Nationality and Borders Bill

Baroness Hollins Excerpts

2nd reading
Wednesday 5th January 2022 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I have had helpful discussions with Professor Katona, the medical director of the Helen Bamber Foundation, an organisation working with survivors of trafficking, torture and other extreme human cruelty. Like me, he worked in the NHS for many years as a consultant psychiatrist. The foundation is very concerned about the impact the Bill could have on the mental health of survivors—particularly those who have experienced trauma—and that it could deny them the protection and support they need. I agree with its concern that the Bill will effectively punish and retraumatise asylum seekers and survivors of human trafficking for behaviour and actions that are inextricably linked to the human rights violations and trauma they have already experienced.

Asylum seekers who have come to the UK by what are termed “illegal” means—such as by small boat across the channel—will be given less protection. Even when their asylum claims are successful, they will still be disadvantaged, despite bravely taking the only means available to them to reach safety. I am unclear whether there are any legal routes available so, before I say more, I ask the Minister to explain in her conclusion exactly what legal means there are and how such routes could be made clearer to people seeking asylum and to protect them when they are the victims of people smugglers and traffickers. How can it be humane to grant people recognised as entitled to refugee status only a temporary form of status simply because of their means of arrival? How can it be fair to restrict their rights to both family reunification and financial support? The loss of hope caused by these actions plus leaving such asylum seekers in a state of limbo and permanent fear of return, unable to rebuild their lives, can only add to their mental distress and will build up problems for all our futures. This is manifestly cruel, particularly in the apparent lack of legal means of arrival.

With respect to the proposal that accommodation centres be used to house those seeking asylum, a review of the evidence by the Helen Bamber Foundation shows that accommodation of this kind has similar adverse effects on mental health to those associated with immigration detention. Offshoring can be expected to have similar, but even worse, effects on mental health to those associated with accommodation centres in the United Kingdom. Evidence from Australia’s use of offshoring has shown how it results in severe harm to people’s physical and mental health. More fundamentally, it would result in major limitations on the human rights of the individuals concerned and would give them little or no chance of subsequent transfer to the UK, even if their asylum claims were successful.

On the idea of so-called late evidence and late claims being treated as lacking in credibility or unmeritorious, this ignores the substantial evidence that trauma and other mental health problems make it emotionally very difficult, if not impossible, for survivors of human rights violations—particularly those whose trauma has a sexual component—to disclose fully what has happened to them unless they are given sufficient time and support to facilitate such disclosure. This is so well evidenced for victims of trafficking and of torture. The assessments provided in reception centres already pay scant attention to the mental health of new arrivals, and staff are unlikely—to be polite—to have the skills or time to enable disclosures. Just the retelling of trauma is retraumatising—I know that from my personal experience. Disclosures of abuse and torture require a relationship of trust and the possibility of sensitive and sustained psychotherapeutic help. To give a parallel example, the average time from abuse to disclosure for survivors of child sexual abuse in one inquiry was 35 years.

I do not expect the Bill’s drafters to have been fully aware of the complexity of the mental health risks faced by asylum seekers, but I seek an assurance from the Minister that the impact of some of the Bill’s provisions on the mental health of asylum seekers will be thought about again and the Bill amended accordingly.

Nationality and Borders Bill

Baroness Hollins Excerpts

Committee stage
Tuesday 8th February 2022 Lords Chamber

Moved by

[Baroness Hollins]

