2. Lawyers for Human Rights is a national non-profit organisation with its head office in Pretoria, South
Africa. LHR’s principal aims and objectives are to promote, uphold, foster, strengthen and enforce all
human rights in South Africa.
Acknowledgments
This report describes the activities of one of Lawyers for Human Rights (LHR)’s more recent Projects, The
Psychosocial Rights of Asylum Seekers and Refugees Project, run in collaboration with CSVR (The Centre
for the Study of Violence and Reconciliation) since August 2013. Funding was provided by UNHCR.
Several individuals and organisations were and continue to be instrumental in implementing the PRASRP.
We are grateful to UNHCR, which funds the Project; to Dr Njogu Patterson of UNHCR, who believed in
LHR’s proposal and facilitated the initial funding; to Luzelle Lestrade of UNHCR, who diligently supervised
and eased the collaboration between all the organisations involved; to Marivic Garcia of CSVR and Claudia
Serra of RAO, who gave essential inputs to the original idea; to the management and the staff of CSVR,
who are indispensable partners in the realisation of PRASRP activities; to the management and the staff
of Jesuit Refugee Services and Future Families, who offer invaluable support to our clients; to Sheenaz
Pahad and Kirsten Thomson of the Wits Reproductive and HIV Clinic, knowledgeable providers of relevant
training. To the shelter in Lenasia and the Bienvenu Shelter in Bertrams, which welcome and assist the more
needy of our beneficiaries.
A special thank you to all the interns and volunteers who dedicate their time and commitment to the
Project.
This report is for Thete, and for all our clients who, every day, teach us resilience, courage and strength.
Design and layout: www.itldesign.co.za
3. 1
TableofContents
Introduction and background to the project
Impact of post-traumatic stress
disorder on a refugee claim
Introduction and background to the project
01
02
03
04
05
06
Other barriers to psychologically challenged
asylum seekers and refugees in accessing rights
Goals of the project
The implementation of the project
Advice and recommendations
07 Bibliography
2
5
8
10
12
15
16
4. MENTALHEALTHREPORT
2
INTRODUCTION AND
BACKGROUND TO
THE PROJECT
L
awyers for Human Rights’s (LHR)
Psychosocial Rights of Asylum Seekers and
Refugees Project (PRASR), funded by the
United Nation High Commissioner for Refugees
(UNHCR) and supported by the Centre for the
Study of Violence and Reconciliation (CSVR)
was launched in 2013 to provide holistic support
to vulnerable refugees.
It recognises the negative impact that violence,
traumatic events and difficult living conditions
have on the mental health of refugees and
asylum seekers living in South Africa. It applies
a holistic approach to the problem of the
psychosocial barriers preventing refugees and
asylum seekers from fully enjoying their human
rights and brings together not only lawyers but
also psychologists, psychiatrists, social workers
and social assistance organisations.1
LHR’s role is to provide legal services to this
vulnerable group while liaising with government
and other stakeholders to ensure a rights-based
approach to identify, prevent and reduce the
effects of psychological disorders among the
migrant population.
1
The project has been most active in Gauteng,
operating from LHR’s offices in Pretoria and
Johannesburg. Therefore the information
reported here refers to the population of interest
in Gauteng. However, training has also been
conducted in Musina, Cape Town and Port
Elizabeth.
Situations of rape, torture, harsh detention
conditions, destruction of personal assets, killing
of family members, separation from communities
and families, discrimination and violations of
basic human rights affect most asylum seekers
and refugees. They are forced to flee their home
countries, often without warning, which causes
further stress amid cultural differences, uncertain
future, xenophobic violence and racism.
The consequences of an inadequately treated
psychological disorder are profound. This group
faces increased difficulties in obtaining and
renewing their documentation, often neglect
to renew their permits, suffer unlawful arrest
and detention, are isolated, become victims
of further violence and abuse and have more
trouble finding employment and accessing
education and other basic services.
They are also made easy prey for various kinds
of psychological and sexual exploitation.
01
5. INTRODUCTIONANDBACKGROUNDTOTHEPROJECT
01
3
In 2012, LHR began informal meetings with the
UNHCR and other service providers, such as
the Refugee Aid Organisation (RAO), Jesuit
Refugee Services (JRS) and the CSVR where
our most vulnerable clients were discussed. This
brought about the realisation of the need to
address similar complex cases in a collaborative
way through multiple strategic role-players.
PRASR provides a unique opportunity to
address all aspects of a client’s problem and not
just provide legal assistance within a vacuum.
