Refugee children, for many reasons, can be particularly vulnerable to mental health problems. Dr Mina Fazel, associate professor in child and adolescent psychiatry at the University of Oxford, is a clinical psychiatrist with a long-standing interest in the mental health needs of refugees.
She has conducted research on the epidemiology of mental health problems in refugee children, the risk factors and protective influences. Dr Fazel believes schools have a key role to play in the mental wellbeing of young refugees.
Refugees’ mental health – key issues for schools
“The most important issues,” she told me, “are the child’s environment and their background. These children have likely come from a difficult environment and may have had no experience of education, or a very disrupted experience. They might have been exposed to traumatic events and a whole range of losses.
“There’s also the journey to a place of safety: that could be a two-hour flight or two years of horrific travelling. Then we need to think about their situation in a country of refuge. We can’t modify what they’ve experienced before but we can do a lot to improve their current experience.”
Asking children directly about their experiences has thrown up some interesting responses: “We did some research where we asked refugee children: ‘What was the most important thing that helped you?’ They often said the thing that helped them most was when they went up in assembly and said something that made everyone laugh and felt accepted by their peer group – or another kid inviting them to football practice.”
So what are the implications for schools? Dr Fazel continued: “I’m a child psychiatrist and clinically I feel I have none of the most important therapeutic interventions available to me, because actually what these kids need most can be found in the school environment rather than a clinical environment.”
Schools, she feels, are in a very good position to support newly arrived refugees, and suggests teachers consider what they can do to help them feel welcome and connected.
“It’s important to prepare the other children at the school to ensure it’s a welcoming environment. You could ask (yourself) which two or three kids are most likely to be welcoming and kind to this child? Why don’t we create natural ways that these young people can build social networks without thinking it’s been engineered? Let’s facilitate that in a way that makes them feel valued.”
Spotting signs of depression or anxiety
While recognising that all children can be a little subdued when starting at a new school, Dr Fazel suggests teachers might notice more pronounced signs in young refugees experiencing depression or anxiety: “Be aware that the most common problems are low mood and anxiety. Every child will be a bit withdrawn in a new environment, but if a young person is more withdrawn than you’d think, if they’re not able to make friends, if their behaviour changes, and it is difficult to help them get beyond that, it is important to ask colleagues what they’ve noticed and ask the family.
“Check these things before anyone needs to get too worried. It is also important to normalise their responses on some level, to convey that their reaction to the situation is understandable and normal.”
Support and interventions
It seems obvious, but it is vital not to overlook the fact that young refugees have the same needs and aspirations as other pupils, as Dr Fazel points out: “They all seem to want to be a normal kid in England. They want to be friends with kids in their classes and be accepted. That’s what every kid wants, isn’t it?
“They want to make friends and learn the language, so facilitating that might be the most powerful intervention – if no-one at school speaks to you, it’s impossible to practise the language. If you’re worried about the kids, do the basic things first: provide linguistic support, help them feel they can build a peer network. If they’ve come with a family, find ways to welcome them too, to help them all feel part of the school community.”
I asked Dr Fazel her view on the best approach for teachers who felt a child needed help from mental health services. She responded: “The big problem for refugee and asylum-seeking children – as with other vulnerable populations – is that services can seem to be quite difficult to access. It’s important to be aware of that. Some families fear that if there is a problem they will be deported or their child will be taken away. You’ve also got to understand the on-going fears and stigma that are quite prevalent.
“We have very few resources about mental health services available in refugees’ native languages, so it is really important to explain a little about how we work in the UK. Schools often have someone in their pastoral team who’s there to talk to them and advise that schools can sometimes help with referrals to mental health services.
“More services are starting to work in collaboration with schools. It is good to explain what services are available and do what you can to facilitate that next step.”
Should you talk about trauma?
Many of us would be apprehensive about talking to a young person who has experienced trauma, as Dr Fazel understands.
“If you’ve not been trained to deal with trauma the natural response is ‘I don’t want to talk about it; I don’t know what to do if they talk about it; I don’t want to make it worse for that child’. But then the subliminal message these kids get is that nobody in the world wants to talk to them about it and that it is potentially damaging.
“If someone is traumatised,” Dr Fazel explained, “a core symptom is often to avoid any reminder of the trauma. If a member of a refugee family is referred to services, they know they will be asked about the one thing their body and mind tells them to avoid. So it’s difficult to expect a family to willingly come to services they don’t understand and talk about the last thing in the world they want to talk about.”
There is no need, says Dr Fazel, to feel you have to know exactly what to do – willingness to help is the most important thing.