119C: After Clause 37, insert the following new Clause—
“Codes of practice
(1) The Secretary of State must prepare and issue one or more codes of practice for the guidance of immigration officers, medical inspectors and other persons assessing the mental and physical health needs of any asylum seeker in accordance with the United Kingdom’s obligations under Article 12 of the International Covenant on Economic, Social and Cultural Rights 1966.(2) The Secretary of State may from time to time revise a code.(3) Before the end of each review period the Secretary of State must—(a) review each code for the guidance of persons exercising functions under this section, and(b) lay a report of the review before Parliament.But this does not affect the Secretary of State’s function under subsection (2).(4) A review period is—(a) in relation to the first review, the period of 3 years beginning with the day on which this subsection comes into force, and(b) in relation to subsequent reviews, each period of 5 years beginning with the day on which the report of the previous review was laid before Parliament.(5) The Secretary of State may delegate the preparation of the review or revision of the whole or any part of a code so far as he or she considers expedient.(6) It is the duty of a person to have regard to any relevant code if acting in relation to a person seeking asylum in one or more of the following ways—(a) in a professional capacity;(b) for remuneration;(c) for a charity or other not-for-profit body.(7) If it appears to a court or tribunal conducting any criminal or civil proceedings that—(a) a provision of a code, or(b) a failure to comply with a code,is relevant to a question arising in the proceedings, the provision or failure must be taken into account in deciding the question.(8) In this section, “code” means a code prepared or revised under this section.”Member’s explanatory statement
This amendment requires the Secretary of State to lay codes of practice before Parliament providing for guidance to assess the mental and physical health needs of any asylum seeker.

--- Later in debate ---

[Baroness Hollins (CB)]

My Lords, Amendments 119C and 119D propose a code of practice for professionals involved in the assessment and care of people seeking asylum. Refugees and asylum seekers often have complex health needs influenced by experiences prior to leaving their home country, during transit or after arrival in the UK. Common examples include untreated communicable diseases, accidental injuries, hypothermia, malnutrition, poor maternity care and inadequately treated mental illness. These are made worse by the barriers to assessment and treatment that they face right from their arrival in the UK to the conclusion of the process and beyond. One common risk factor for poor health and well-being among this community is trauma. This may be the very trauma that they are fleeing from, the trauma of the journey or the psychological distress of overcrowding, the lack of privacy and the absence of culturally appropriate community support upon their arrival.

The World Health Organization reports double the rate of depression and anxiety in a humanitarian crisis; that is worth noting. Mental illness can influence the ability of asylum seekers to present their claims in a coherent way. The assessment of credibility is a fundamental aspect of the asylum decision-making process, and the decision-making immigration officer needs information to make their decision but they may be faced with a person with symptoms associated with a mental disorder and the psychological effects of trauma, such as memory loss, an inability to express or even feel emotions or profound guilt and shame at what they have experienced. Such trauma, which disproportionately affects women, may also lead to a reluctance or delay in disclosure that can negatively affect the application, as already highlighted in Amendment 40, moved by the noble Baroness, Lady Lister of Burtersett.

The current government policy, as set out in the guidance on adults at risk in immigration detention, centres on indicators of vulnerability, including persons suffering from a mental health condition or impairment; victims of torture; those who have been a victim of sexual or gender-based violence; those who have been a victim of human trafficking or modern slavery; and those suffering from post-traumatic stress disorder.

Once a person has been identified as having an indicator of risk, the “adults at risk” policy identifies levels of evidence for that risk. The level of evidence is used as a measure of the degree of risk, which is then weighed against a range of immigration factors when making decisions regarding the immigration process, particularly the detention of the person. However, the Royal College of Psychiatrists has raised concerns that people with significant mental illness may have difficulty in being effective self-advocates or may lack a full appreciation of the extent of their own vulnerability. They may lack the mental capacity to make decisions relating to their immigration situation. Many do not have access to a robust assessment process or, if identified as lacking relevant capacity, to a system designed to safeguard them or advocate for them in their best interest.

The Helen Bamber Foundation says that in its experience persons with significant mental illness, as well as those with evidence of past torture, sexual gender-based violence and those with PTSD, are being detained despite their mental-health-related vulnerability. The assessment and identification of mental health problems requires appropriately trained staff in a facilitative environment as well as close multidisciplinary working.

For some, the treatment of mental illness will require specialist trauma-focused therapeutic support. I am told that this is not happening in existing facilities, such as Napier Barracks. It is intended that through these amendments the mental health, mental capacity and physical health of asylum seekers would be assessed and considered properly on arrival and throughout the asylum claim processes, and that the treatment and care of asylum seekers would be sufficient to ensure their health and well-being by standardising and regulating a process that would apply to numerous agencies, public, independent and third sector.

