Beyond PTSD: New study reveals pervasiveness of torture effects

Eating, showering and getting dressed. Most of us do these basic activities every day. Many of us also use a phone or some other form of technology on a daily basis and housework and grocery shopping are part of our weekly chores. Performing these and other daily activities come natural to the majority of us, yet for some, even a simple task like brushing your teeth is a daily struggle.

The latest issue of Torture Journal is now online and can be downloaded from the IRCT website.

A recent study in Denmark has established a link between exposure to torture, trauma and post-migration stress in newly arrived asylum seekers and a decreased ability to perform activities of daily living. The researchers behind the report Activity of Daily Living Performance amongst Danish Asylum Seekers: A cross-sectional study used a number of different measures to first determine the health of 43 asylum seekers and then look at their ability to perform basic everyday tasks. The result showed an overwhelming 62% struggled with completing some of their daily tasks.

Across the world, health professionals often refer to activities of daily living (ADLs) when measuring the functional status of a person. While there is much information on how well individual groups such as the elderly or people with disabilities perform ADLs, no larger studies have addressed ADL issues encountered by traumatised asylum seekers and refugees. Although relatively small, the Danish study is a good indicator of what to expect from future studies addressing this issue.

When it comes to measuring a person’s ability to perform ADLs, it is impossible to ignore their health and well-being. Pain in particular, is an important factor when discussing ADL ability, as it is well documented that persistent pain interferes with a person’s ADL performance and social participation.

In the Danish study, which involved asylum seekers from Syria, Iran and Afghanistan, a staggering 72% of the participants reported that they suffered from a pain problem. Alarmingly, most of them had been exposed to torture and many of them showed signs of stress and depression, both of which can contribute to a low ADL score.

Most people arriving in a new country after fleeing war and mass conflict need urgent treatment and rehabilitation to help tackle the trauma and other physical and mental after-effects. Yet, unlike other groups in Denmark that struggle with completing everyday tasks, asylum seekers, tortured or not, do not instantly have access to treatment or rehabilitation.

Many of the specialised rehabilitation centres simply do not offer rehabilitation before the asylum seeker has been granted asylum just as health care and social subsidies remain a privilege for the resident population. Until their pending case is decided and they receive refugee status, asylum seekers only have access to acute medical needs, unless they apply to the Danish Immigration Service for further medical attention.

As the study points out, the right to rehabilitation should in principle be regarded as an obligation to rehabilitate those who are in need. Failing to do so can have far-reaching consequences for traumatised asylum seekers, including social isolation, dependency on others and deteriorating health.

According to the Danish researchers, one way of preventing further loss of ADL ability among traumatised asylum seekers is to provide them with the appropriate rehabilitation upon arrival, and not wait until they have been granted asylum. An argument that is difficult to disagree with when reality is that most asylum seekers have complex health and social care needs that require our immediate attention.

In other words, health impediments that reduce someone’s quality of life must be addressed as soon as possible. After all, something as simple as brushing your teeth should not be a struggle for anyone.

 

To read the latest issue of Torture Journal click here.

Stress and non-clinical staff: SPIRASI director reflects on lessons learned in care for caregivers

Editor’s Note: This is the final blog in a regular series from centres involved in the Peer Support project (more fully described in our introduction blog here). See other previous posts in this series here.

I was discussing our work recently with the CEO of a company who are redesigning our website, and he exclaimed: “I don’t know how you deal with all of that on daily basis. I just don’t know”.

As of this month I have been working with SPIRASI for ten years, and I can’t count how many times I have been asked this question, both professionally and personally. It’s a question that I know others who work with asylum seekers grapple with; but it’s also something that over my ten years of being at SPIRASI we have tried, sometimes with limited success, to deal with.

It’s an important distinction, in this work with victims of torture, for me to state that I’m not a clinician. I’m neither a psychologist nor doctor, although I have been asked a good few times if I’m a priest given that we’ve been founded by a religious order called the Spiritans (I’m not).   Being a non-clinician does mean that I don’t meet with clients to conduct assessments or therapy sessions. Although I do interact with some of the clients of our centre, it’s often unscheduled and normally from a distance. This distinction in our work is important because it can determine not only the impact of the work, but how the response to that impact is often formulated and how readily you can identify the impact.