“I think it’s perfectly okay to say ‘I don’t really know how I can help but I’ll come with you to find out. So tell me, are there things that are worrying you? I saw you jump when the door slammed – is that because it reminded you of something bad that happened? If it is, I’m going to help you, I’ll come with you to your first appointment.
“In Oxford we placed mental health services in the school, so teachers can come for the first 10 minutes of an appointment, if needed. The transition into mental health services is then much easier.”
Practical strategies
There are, says Dr Fazel, practical ways in which school staff and pupils can help refugee children settle in, feel comfortable and learn well. A lot of important work can be done even before they cross the threshold, and it is vital also to consider the situation from the perspective of existing students.
“It’s so important that schools prepare themselves before any kids arrive. This is a whole-school responsibility. What can you do to prepare your school in the most creative way, so when these kids arrive, everyone is prepared – and excited? A lot of thought goes into what we do for refugee kids but, actually, what do we do for the host population? No-one seems to be doing that well, I think.”
I asked Dr Fazel if, in her experience, it is helpful for refugee children to form friendships with each other: “Many young refugees say that in the first few weeks or months it is useful to have friends who have gone through similar experiences, but after a couple of months they just want to make friends with the host population. Schools can facilitate that better than anyone.
“Why not create a new football club for kids who’ve never been in a club before?” Dr Fazel suggests. “Or cricket – for many kids from parts of Asia cricket is a massive sport. For girls, we’ve got to be more creative as they don’t seem to want to go to the sports clubs as much – dance or sewing clubs have worked in other places. We need to create lunchtime clubs that are attractive to all the kids.”
Schools can help support families too
“If children have come with their family, there are likely to be many complex needs, so perhaps write things down. Online translation tools can translate into any language, so why not write a little note – ‘Dear parents, just to let you know she’s doing really well, this homework’s going to be quite difficult and this is what it’s about’ – and get it translated?
“There are lots of ways we can make it easier, without too much effort. Just go that little extra step because these kids are likely to have a lot of responsibility at home. If they’re the only person who can speak the host language they’ll probably be helping translate legal documents. Anything to support the parent to maintain their parental role by giving them information is really valuable.”
Classroom activities
Simple activities, suggests Dr Fazel, can help children settle into a new school in a natural and positive way, such as talking about the good things in every culture.
“Syria, for example, is a beautiful, culturally stunning place. How can we help children feel proud about where they come from as well as helping the community be aware of how hard it must be to be displaced? Schools need to help the kids in the class understand this without the refugee kid having to be the main educator.
“What do we think it might feel like to arrive new in a school mid-term? You can prepare the kids without saying ‘by the way, we’ve got one coming next week’. If that work is done a fortnight before a new arrival, who knows what the shift might be?”
Shared meals are also a good way to get young people and families talking to each other, says Dr Fazel: “Some schools invite families to bring in their national dish for everyone to try. There are very positive aspects about every culture and a lot of it is around food.”
Rising to the challenge
The number of people compelled to move countries because of global crises and organised violence is massive. Forced migration affects 60 million people, of whom half are children. I asked Dr Fazel if, in addition to practical activities, there was anything else schools should bear in mind.
“The refugees that come to high-income countries like England are a very specific group. They’re probably the most resilient, resourceful and capable people in their own societies. We need to ask how we can support them because they’ll become incredible resources either for this nation or for their own if and when they choose to return.”
Ten ideas
Here are 10 ways to support refugees and help them enrich school life:
- Prepare for refugees’ arrival well in advance. Stimulate pupils’ interest in their situation and what might make them feel welcome.
- Help refugees learn the host language – a powerful form of support.
- Welcome families too, perhaps by sharing an “international” meal.
- Learn to spot signs of depression and anxiety, such as behaviour changes or prolonged withdrawal.
- If you think a child needs help with their mental health, give them or their family basic information about how our services work.
- Remember that asking a child about something that may be affecting them is unlikely to make things worse.
- Create clubs to help the children mix – football, cricket, dance and sewing are all possibilities.
- Write simple notes home in refugees’ own language, to support parents and carers in their role.
- Talk positively about refugees’ home countries to help them feel proud of where they come from.
- Bear in mind what a potentially rich resource young refugees will be in the future.SecEd
- Clare Stafford is CEO of the Charlie Waller Memorial Trust, a charity that provides fully funded mental health training to schools. Visit www.cwmt.org.uk
Further reading
The Charlie Waller Memorial Trust’s Stella Project has been working with professionals to provide mental health training in order to better support vulnerable learners. This series of articles is part of the legacy the year-long project hopes to leave. For more information, see The Stella Project: Supporting vulnerable learners, SecEd, February 2018: http://bit.ly/2qY0FFV