The focus is on those vulnerable clients who
struggle even more than their counterparts in
accessing documentation and other essential
services and as such are in more urgent need
of assistance. An example of this are single
mothers with small children, victims of gender-
based violence, victims of torture, homeless
clients and HIV positive refugees.2
The scope of our meetings was to highlight the
need for urgent intervention and review any
and all potential avenues of support and aid
assistance, including advocacy, when long-term
intervention was required.
The intervention through advocacy was
particularly relevant because local NGOs often
can only guarantee short-term social assistance
to asylum seekers and refugees – generally for
the first three months of their arrival in South
Africa.
This is contrasted against recognised refugees
who have access to social grants from the
Department of Social Development, in line with
the criteria applied to South African citizens.
The reason for focusing primary on short-term
relief is that, in South African law refugees and
asylum seekers have freedom of movement and
the right to work and study during their stay.3
The assumption, then, is that after a period of
initial orientation upon arrival in South Africa,
this group will be able to find employment and
provide for themselves and their families.
2
The term “refugee” will be used in this report to
include both recognised refugees and asylum
seekers, unless a specific indication of the legal
status of the person is needed.
3
http://www.home-affairs.gov.za/index.php/
immigration-services/refugee-status-asylum
This is part of the concept of “independent
livelihood” embodied by the Refugees Act.
Unfortunately this assumption does not
correspond with the reality of the situation.
Given the already high levels of unemployment
and poverty in South Africa, a large amount of
refugees and asylum seekers must battle to find
a decent living to support their families. Due to
the lack of employment opportunities, many
turn to informal trading.
We realised that a large number of our most
vulnerable clients also presented with some
form of psychological illness4
that was not
always properly recognised and/or did not
receive adequate treatment.
In the case of psychologically-affected clients,
their vulnerability is frequently exacerbated by
an inability to take care of themselves due to their
affliction. This incapacitation leads to gaps and
limitations in the social and medical assistance
they receive. More still, it affects the way in
which their refugee claim is handled, not only by
the adjudicating authorities – the Department
of Home Affairs - but also social assistance
organisations, resulting in serious repercussions
on their ability to access documentation.
It will be explained in detail further in this report
how severe trauma can impact on the ability
of a person to coherently relay their story in a
manner which would satisfy an adjudicator as
to the veracity and credibility of an applicant’s
story.
It is important to remember that while anyone
can be a victim of a traumatising event, the
effects of trauma vary from person to person. The
devastation of trauma, however, is undeniable
on a person’s behaviour and cognitive
reasoning. This has dire consequences on the
narrative abilities of an asylum seeker and, most
concerning, on how their credibility is perceived
by those in charge of status determination.
4
Terms such as “psychological disorder”,
“mental health challenges”, “mental illness” and
“psychological illness” refer broadly to any kind
of long or short-term effect on the psychosocial
well-being of a person. No specific medical or
clinical interpretation should be argued from
them.
3
6. MENTALHEALTHREPORT
4
Preliminary discussions with partner
organisations helped us to identify further
limitations in the assistance we were able to
provide to our most vulnerable clients. We did
not have in place a proper system of referrals
between our organisations, communication
between ourselves as service providers
and relevant government departments and
stakeholders (including the Departments of
Home Affairs, Social Development and Health,
psychiatric centres and shelters) was limited,
our staff lacked specific and professional
training on how to better relate to these clients
and the information about where we could find
additional resources were hard to find.
The obvious consequence was that many of
our psychologically vulnerable clients would fall
through the cracks of the system without being
able to access their basic human rights.
At the end of 2012, with the aim of raising
awareness on the issues and brainstorming
ways forward, the UNHCR, in cooperation with
LHR, extended a discussion to the migrant
communities, relevant government departments
and Weskoppies Psychiatric Hospital.
A sensitisation event was organised in Pretoria
in December 2012. The conference, attended by
representatives of the International Organisation
for Migration (IOM), the CSVR and other NGOs,
attracted a wide audience and underlined the
need for prompt intervention. This brought to
light the need for culturally sensitive approach
to the concept of mental illness.
It also highlighted the difficulties that migrant
communities find themselves in when facing
inadequatesupportformentalandpsychological
challenges, a lack of resources and the stigma
and discrimination against such persons. This
inevitably results in feelings of isolation and
exclusion.
The debate among stakeholders continued and
agreements of cooperation were cemented.
7. IMPACTOFPOST-TRAUMATICSTRESSDISORDERONAREFUGEECLAIM
02
5
A
nxiety, depression, stress and post-
traumatic stress disorder (PTSD) were
found to be the most common types of
psychological problems experienced by asylum
seekers and refugees.