The Secretary of State said in the other place that the Bill will increase the fairness of our system so we can better protect those who are in genuine need of asylum and continue to strengthen our proud record of supporting those in need. The amendments seek to support the Government in achieving just that. I beg to move.

[Baroness Hamwee (LD)]

My Lords, my name is on this amendment. The noble Baroness, Lady Hollins, knows whereof she speaks, so I shall not attempt to do more than support her. To me, this is a matter of professional judgment, which she has brought, but also of common sense. What I hope is my common sense has been informed by what I have heard over quite some years, including, very significantly, in the debate that we had last week. It is clear that in the UK—it may in this context be England and Wales—the systems, if they can be called systems, for assessing the health needs of asylum seekers are patchy and often inadequate.

It is also common sense that assessment should start from a solid, informed base, incorporating the best, up-to-date understanding and experience, so a review is important. So is consultation with those who are expert in the field. I support the amendments.

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[Baroness Hamwee (LD)]

Before the noble Baroness responds, it may be that this amendment could be worded to put more emphasis on the guidance of those who come into contact with asylum seekers, rather than just assessment. Does the Minister accept that this is a very specialised area? Without for a moment being critical of the NHS, I suggest that that specialism needs to be recognised and learning from it made available to those who come into contact with the cohort we are discussing.

[Baroness Hollins (CB)]

My Lords, I cut my speech rather, because of the time, and I feel that maybe I did not manage to explain adequately. These are people with complex health needs. They are not just like any other patient in the NHS. They have had very difficult experiences and have difficult mental health needs. It is difficult for them to try to explain about their trauma to the first interpreter or the first person assessing them that they meet. This is something where it often takes years for people to trust sufficiently to be able to explain the impact on their situation, their circumstances, and their life chances. This is not just having an assessment and a conversation. It is about building a relationship of trust when people have experienced the most terrible circumstances. That is the difficulty.

I will give one quick example. One still very troubled lady, whose asylum claim was successful, described her claim and subsequent requests for ongoing support as “seriously retraumatising”. The paperwork that she received was confusing and negative in tone, with any success hidden somewhere in the small print. She asked, “Why do they do that to me? Why can’t they communicate with me? Why should I struggle so much? I feel like I’ve been through another fight”. This lady feels like giving up, despite the fact that her claim was eventually successful.

These amendments seek to see people treated fairly, compassionately and with more skill and understanding, so that they have the best hope of healing and settling in the UK. I thank noble Lords who have supported these amendments. I hope that the Minister will think again and accept the spirit of what I have proposed; otherwise, I and others will bring these amendments back on Report.

I beg leave to withdraw my amendment.

Amendment 119C withdrawn.

Nationality and Borders Bill

Baroness Hollins Excerpts

Lords Hansard - Part 2 & Report stage
Monday 28th February 2022 Lords Chamber

[Lord Kerr of Kinlochard (CB)]

I hope the Government accept the amendment from the noble Baroness, Lady Stroud, which clearly is supported all around the House. I believe it is supported in the higher ranks of the governing party. I quote from no less an expert than Mr Dominic Raab in the Spectator from 2 October:

“If they learn the language and they can work, they integrate much better and they make a positive contribution.”


Correct.

The noble Baroness, Lady Ludford, said it is a win-win. No less an authority than the Adam Smith Institute and Bright Blue said that asylum seekers pay increased tax and national insurance revenue and we pay them a lower asylum support payment, and that it is a win for the Exchequer. These are very Conservative arguments, and they happen to be true. It is a win for them and a win for us. I hope the Government accept the amendment.

[Baroness Hollins (CB)]

My Lords, I rise to speak to Amendments 30A and 84A, but I also support the amendments from the noble Baroness, Lady Stroud, and I will explain why as I introduce these two amendments.

I first thank representatives from the Royal College of Psychiatrists and the Helen Bamber Foundation for their support of these amendments. The proposed new clause in Amendment 30A would make provision for the Secretary of State to

“commission a review of the processes and services”

that will be in place and their impact on

“the well-being of refugees and asylum seekers.”

