Asylum, destitution and harmful alcohol use

By Dr Steph Grohmann, Leverhulme Early Career Fellow at the Centre for Homelessness and Inclusion Health (CHIH), University of Edinburgh

If somebody has no hope for tomorrow it becomes unbearable, yeah. If he’s been waiting for years and no answer, no decision, no nothing, you don’t know what it’s for and about what, that is a bad situation. It’s a mental torture at one point, so that can cause somebody to switch on something which is wrong” Former UK asylum seeker

In 2019, more than 70 million people globally were forcibly displaced by armed conflict or natural disasters. As a signatory to the 1951 Convention on Refugees, the UK is legally obliged to admit any persons seeking asylum at its borders, currently roughly 35.000 persons a year. Most of those claiming asylum in the UK have already gone through traumatic experiences in their countries of origin or on the journey. Once arrived, they find that despite their hopes of finally having reached safety, they are only at the start of a years-long process of waiting and hoping for a positive asylum decision. Despite these many stressors, however, very little data exists on what role, if any, harmful alcohol use plays in this population.

As a member of the research team for the recently published “Exploring the factors that influence harmful alcohol use through the refugee journey: a qualitative study” by the University of Edinburgh Centre for Homelessness and Inclusion Health, generously supported by SHAAP, I recently set out to shed some light on this topic. Dr Fiona Cuthill, the study lead, and I were clear that we were touching a sensitive subject: after all, harmful alcohol use is a potentially upsetting or shameful topic for many people. In the context of asylum, however, there is also the risk of inadvertently giving ammunition to those who, for political reasons, want to associate asylum seekers and refugees with socially undesirable behavior. The qualitative data we gathered over the course of three months in Scotland and England showed, however, that harmful alcohol use in this population is not an ‘imported’ problem: all our respondents – 20 people with lived experience of the UK asylum system, and 6 members of staff from agencies working with this group – agreed that where harmful drinking emerged, it was inevitably linked to the asylum process itself. As one former asylum seeker put it:

“Some people don’t drink when they’re from their country [but] when they get here they have a problem, because most people are coming here, they do not know what they are going to see in this country. So [...] some of them become…they can’t cope, so they think that when I start drinking I’ll forget about what’s going on”.

What is ‘going on’ is that the UK asylum process – a non-devolved matter and therefore the same across Scotland and England – is an extremely stressful experience for those subjected to it. Asylum seekers are entitled to housing and a modest support payment, but they are not allowed to work until the Home Office has reached a decision on their claim, which can routinely take years:

“You have nothing to do, because you’re caught in the middle here. You’re not allowed to do anything, you’re not having any income. Even if they give you income, but for how long are they going to support you, to get what you intended to get. If you apply and they tell you to wait, come and sign on, wait for two or three years, five years, the process itself breaks you down, year after year. And you are wearing down, you are wearing down, you’re growing, you’re wearing down”.

The boredom and enforced idleness during this time, alongside loss of a previous social identity, isolation from the ‘mainstream’ of society, and confinement to marginalized communities, were seen by our respondents as the main reasons some asylum seekers may start consuming alcohol (and other drugs) during the waiting period. At the same time, however, they stressed that hope – of a positive decision and finally the chance to move on with their life – was the greatest protective factor against ending up on such a slippery slope. It is only when, after years of waiting, an asylum claim is refused that people, in the words of one asylum seeker “crack up”.

Refused asylum seekers are labelled ‘NRF’ (no recourse to public funds), which means the immediate withdrawal of any state support, accommodation and right to use NHS services:

“you’ve got no doctor, because even if they kick you out of the house [i.e. state-provided accommodation], the day they kick you out of the house, your supports stops running, maybe you’ve got no GP because all them things they will cancel them”.

In some cases, staff told us, people’s children are taken into care whilst their parents are evicted and left on the streets. The UK government’s intention, as part of the infamous longstanding ‘hostile environment’ policy, is to make life in the UK impossible to these people, so they voluntarily return to their countries of origin. However, for many return is not an option, be it because they fear persecution in their home countries, or because these countries refuse to re-admit them for lack of travel or identity documents. Many – there are no firm numbers but estimates are in the thousands – therefore simply ‘disappear’ from the radar of the state. They become homeless and destitute, with begging, small-scale criminality, prostitution or informal, exploitative work their only options for survival:

“They’re cut off from everything, they’re not allowed anything, so they come to live streetwise, so, in that case, when people go to sleep in garages, people sleep in parks, people hang out in other busy places, that is where they engage with other people that are involved them, that engage them in evil things, drugs, alcohol, because that’s the only way to survive and some of them, they do it to buy friendship”.

Apart from pushing asylum seekers into company where harmful habits are common, asylum refusal also removes all hope of a desperate situation eventually turning for the better. As a result, mental health deteriorates, making it difficult for the support system to reach people: “The thing is, there are places where people can go for help” one staff member explained, “but that help, how long is it going to take to help them, and after that then what? It is a cycle back to the same thing. So it’s not improving, it’s not improving anything”.

The overwhelming lack of perspective after a refused claim makes it difficult to argue for healthier lifestyle choices, as any investment in the future appears futile. At the same time, the designation ‘NRF’ does not mean that people’s medical problems disappear. They only take longer to address, as health problems frequently only become visible when a person ends up in A&E, at a higher expense to the NHS than if they had been able to use GP services. Far from saving tax money, the Home Office’s ‘throw them out on the street’ policy of managing failed asylum seekers therefore ends up producing higher health care costs.  It also specifically contributes to the emergence of alcohol-related health problems that are often only treated when they have caused grave damage or ended in self harm:

“Being destitute [...] can even drive somebody to the length of committing suicide, because you can imagine this country, as you’re well aware, is nothing for free”.

In our research report, we therefore recommend that if all asylum claims cannot be accepted, then at least decisions should be made considerably faster. Where return is an option, it should be facilitated without delay. For those waiting, culturally appropriate mental health services should address pre-and post-displacement trauma, and some kind of meaningful activity (work, volunteering) should be permitted. Agencies working with refugees and asylum seekers should receive additional resources to address alcohol related issues, and further research should look into the relationship between alcohol- and drug consumption. Overall, we come to the conclusion that while harmful alcohol use is a serious problem for some people seeking asylum, it is a symptom of a dysfunctional and inhumane immigration system, rather than a standalone issue. To address its root causes therefore means addressing the ‘hostile environment’ that homelessness, destitution and despair.

All SHAAP Blogposts are published with the permission of the author. The views expressed are solely the author's own and do not necessarily represent the views of Scottish Health Action on Alcohol Problems.