I think it’s only natural that on the scale of need in the centre for support that I and other administrative staff are often the lowest on that scale – especially when you are aware of the depth of suffering and despair of our clients and what confronts our clinical team. Before the Peer Support Project, we only really thought of the need to support staff in terms of that front line clinical team and along traditional lines, such as individual supervision for therapists. There is an undeniable and demonstrable need to ensure that therapists, social workers and physicians receive regular supervision and support, but the Peer Support Project has shifted this assumption in our organisation. We now accept the need to provide support to those on that lower and less visible end of the spectrum.

Non-clinical team members are impacted by the work. This impact is often through high levels of stress and some vicarious traumatisation and these needs cannot be ignored by rehabilitation centres. Through the use of the Stress Management Cycle (SMC) that was shared by the Antares Foundation, we now have the ability to approach the stress related to the work in a much more systematic and considered way.

As a result of working daily with victims of torture, it becomes a challenge to see beyond the individual needs of victims and focus on self, team and organisation.  The SMC gives us the tools to look at what needs to be in place on a policy level and to ensure that through the time of an employee/intern/volunteer within our organisation, from selection and induction through to post employment support, that we have appropriate mechanisms to support staff, both clinical and non-clinical.

The work is stressful and difficult, and I now readily admit to people like the CEO of our web-design company that it is. But I also make the point to him that it is one of the most rewarding and inspiring jobs that I could have ever wished for and that it’s an honour to work for victims of torture.

By Greg Straton, Director of SPIRASI, Ireland

Progress at Hemayat: new systems, structures and offices in Austria

Editor’s Note: This is the seventh in a regular series from centres involved in the Peer Support project (more fully described in our earlier blog here). See other previous posts in this series here, here, here, here, here and here.

Shortly before the start of our participation in the PEER SUPPORT Project, Hemayat moved to new premises because our old office had become too small. Since the old centre did not have enough therapy rooms, many of our therapists had to work in their own offices. This solution enabled us to still treat more patients. On the other hand, this system led to few opportunities to share experiences and lend mutual support between the therapists. The PEER SUPPORT Project showed us that there is still a lot of work to do to enhance the wellbeing of our staff. In our new space we now do have possibilities to do so.

Since our last blog, some things have changed for the better, as our new organisational structure is now partially in place. The therapists and the translators elected members of their groups to represent their needs and wishes within the organisation. Regular meetings between the managing staff and the representatives of these groups are held to discuss topics concerning the running of the organisation as well as the wellbeing of the staff.

We also started to evaluate our written staff policies: what is in place? What is missing? What needs enhancing? The information we received during the PEER SUPPORT project training in Barcelona helped us to find some of our blind spots concerning the support of our staff and its wellbeing. The therapists decided it would be good for them to have the opportunity to meet outside the office in an informal way. So they now installed a jour-fix and meet in a restaurant. The new intervision system is also about to be installed. Since a lot of the staff will take holiday leaves during the summer, we decided to start in September with regular intervision groups. The response of the staff toward the intervision meetings was favourable – many therapists feel it could help them and their work by sharing their experiences with each other.

In our last blog post, we had mentioned that money is always a big issue. We have very long waiting lists, which puts a lot of pressure on our shoulders. We want to provide the much needed help as quickly as possible. The downside to our new premises is that they are more costly than the old ones. We did not want this to affect the extent of therapy sessions we offer.

We therefore hosted a charity event on 21^st of June. A lot of artists and well-known persons offered their support and we received so many donations that we can even increase our therapy hours!

 

By Nora Ramirez Castillo, psychologist & assistant manager Hemayat.

No state support, little funding: how Bulgaria centre manages to treat torture victims in trying times

Editor’s Note: This is the second in a regular series from centres involved in the Peer Support project (more fully described in our previous blog here). 
In Bulgaria, the problems of asylum seekers and refugees are not being sufficiently discussed. Yet, the problems of torture victims are even more neglected. The attempts to initiate and sustain a dialogue on this vulnerable group of people with Bulgarian state institutions that deal with asylum seekers and refugees have until now been met with disregard. There is no Bulgarian municipality or state-run institution that provides funding for the support of torture victims.

This is the environment in which Assistance Centre for Torture Survivors (ACET) — the only Bulgarian organisation that offers services to torture victims — is trying to develop a rehabilitation programme. Over the last couple of years, the team of ACET has gone through serious funding-related challenges and difficulties.