Several factors worsen these disorders,
including torture, exposure to mass violence and
aggression, bereavement, loss of family, language
and cultural difficulties, unemployment, poverty
and discrimination, xenophobic attitudes and
cultural bias from the local population.
Extremely long waiting periods and delays on
claim assessments often act as an additional
stressor because of its continuation of feelings of
instability and uncertainty in the life of an asylum
seeker. The sense of precariousness, not only by
the fear of being arrested and deported but also
by the inability to find regular occupation, study,
open a bank account or find a stable and decent
accommodation often exacerbates anxiety.
It is important to note a few considerations about
how the consequences of trauma, and of stress
and anxiety, negatively impact on the freedom
and liberty of these clients.
Due to incomplete and uncertain physical
evidence (for example, identity documents left
behind during flight), the decision of whether
to grant refugee status often rests almost
entirely upon the perceived credibility of the
asylum seeker’s testimony and how convincing
and consistent their story is. Unfortunately,
credibility is notoriously difficult to determine.
The substantive interview of the first instance
adjudicator, the Refugee Status Determination
Officer (RSDO) relies almost exclusively on
autobiographicalmemory.Psychologicalresearch
tells us that autobiographical memory is subject
to distortion, decay and even false memories.
Experimental studies show that some information
is not encoded in memory or is poorly encoded,
making it difficult to access. For example, memory
for specific dates, times, duration, frequency and
sequence of events is especially variable between
individuals and prone to errors.
PTSD, in particular, was proven to have a severe
impact on how a person recalls traumatic
events and, as a consequence, is able to report
them. The typical symptoms of PTSD include
disruption in the ability to process information,
emotions and physiological functioning and as a
result leads to a progressive failure to integrate
traumatic experiences into personal meaning
frameworks.
This translates in memory loss, memory blocks,
inconsistencies in the narrative regarding time
and space, dissociation and late or non-disclosure.
IMPACT OF POST-TRAUMATIC
STRESS DISORDER ON A
REFUGEE CLAIM
02
8. MENTALHEALTHREPORT
6
“The failure to adequately elaborate
and process the traumatic experience in
memory is also manifest in the emergence
of habitual avoidance strategies that impair
the integration of trauma experiences into
memory.
Trauma experiences can also alter the
perception of time and distort time
sequencing; interfere with spatial
perception; produce memory blocks,
including, in extreme circumstances,
amnesia for complete or partial details of
an event; produce dissociative phenomena
where the person is not fully in touch with
reality such as flashbacks, derealisation
and depersonalisation; generate ongoing
impairments in concentration; and create a
tendency to hyper-arousal and startle when
confronted by environmental cues and
triggers reminiscent of or resembling the
traumatic event.”
“The late or non-disclosure of applicant
information within the RSD procedure may
lead to inconsistencies within a testimony
and is assumed to indicate fabrication.
However, disclosure is influenced by a
number of psychological factors, including
memory, trust, culture, emotions during
disclosure (e.g. shame, depressed mood)
and the emotional content of the events
disclosed (possibly leading to dissociation,
avoidance, breakdown of narrative).”5
Despite legal decisions meaning to be impartial
and without bias, there are a number of
assumptions made by decision makers and by us,
legal counsellors, relating to the credibility of a
person’s testimony.
Studies show that an interviewer often bases
decisions on what they would have done in the
same circumstances. For example, testimonies are
judged to be more credible when the emotions
displayed while giving a testimony are seen as
being congruent with its emotional content.
5
Part I—The mental health impacts of migration: the
law and its effects. Failing to understand: refugee
determination and the traumatised applicant -
International Journal of Law and Psychiatry 27 (2004)
511–528. Steel-Frommer-Silove
However, typical symptoms of PTSD are emotional
dissociation and depersonalisation, which allow
situations where no particular feelings are shown
while delivering a narrative. This can be totally
misleading for the non-expert decision maker
and suggests that it is more difficult for people
not reacting in the manner expected by decision
makers to be perceived as being truthful.
It should not be overlooked that the symptoms of
PTSD may not only last for several years after the
traumatising event/s, but they might also manifest
quite some time (even years) after the event/s.
It is quite plausible that significant numbers of our
clients suffer from PTSD or from any kind other
psychological or psychiatric condition, when they
approach us and/or the decision makers.
An overwhelming body of evidence demonstrate
that populations exposed to mass trauma
and conflict are at heightened risk of ongoing
psychological distress and psychiatric illness.
The impact of such disturbances in mental state
on refugee determination becomes particularly
important.