We know a great deal more about the long-term impact of trauma on people’s mental and physical health, their memory and their ability to make sense of their experiences, adjust to a new situation, engage productively in work, advocate for themselves and avoid being retraumatised. The very system designed to protect them, whether by poor design or by poor execution, risks worsening the health of refugees and people seeking asylum, and increasing their vulnerability.

With respect to work, there is evidence that people with mental health problems of any sort who are out of work for more than six months have real difficulty getting back into work—ever. This is a really key, important point. Research by the Royal College of Psychiatrists has evidenced that people with significant mental illness, as well as those with evidence of torture or sexual or gender-based violence, are being detained despite their mental health-related vulnerabilities, and that their mental health is deteriorating further in immigration detention. This remains the case, despite the statutory guidance on adults at risk and associated caseworker guidance introduced by the Government in response to the highly critical Shaw report.

The health needs of refugees and those seeking asylum require close multidisciplinary working, continuity of care and a regular review of these processes to ensure that, unlike what happened in Napier barracks, these systems are working in the way intended. I urge the Minister to commit to a review of the processes and services in place with regard to the well-being of refugees and asylum seekers, carried out by a body with the necessary expertise.

Nationality and Borders Bill

Baroness Hollins Excerpts

Report stage
Tuesday 8th March 2022 Lords Chamber

Given the long-standing and very respectable genesis of ABE in that context—in fact, a psychologist who works with victims of torture told me it works very well as an approach—I hope the Government might accept that work on applying it in the immigration and asylum context would be valuable. I beg to move.

[Baroness Hollins (CB)]

My Lords, this amendment, which I am pleased to add my name to, aligns well with the principles of my own earlier amendments on Report and in Committee. On all the previous occasions, the government response highlighted just how underappreciated the impact of trauma is on the health and recovery of refugees and asylum seekers.

Public Health England has produced advice and guidance on the health needs of migrant patients for healthcare practitioners. This was updated in August 2021 to include advice that practitioners should:

“Consider applying trauma-informed practice principles when working with migrants affected by trauma.”


The guidance emphasised the six principles of trauma-informed practice, including safety, trust, choice, collaboration, empowerment and cultural consideration. I will quote just one paragraph from the guidance:

“Trauma-informed practice is not intended to treat trauma-related issues. It seeks to reduce the barriers to service access for individuals affected by trauma. While more evidence is needed to gain an in-depth understanding of the effects of trauma-informed practice for migrant populations, there is evidence that services provided to vulnerable migrants without a trauma-informed approach can result in harm.”


Unfortunately, the recent report We Want to Be Strong, But We Don’t Have the Chance, published by the British Red Cross in 2022, stated that

“for many women, the UK’s asylum process is not sensitive to gender or trauma and does not provide the support they need.”

It gave examples, which I will not repeat at this time of night, but one of the key recommendations of the report is to

“Ensure each stage of the asylum process is trauma-informed and gender-sensitive”.


This amendment seeks to achieve consistency and accountability in achieving this, with the person at the centre, not the process. I urge the Minister to accept this amendment.

[Lord Coaker (Lab)]

My Lords, I will just make a couple of remarks about this amendment from the noble Baronesses, Lady Hamwee and Lady Hollins, which I support. It is a shame that we are right at the end of the evening—or in the middle of the night, or in the morning, or whatever—because it is one of those amendments that raises a number of really important questions for the Government. It is really quite an appropriate way—not at this time—to end the Report stage, because it encompasses so much of what has been debated on the Bill so far.

We are talking about people who are traumatised, fleeing war, risking their lives; people who have lost their homes and loved ones, experienced extreme violence, and children who have been trafficked and exploited. One of the criticisms throughout the passage of the Bill so far is that we are debating measures that we believe would remove support from these people, damage their credibility, penalise them for not providing evidence neatly to a deadline, as we heard earlier, and make it harder, for example, for modern slavery victims to report abuse. That is a point of difference between us.

I am sure the Minister will say that of course, people will take account of trauma, and they will interview, meet and discuss such issues with these individuals and support them in a way which reflects that. But what this really important amendment is driving at is the absolutely essential need to have a trauma-informed approach. If the amendment does nothing else but remind those who work with victims and survivors that that sort of approach is the best way forward, then it has served its purpose.