title: The Mental Health and Wellbeing of Asylum Seeking and Refugee Populations in High-Income Countries: A Capabilities Approach
Creators: name: Van Der Boor, Catharina
Publisher: name: University of Liverpool Repository
Year: 2022

description: The number of people who have been forcibly displaced is at an all-time high. Forcibly displaced individuals have often suffered acutely distressing experiences pre-migration, during their migration journeys, and post-resettlement in their host countries. Whilst there is a large research base which shows this can have a profoundly negative impact on their mental health and wellbeing, comparatively less research attention has been allocated to exploring indices of positive outcomes for this population. The aim of the current thesis was to understand the predictors of mental health and wellbeing of asylum seekers and refugees post-resettlement in high-income settings. Specifically, the research aimed to shed light on the barriers and facilitators that may hinder or promote positive mental health and wellbeing outcomes for these groups. The focus on positive outcomes allows a shift away from an exclusive focus on the presence or absence of psychopathology alone, to a more holistic consideration of what factors can bring vitality to an individual’s lived experience post-migration. During the initial phase of this thesis, two systematic reviews were carried out to identify existing research on barriers and facilitators of mental health and wellbeing in asylum seeking and refugee populations, including access to mental health services, and wider socio-cultural, political, and environmental factors that may impact on mental health outcomes and quality of life outside of formal healthcare. The findings of these reviews revealed that the bio-medical model may not be an adequate service model for meeting the mental health needs of forcibly displaced populations. Instead, more attention should be focused on non-health sector interventions that use more inclusive explanatory models of health and can increase access to care. Additionally, attention needs to be shifted towards the inclusion of social determinants of quality of life outside of formal healthcare systems. Following on from these literature reviews, the Capability Approach (Sen, 1999) is proposed as a valuable theoretical framework that can inform the evaluation and assessment of mental health, wellbeing, and quality of life outcomes of migrant populations post-resettlement. A crucial argument of the Capability Approach is that wellbeing should be understood as the freedoms (or ‘capabilities’) individuals have to live the kind of life that they have reason to value. Central to this is the social climate into which migrants resettle. To explore this climate, a survey study was carried out to shed light on the perceptions of a sample of community members in the United Kingdom of the capability-based wellbeing of different migrant groups (refugees and economic migrants). The findings of this empirical study highlighted recognition that refugees may have more limited capabilities in the United Kingdom and may not be achieving similar levels of the ‘good life’ as compared to economic migrants and British nationals. To explore the lived experiences of refugees themselves and identify locally relevant dimensions of capability-based wellbeing, a series of focus groups were carried out with refugee women residing in the United Kingdom. An Interpretative Phenomenological Analysis was used, and the findings revealed three highly interconnected themes that were considered necessary to achieve a ‘good life’ post-resettlement namely legal security, social cohesion, and personal agency. These themes clearly confirmed that mental health status and access to formal health systems, whilst important, are not all that matters to mental health, wellbeing, and quality of life for forcibly displaced groups, rather broader social determinants need to be considered. The themes that emerged through the qualitative analysis were subsequently aggregated into a capability-based wellbeing measure for migrant women in high-income settings. This measure was piloted on a sample of migrant women (refugees, asylum seekers and economic migrants) and validity and reliability analyses were carried out. A 17-item ‘Good Life in the Community Scale’ (GLiCS) with three meaningful subscales (i.e. (i) access to resources, (ii) belonging and contributing, and (iii) independence) was developed. The GLiCS demonstrated good internal consistency and construct validity. Furthermore, the findings of this study provide evidence of the validity and utility of operationalizing the Capability Approach for particular populations, and the relevance of developing a measure that speaks directly to the needs of migrant women post-resettlement specifically. Overall, this thesis sheds light on the barriers and facilitators that are directly relevant to the mental health, wellbeing and integration of migrants in high-income settings, and develops an outcome measure inspired by the Capability Approach to assess migrant women’s capability based wellbeing post-resettlement.