In South Africa there are no guidelines for
RSDOs and Refugee Appeal Judges to follow
in interpreting the various ways in which such
psychological symptoms may manifest or how
they may affect the presentation of the applicant’s
evidence. There is no requirement for decision
makers to seek expert psychological evidence
even in situations where applicants present with
complex traumatic histories.
It is clear that the failure to obtain such evidence
can profoundly undermine the ability of the
decision maker to interpret an applicant’s claim
adequately. Of equal concern is the willingness
and/or capacity of decision makers to make
appropriate use of expert psychological evidence
presented to them.
9. 7
This is despite the very clear guidance provided in
the UNHCR Handbook Guidelines, B (1), 196.6
“While the burden of proof in principle
rests on the applicant, the duty to ascertain
and evaluate all the relevant facts is
shared between the applicant and the
examiner. Indeed, in some cases, it may be
for the examiner to use all the means at his
disposal to produce the necessary evidence
in support of the application.”
Research and relevant practice suggest that, as
traumatic memories are processed, the recall of
events changes and stress symptoms subside.
Therapeutic interventions have been successful
in treating PTSD which gradually facilitates
the processing of traumatic memories. The
6
HANDBOOK AND GUIDELINES ON PROCEDURES
AND CRITERIA FOR DETERMINING REFUGEE
STATUS - under the 1951 Convention and the
1967 Protocol relating to the Status of Refugees
Reissued Geneva, DECEMBER 2011
result is generally greater organisation and
less fragmentation in trauma memories and
an associated reduction in PTSD symptoms.
The natural process of recovery from a trauma
seems, in part, to involve the organising of
memories associated with the trauma, as well
as the ability to access these memories in an
intentional or strategic way.
Without therapeutic interventions, however,
and without the will and the ability of the
legal practitioners, RSDOs and RAB judges
to recognise the effects of trauma, stress
and anxiety on the narratives of applicants, a
consistent number of our clients is at risk of
having their right to protection and asylum
unlawfully denied.
*Karim, a Sudanese asylum seeker, had had his permit renewed 12 times before RRO officials
refused to renew it again, claiming a fault of the electronic documentation system.
Karim then approached LHR for help. Having spent about seven years in the country and denied
a hearing with RAB, he remained undocumented through no fault of his own.
During our first consultation, Karim was inconsolable over his precarious situation. Due to the
nature of his situation, Karim could not be employed full-time and had to acquiesce to stipends
for his work and was often arrested, sleeping in police cells while his status was verified.
Followingthisinitialassessment,wedeterminedthatKarim,despiteneedinglegalintervention,
was also in desperate need of counseling to try and stabilise his mental well-being.
Counseling revealed that Karim had endured harrowing experiences while in Sudan. Due to
alleged political affiliations not approved by the Sudanese government, members of his family
had been killed and he himself had spent a long time in prison, possibly being subjected to
torture.
While Karim was undergoing counseling, LHR succeeded in scheduling a date for his RAB
hearing. After a few months of counseling, Karim was ready to tell his story in a consistent
way without becoming too emotional, which would have compromised his hearing.
Alongwithcourtpapers,LHRfiledadetailedreportfromKarim’scounselorthatcorroborated
his testimony. The report went further to say that he had never had an opportunity to
cope with these experiences. Challenging living conditions in South Africa had worsened his
mental health.
The counselor warned against deporting Karim because his emotional stability would be
irreversibly damaged by having to go return to a place still not safe for him and full of horrific
memories. The RAB showed consideration of these arguments and granted him refugee status.
This decision translated in a very positive change in the attitude for Karim as he is now able to
continue his life.
*Not his real name
CASESTUDY
IMPACTOFPOST-TRAUMATICSTRESSDISORDERONAREFUGEECLAIM
02
10. MENTALHEALTHREPORT
8
W
hen we began focusing our attention
on the specific barriers that
prevented clients from accessing
legal protection, we realised that, in addition
to the necessity of an intensified cooperation
with counsellors and mental health practitioners
on issues of credibility, the following situations
needed to be addressed:
1. Our clients battled to access not only
our services but also those of the
Department of Home Affairs for a
number of reasons: They gave priority
to social assistance; there was a lack of
mutual understanding, language barriers
between them and the legal practitioners
and Department officials; our clients
feared discrimination and stigma; they
did not trust the interviewer; they were
misinformed about services, including
legal, available to them; sometimes they
abused illegal substances to cope with
their disorders and became difficult to
handle; they had no access to funds for
transport; they were occasionally violent
or aggressive and their attitude provoked
rejection from legal counsellors; they
were discouraged by xenophobic
attitudes from service providers.
