Jean fled to the UK from Rwanda in 2001. Most of his family had been massacred in the 1994 genocide. The UK was to be a fresh start for him and his wife and children. He expected people to be welcoming. What he found was something different.
‘People would call us niggers, pakis and names like this. Lads would pelt our house with stones and the police would do nothing,’ he says. ‘We were continually harassed by the locals. If my children wanted to go to the park, the other children would turn them away and say no, go back to where you come from.’
While it is easy to see how this sort of abuse would cause someone to become angry, anxious or depressed, there is increasing evidence that discrimination is a trigger for much more serious mental health problems among migrants.
‘If people feel racially discriminated against, even in a small amount, chronic stress can occur which can then lead to full-blown psychosis in some cases,’ says Susham Gupta, consultant psychiatrist, and co-editor of Migration and Mental Health (2011).
Each year, one in eight people from an ethnic minority are the victims of racial harassment in the UK, with many more reporting what is known as ‘everyday discrimination’.
And with research also suggesting that, depending on the circumstances, a migrant is up to five times more likely to be diagnosed with schizophrenia than a white British person, many are beginning to link the two.
Rather dubious theories have been put forward by psychiatrists in the past regarding the high levels of schizophrenia among migrants. These included there being higher rates of mental illness in the countries migrants had left, that some races are genetically predisposed to problems, or even that drug use among migrants acts as a trigger. All of these have been found to be baseless upon further interrogation.
'The risk of schizophrenia actually goes up for second-generation migrants and this kind of rules out that it has something to do with the shock of migration'
There has been some focus on migrants’ difficulties in adjusting to a new culture as the possible cause – such as language problems, homesickness and lack of support networks – but in fact rates of mental illness, particularly schizophrenia, are even higher in second-generation migrants who are born in the UK.
‘We see a pattern in many studies from all over the world where the risk of schizophrenia actually goes up for second-generation migrants and this kind of rules out that it has something to do with the shock of migration or that they were having problems before they came,’ says Elizabeth Cantor-Graae, associate professor at Lund University in Sweden and author of several ground-breaking studies in mental health and migration.
The reason some mental health problems are even higher in second-generation migrants, she says, could be that the rejection comes from a society they were born in, that is all they’ve ever known.
‘It is very important in human development that not only can you recognize your place in the social context but that you are accepted within it and that’s why this experience of being rejected by the group can be so distressing,’ says Cantor-Graae. ‘And this is particularly true for second-generation immigrants who really feel it is their country, they are going to the same schools, applying for the same jobs and one day, as young adults, they realize that they’re not getting the same job interview opportunities as their housemates who don’t have foreign-sounding names.’
'The stress of not being included in society can have an adverse effect on the brain itself if it takes place over a long period of time'
It has also been suggested that the higher rates of mental illness could be due to a racist or culturally biased medical system. Yet while the misdiagnosis of migrants could indeed inflate the figures, studies which have used mental health professionals from the same ethnic background as the patients seem to suggest that this is not the root cause.
But schizophrenia is a serious condition that involves major structural changes to the brain and, once you have it, you have it for life. So what is it about being discriminated against that could lead to the onset of such a massively debilitating illness? This is where many psychiatrists come unstuck.
One explanation that has been put forward is the ‘social defeat hypothesis’, which argues that the distress a migrant feels on being rejected by the people in the country they move to − whether social, educational and vocational − can actually cause changes in the brain that can then develop into full psychosis.
‘If migrants are exposed to what we call social defeat, and it’s not just any kind of stress, it’s a very specific stress of not being included in society, then this could indeed have a very adverse effect on the brain itself if it were to take place over a long period of time,’ says Cantor-Graae.
Refugees and asylum seekers are particularly vulnerable to a wide range of mental health problems as they not only face discrimination but the arduous asylum procedures they must go through on arrival can exacerbate any traumas they may have suffered in the past.
With deep cuts being made to services for refugees, including a 62-per-cent reduction in the budget of the Refugee Council, many fear that the stresses this group experience will only become worse.
‘The organizations that help ease our situation and set up activities and get-togethers for us are closing down. Even legal aid for refugees may be stopping, which is having a massive impact on refugees and their mental health,’ says Jean. ‘I don’t know how I would have survived without some of these organizations for guidance and help. I might have gone over the edge without them.’