Service Provider Views on Mental Healthcare Access for UK Asylum Seekers Residing in Home Office Contingency Accommodation: A Qualitative Research Study

AIMS: Since 2020, the number of asylum-seekers residing in hotels sourced by the UK Home Office, termed Contingency Accommodation, has increased by over 20,000. Reports suggest that the risk of poor mental health in this population is high. The aim of this study was to help inform improvements to mental healthcare provision for UK asylum-seekers living in contingency accommodation by gaining a greater understanding of perceived barriers and facilitators to accessing care. METHODS: Seventeen semi-structured interviews were conducted remotely with Healthcare Service Providers between June and August 2022. Study Participants were recruited using purposive and snowball sampling to include stakeholders from primary care, secondary care, and third sector organisations. Data were analysed initially using deductive analysis based on the Levesque et al Conceptual Framework. Further emergent themes were identified using inductive analysis conducted sequentially on the data. RESULTS: Twelve themes relating to barriers and three to facilitators to mental healthcare access were identified. The most dominant themes were language barriers and long referral wait times, particularly to access specialist services for torture survivors. Other emergent themes included differing explanatory models of mental distress between Service Users and Providers and fear of authorities and data sharing. Within hotels, there was a lack of standardisation to facilitate mental healthcare access and a reliance on outreach organisations to explain the structure of the health system. Digital exclusion was described in the form of poor reception in hotel rooms and lack of privacy for remote consultations. Perceived mental health complexity was found to act as a barrier to referrals for low intensity psychological therapies such as IAPT being made and accepted. There was a lack of consensus amongst stakeholders about the appropriate time in the asylum journey to refer for trauma-focused therapy. Voluntary and community services (VCS) were described as plugging gaps in mental healthcare, but their role was ill-defined and concerns were expressed about sustainability. CONCLUSION: This study identified complex and intersecting barriers at individual, community, health-system, and structural levels which, if addressed, could improve access to mental healthcare. Further work is required to quantify the burden of mental ill health amongst this group and to triangulate findings from this study with views of the asylum-seeking population. Specifically, this study highlights the need to establish exactly how VCS are meeting mental healthcare needs and how they can be better integrated into the healthcare system. Further research exploring the timing of trauma-focused therapy is also warranted.