2. There was a lack of knowledge around
issues related to mental health among
human rights practitioners, RSDOs and
RAB judges.
3. Proper communication was lacking
among service providers on issues
that had the potential to impact their
relationship with the legal counsellor.
This included information on substance
abuse or the presence of a mental
or physical condition (HIV, diabetes,
epilepsy are all physical illnesses that
have serious links with a person’s mental
health).
4. No proper policies and practices are in
place within government departments
and bodies. This is particularly true of
the Department of Home Affairs and
RAB.
5. The refugee claim assessment takes an
incredibly long time, instead of the six
months prescribed by the law.
OTHER BARRIERS TO
TRAUMATISED ASYLUM
SEEKERS AND REFUGEES
IN ACCESSING RIGHTS
03
11. OTHERBARRIERSTOPSYCHOLOGICALLYTRAUMATISEDASYLUMSEEKERSANDREFUGEESINACCESSINGRIGHTS
03
9
6. Mentally ill applicants are mistreated
and discriminated at refugee reception
offices.
7. There was limited or no availability of
dedicated and informed pro-bono legal
services.
8. Mental illness was identified late or not
at all; the medical institutions would
deny intervention.
9. Structured and planned interventions
for clients discharged from mental
health facilities were absent. In the
absence of adequate arrangements,
institution staff would sometimes refer
undocumented patients back to the
Department of Home Affairs with the risk
of unjust detention and deportation.
10. Mentally challenged children were
unable to attend special needs schools
and exercise their right to education.
11. There was no statistical information
about the size and characteristics of the
problem among the refugee population.
The negative consequences for our clients were
several.
One of the worst was that these clients
remained undocumented for long periods of
time. As a result of their lack of documentation,
they struggled to access legal, health and social
services, let alone employment to provide for
themselves and their families. HIV, diabetes,
epilepsy and other serious conditions were left
untreated.
They would spend long periods in detention
without assistance and medication, in situations
that would only contribute to the deterioration
of their mental state.
Paradoxically, some of our most traumatised
clients were unable to obtain refugee status
because of their inability to formulate their
claim in a credible manner. Therefore they could
not benefit of the social disability grant, even if
unable to keep a regular occupation due to their
condition.
Discrimination, stigmatisation and isolation
by migrant communities increase the chances
of homelessness, joblessness and sexual
exploitation with the constant danger that this
particular category of clients become victim of
sexually transmitted diseases.
12. MENTALHEALTHREPORT
10
P
RASR’s main purpose is to crumble the
barriers between our clients with mental
disorders and the enjoyment of their civil,
social and human rights, including the right to
documentation, a just and fair refugee claim
assessment process, health, special assistance
and the right to work and education.
The main goals are7
:
`` Offer informed and knowledgeable legal
assistance to psychosocially affected
refugees
`` Improve access to proper documentation
`` Strengthen cooperation with other service
providers, improve referral systems and
facilitate access to the services for these
clients
`` Collect statistical data on the size of the
migrant population affected by mental
illness, the type of mental disabilities and the
main challenges
`` Train legal and human rights practitioners
to offer informed and knowledgeable legal
assistance
`` Offer training to officials at the Department
of Home Affairs and cooperate with them to
7
Limited to the Gauteng
introduce specific policies and practices so
claims are adequately assessed
`` Fast-track the claim assessment procedure
at the RAB so that clients can be granted
refugee status in a reasonable amount time
or at least not kept in situations of uncertainty
`` Facilitate and speed up resettlement and
repatriation processes, in particular
when they would lead to family reunification
and/or access to long term assistance
`` Enforce the rights to health (both physical
and mental health) of psychosocially affected
refugees; facilitate access to counselling and
medication and ensure they benefit from
long-term assistance, when necessary
`` Enforce the right to social and/or disability
grants of mentally ill clients
`` Promote access to curatorship for refugee
clients with a mental illness that limits their
legal capacity
`` Liaise with other government departments
(including social development, health and
education) and other service providers
like hospitals, schools, police stations and
detention centres
GOALS OF
THE PROJECT
04
13. GOALSOFTHEPROJECT
04
11
*Rahel arrived in South Africa 10 years ago as an Ethiopian asylum seeker. She had been
a political activist in her home country and for this was arrested and tortured repeatedly.
Her family, too, was targeted because of their strong political opposition. Their family
business was forced into bankruptcy for this opposition. It ultimately led to the brutal
deaths of Rahel’s father and one of her brothers. Both she and her fiancé fled Ethiopia
but lost contact along the way.
