abusive towards his wife as a result their marriage ended in divorce. She started worrying for the welfare of the children and for herself with no family/friends to seek for help. All these responsibilities and burden gave way to more stress and depression she knew something was wrong but refused to admit and didnt seek a medical help and started to panic , suffer with anxiety sleep-less sometimes even memory-loss , but she preferred to keep everything for herself for a number of years fear of being stigmatized and discriminated and again fear for her children being taken away from her , however at the end she managed to seek medical help but was too late for the early stage treatment and diagnosed with MHP. And she has been admitted to the Hospital. Then the participant refused believing and trusting anybody around her, this was because she felt betrayed by her exhusband.

Interview2: Hannah (name has been changed for confidential purpose) a 42 years old
single she has been in the UK for the last 15 yrs, with no history of depression or mental health problem, after she arrived felt lonely, with language barrier and lack of confidence, and un employed, she found it very difficult to socialize as a result started to get depressed and preferred to stay away from her community, because she believed that she would be stigmatized and discriminated. Even to make the matter worst one day she opened her main entrance door and in the sitting room a young boy neighbor from the same community aged 28 had hanged himself. , Hannah banged her head to the dead body when she realized she fainted and was taken to the hospital. Since then her mental health has deteriorated. She started medication and now easily became frustrated and angry .She said she finds it very hard to control her state of mind and has been admitted to the psychiatric units two times and she has since been evicted from her home for a number of moths nowhere to go and, she was not happy to approach her community because they were not willing to socialize as a result she said I prefer to die rather than asking help from this community, because they lost the cultural value of socializing, helping and respecting each other which have to be restored in order to have or create a healthy community or society .This has made her life hell again and blamed a weak community, bad networking and not enough services and information from the local authorities. She said the government

doing too little too late and medication never cures but makes a bit better, because if she stops the medication for a short time or gets angry or frustrated it is very hard to control herself as a result one day she was almost run over by bus on the road she said I need someone to be with me for most of the time because when someone is in depression or with MHPs he or she is always exposed to danger.