The team of ACET consists of five psychologists, a psychiatrist, a social worker who is responsible for a great part of the administrative work, and three translators. All of them work part-time. Over the last years, since the professionals have started working part-time, the rehabilitation programme of ACET serves just more than 100 people per year and the consultations take place at the office of ACET, at the Reception Center of the State Agency for Refugees, and at the Special Home for Temporary Placement of Foreign Nationals in Busmantsi.

When we learnt about the option to take part in Peer Support project, our team saw an opportunity for support as ACET was not able to provide its team with stress prevention activities. Due to financial difficulties, we had stopped receiving clinical supervision and having the weekly meetings of the team, as most of the consultants could not invest more time than stipulated for meetings with the clients of the rehabilitation programme.

This is why we saw in Peer Support project as an opportunity for overcoming the fragmentation of the team and its gradual marginalisation, and a chance to create a new model to deal with stress. In addition, the exchange of experiences with colleagues from various European rehabilitation centres has always been inspiring for us, and this project has given us such an opportunity.

During the needs assessment visit in November 2012, we already experienced the advantages of our participation in the project. With the help of the Peer Support project team, we managed to identify some important steps towards improving the communication within the organisation and the planning of our activities. We have identified steps for improving the management of the organisation, the delegation and distribution of administrative tasks that — in the context of a restricted budged — should be managed by the clinical specialists. As a result of the Peer Support project team and the offered recommendations, we renewed the weekly meetings of the team.

The training in the method of intervision during our meeting in Barcelona has enabled the decrease of tension among the team members and triggered ideas about how to overcome the accumulated problems. With the help of the intervision technique, we managed to constructively overcome the misunderstandings in the team related to the communication strategy with the still quite unresponsive Bulgarian state institutions that deal with asylum seekers and refugees.

We are now looking forward to ANTARES’ visit in order to gain insights about creating a pre-accession training for everybody who will become part of our team in the years to come.

By Kristina Gologanova, social worker and assistant project coordinator, Assistance Centre for Torture Survivors (ACET)

Reducing stress for care-givers of torture victims

Editor’s Note: This is the first in a regular series from centres involved in the Peer Support project (more fully described in our previous blog here). 

I am the director of a rehabilitation centre for survivors of torture in Ireland called SPIRASI, and we are a participant on the Peer Support Project.

Last year, SPIRASI helped 600 survivors of torture from 75 different countries.  Approximately 90% of those people referred to the centre from physicians and attorneys nationally in Ireland are seeking protection.  SPIRASI offers a wide range of rehabilitative interventions including medical assessments, therapeutic treatment, social supports, education and assistance with integration.

SPIRASI decided to get involved in the Peer Support project because we all know that the stress and the very subject that we are dealing with — torture — can and does have a real impact on how we perform in our work, in rehabilitating survivors of torture. It seems that as a result we are mostly in a state of disorder and hyper-sensitivity. In the NGO sector, that is a very difficult admission to make. NGOs are under immense pressure to exude professionalism and success. Donors and other supporters expect very high standards and we compete against a myriad of other organisations for support for our cause.

Last December we gathered with our colleagues from across Europe in Barcelona to look at the outcome of visits we received by the Peer Support Project leaders to examine the impact of stress and to begin to put together strategies for coping.

I found the meeting exceptionally helpful. I was immediately struck by the fact that we were not alone in grappling with the effects of stress and trauma and that we all had remarkably similar problems to deal with and exceptionally busy schedules. The input from ANTARES, a foundation based in the Netherlands who work with international humanitarian organisations to help them address such issues, was excellent. They shared with us a model and tools to help with the development of policies and processes. The model provides a life cycle approach to managing stress with staff, with suggestions at each phase, from screening to post-exit supports. We are hoping to adopt many of the good practice guidelines suggested in this model.

I was also taken with a problem solving model that has been championed by bzfo, a center in Berlin, called Intervision. This model helps people with problems through a process that involves empathising with the problem holder, drawing out salient points and providing solutions.

Already the tools and mechanisms that we are acquiring through the project are helping us to become more effective in our work. For example, since the start of the project, we have begun a re-structuring process in our service provision  to draw our therapeutic staff more into the centre of our organisation. This we hope will build greater cohesiveness and aid in better communication. In addition, in light of the discussion on stress, we have looked at decision making in the organisation and have made some important changes by giving more input into decisions to the coordination team and changing our meeting structure.

We are looking forward to the coming follow-up visits and to working more with the Peer Support project team and our European partners.

By Greg Straton, Director SPIRASI