When Rahel arrived at LHR she was in the grips of uncontrollable anxiety brought
on by severe paranoia. This paranoia led her to seek out some sense of security by
spending several nights at a police station out of fear of possible attackers.
Her emotional state was worsened by several xenophobic attacks since arriving in
South Africa – one of which resulted in rape.
LHR referred Rahel to the Weskoppies Psychiatric Centre in Pretoria for three
months for treatment and to allow her time to recover physically and psychologically.
It was only after her discharge that we were able to piece together her account of
events. She continues regular counseling from CSVR.
Working with her counselor, LHR has prepared Rahel for her RAB hearing. We also
submitted a psychosocial report to the RAB and are hopeful it will be taken into
consideration.
Rahel still battles to cope, which is made all the more difficult due to her struggle to find
employment.
* Not her real name
CASESTUDY`` Raise awareness among migrant
communities about the rights of clients and
the services available to them and the ways
communities can cooperate to give proper
support to their members
`` Implement a specific capacity-building plan
to train staff like doctors, nurses, social
workers and teachers
`` Consider strategic litigation when necessary
`` Lobby the government for the application
of relevant national and international
regulations that would increase the rights of
this specific group but also contribute to the
enforcement of existing rights
14. MENTALHEALTHREPORT
12
From the start of the PRASR Project, LHR has
assisted roughly 60 to 80 clients every quarter
from its offices in Pretoria and Johannesburg.
Some of the matters dealt with were of
relatively quick to resolve while others were in
need of long-term assistance, not only because
the assessment of the client’s claim sometimes
required urgent attention to their psychosocial
well-being but also because of various legal
issues needing intervention.
It is, therefore, difficult to indicate exactly the
total number of individuals assisted by PRASR
at a particular point in time, nor it is possible
to say whether those numbers mirror the
percentages of persons affected by some sort
of mental illness within the migrant communities
that access our services.
This was due to the limited capacity of the
project in terms of staff, restricting the ability to
collect thorough statistical reports and because
of the stigmatisation of mental illness among
the refugee population, which makes them cagy
on these arguments.
It is hoped to collect more thorough statistics in
future, when further resources are attained.
It is possible to reach a few summary conclusions
regarding some characteristics of the migrant
population afflicted by mental illness in South
Africa:
a) the majority of assisted clients were
women, mainly from the Congolese and
Ethiopian communities, but we have seen
an increase in the number of men seeking
psychosocial help
b) the Somali community is less represented
and mainly in conjunction with the
psychological impact of xenophobic
attacks
c) the most traumatising events brought to
our attention were rape, gender-based
violence and torture but uncertainties
linked to the unreasonably long duration
of the refugee claim assessment and
xenophobic attacks also ranked high as
main stressors
d) a considerable number of clients
periodically regressed from a previously
reached psychological health due to the
lack of continuous medical and social
support.
One of the most important steps in the
implementation of the project was to intensify
the cooperation between LHR, CSVR, UNHCR
and other UNHCR partner organisations.
A regular system of referrals between the
organisations, in particular between LHR and
CSVR, has been established so that clients
mutually recommended by the two organisations
receive immediate attention. Counsellors from
the CSVR pay weekly visits to LHR offices in
THE IMPLEMENTATION
OF THE PROJECT
05
15. THEIMPLEMENTATIONOFTHEPROJECT
05
13
Pretoria and LHR regularly approaches the CSVR
for psychosocial reports to support refugee
claim applications and access to health care and
education.
Beside the psychiatric assistance our clients
benefit from in Johannesburg, from August
2015, due to cooperation between the CSVR
and Weskoppies Hospital, these clients can now
access the same services at LHR’s Pretoria office.
In addition, LHR acts the case manager for
monthly mental health case discussions, held
between us, UNHCR, CSVR and other social
assistance organisations, including Future
Families and JRS.
A competent person has been appointed as
representative for each organisation.
This close cooperation allows for a more holistic
and structured approach to the matter. The
joint offer of legal assistance, counselling and
social services, produces a more effective
and time sensitive targeting of the problem, a
timely exchange of opinions and advice, the
development of specific relevant skills and an
increased accountability of each organisation.
Xenophobic attacks and tribal infighting are often
the causes of psychological breakdowns among
our clients. LHR has succeeded in advocating
for and speeding up a few resettlements of
clients to countries where they can feel safer and
access lasting psychological support. UNHCR
has favoured the resettlement of three clients to
Finland, two to Australia and a few others to the
United States and Canada.
Trainings on issues of mental health among the
migrant population are regularly offered to LHR
staff, which not only refer to the type of mental
illnesses that might affect our clients but also
on the ways we can recognise these problems,
write appropriate referrals and better deal with
the clients affected, in particular when they show
aggressiveness and/or abuse of substances. The
trainings include information about the links
between HIV and mental health.
During these trainings, important information
is shared also with regard to the effects of
“burnout” and “compassion fatigue” that might,
and often does, affect practitioners working with
severely traumatised clients. In order to ensure
that the psychosocial well-being of our staff is
not forgotten, recently special attention has been
devoted also to self-care practices.
Further trainings and workshops have been
offered by LHR, in cooperation with CSVR and
counsellors from the Wits HIV Clinic in Musina,
Cape Town and Port Elizabeth. These were
attended by a large number of human rights
practitioners, social workers, community leaders
and representatives of the Department of Home
Affairs and other relevant departments and they
helped, among other things, to map the services
already available locally and plan for feasible
improvements of the existing reality.
In several occasions, LHR has endeavoured to
engage migrant communities on mental health.
Meetings have been held with the Somali
community in both Pretoria and Johannesburg,
the Eritrean community in Pretoria, the
Congolese, Rwandese and Burundian
communities in Johannesburg (Bertrams and
Yeoville). A discussion has begun with the Oromo
community in Secunda, Mpumalanga.
A channel of communication and mutual
assistance has been established with Weskoppies
in Pretoria and Sterkfontein in Krugerdorp:
Training has been offered to the two hospitals’
staff (particularly social workers) on the legal
status of asylum seekers and refugees in the
country. The intervention of the social workers
has been instrumental in a few circumstances
to advocate the case of our clients with the
Department of Home Affairs and to get them
refugee status.
Both Weskoppies’ and Strekfontein’ staff
have been very supportive in placing some of
our clients in long-term care after they were
discharged from the main wards where they
received urgent and primary care.
The psychosocial reports we request from
psychiatric institutions and the CSVR have
been useful in preventing our clients having to
pay overstay fines when we were able to prove
that the client did not neglect to renew their
documents but were unable to do so because
they were admitted to hospital at the time when
the renewal was due and/or was not in a sound
state of mind around that time.
16. MENTALHEALTHREPORT
14
Despite our initial intentions, PRASR has not been
able to interact consistently with RAB for us to
have a say on issues of credibility of these clients.
This in particularly because, for a large part of the
project, the RAB has not been functioning.
Nevertheless, in one occasion, RAB accepted to
consider the written report and oral opinion of a
psychologist from CSVR in support of our request
as expert witness evidence to grant refugee
status to a an asylum seeker from Sudan whose
mental health had been severely compromised by
the trauma encountered in his country of origin
and who would incur in irreversible psychological
damage if he was returned.
We are assisting a few other clients with similar
issues and hope for the continuous consideration
by the RAB.
Unfortunately the feedback from the Department
of Home Affairs regarding the impact of mental
health on the documentation issue for our
clients has been inconsistent: The mental illness
is acknowledged by the Department in solving
access problems, fine issues and, when possible,
to fast-track the appeal procedure but it has not
worked as valid argument in order to obtain more
rapid RAB decisions, nor has helped to facilitate
and accelerate access to file contents.
LHR participates to the Migrants Health Forum
that has monthly meetings at the Wits HIV Clinic,
supporting and contributing to the research and
lobbying of the group with the Department of
Health, with regard to issues of mental health.
In September 2015, Sophiatown psychological
services in Bertrams, Johannesburg, together
with LHR, arranged a meeting between various
refugee organisations to improve implementation
and coordination of the services already
available to our affected clients. The meeting
was important in shedding light on the lack of
sufficient support for families with children with
mental disabilities, who are often rejected by
hospitals and special educational institutions,
even before an assessment of the intellectual
capacity of the child has been conducted.
In terms of relevant applicable legal instruments, it
has been recognised that South Africa is ahead of
other African countries in terms of mental health
legislation. In particular the Mental Health Care
Act no 17 of 2002 is consistent with international
human rights standards and provides for a
system which helps with monitoring mental
health services.
Further, the government has acknowledged the
need to increase the budget and the activities
towards mental health care through the
introduction of the National Mental Health Policy
Framework and Strategic Plan 2013-2020.
Unfortunately there are challenges to the
implementation of the above-mentioned
provisions and policies, not only with regard
to the migrant population. LHR will work in
conjunction with other partner organisations to
ensure the realisation of these provisions.
LHR intends as well to take advantage of
the recent ratification by South Africa of the
International Covenant on Economic, Social and
Cultural Rights (18 January 2015, which came into
force on 12 April 2015).
Article 12 of the Covenant recognises the right
of everyone to “the enjoyment of the highest
attainable standard of physical and mental
health. States must protect this right by ensuring
that everyone within their jurisdiction has access
to the underlying determinants of health, such
as clean water, sanitation, food, nutrition and
housing, and through a comprehensive system of
health care, which is available to everyone without
discrimination, and economically accessible to
all.”
The same Covenant provides for an individual
complaint mechanism (such as exists for
the other major international human rights
treaties, including the International Covenant
on Civil and Political Rights). This mechanism
further promotes a culture of accountability
for implementing the ICESCR. It empowers
vulnerable and marginalised groups to lodge
individual complaints at the international level
regarding violations of their socio-economic
rights.
LHR will raise awareness and advocate for the
actual implementation of the Covenant and
recourse to the individual complaint mechanism,
if necessary.
17. ADVICEANDRECOMMENDATIONS
06
15
Legal representatives
`` Receive/access training on the negative
impact of mental illness in general and on the
narrative of their migrant clients and on their
perceived credibility in particular
`` Receive cultural and sensitivity training
`` Allow sufficient time for the establishment of
a relationship of trust with the client, even if
this requires several interviews
`` Cooperate closely with mental health experts
to ensure the best possible understanding
and treatment of traumatised clients,
including searching for plausible explanations
of memory voids, dissociation phenomena,
late or non-disclosure
`` Make use of psychosocial reports when
needed to corroborate the client’s claim
`` Be aware of culturally and/or gender-based
reticence in disclosing or addressing issues of
mental illness
`` Establish and expand networks with
other organisations providing social and
psychosocial services
`` Practice self-care
Department of Home Affairs
Establish ad hoc policies and practices to ensure that:
a) applicants are identified and given prompt
attention, both at the time of the asylum
application and in further renewals of the
permit
b) relevant training (including sensitivity
training) is offered to RRO officers and RAB
judges to make them able to connect issues
of credibility to trauma and/or temporary or
long-term mental illness
c) the cooperation with legal representatives
and mental health experts is intensified and
psychosocial reports and expert witness oral
evidence are allowed and/or requested by
RROs and RAB judges when clarity on the
above-mentioned issues is needed
d) the refugee claim assessment is fast-tracked
when there is evidence that the excessive
length taken by the adjudication process
has a negative impact on the mental health
of the applicant
e) relevant self-care training is provided to
staff and RAB judges
Departments of Health,
Department of Education,
SAPS and DSD
`` offer training to the staff directly involved
with the service users about the rights of
asylum seekers and refugees in South Africa,
including relevant mental health training,
culturally and gender sensitive training and
self-care training
`` introduce clear and transparent policies on
the services accorded to asylum seekers and
refugees by their respective departments,
consistent with the South African
Constitution, the national and international
applicable legislation and the relevant policies
`` introduce strict rules against xenophobic
attitudes and ad hoc monitoring and
complaint systems
RELEVANT ADVICE AND
RECOMMENDATIONS
06
18. MENTALHEALTHREPORT
16
`` Mental Illness in Asylum seekers and
Refugees - Mann, Fazil
`` http://www.mhfmjournal.com/mental-
health/mental-illness-in-asylum-seekers-
and-refugees.pdf
`` Part I—The mental health impacts of
migration: the law and its effects. Failing to
understand: refugee determination and the
traumatised applicant - International Journal
of Law and Psychiatry 27 (2004) 511–528.
Steel-Frommer-Silove
`` Refugees and Psychological trauma:
psychosocial perspectives - Renos
Papadopoulos (http://isites.harvard.
edu/fs/docs/icb.topic920418.files/
arc_1_10refandpsych-1.pdf)
`` Credibility Assessment in Asylum
Procedures - A Multidisciplinary Training
Manual (Volumes 1 and 2) - http://www.
refworld.org/docid/5253bd9a4.html
`` Centre for the study of emotion and law.
http://csel.org.uk
`` Psychiatry in distress: how far has South
Africa progressed in supporting mental-
health (http://www.dailymaverick.
co.za/article/2015-07-15)
`` UNHCR HANDBOOK AND GUIDELINES
ON PROCEDURES AND CRITERIA FOR
DETERMINING REFUGEE STATUS - under
the 1951 Convention and the 1967 Protocol
relating to the Status of Refugees Reissued
Geneva, DECEMBER 2011
BIBLIOGRAPHY
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