Breaking Barriers to Migrant Communities and Mental Health Services
Migrants and refugee communities face significant inequalities in mental health access and outcomes. They often struggle to understand available services, and those with insecure immigration status avoid essential health services for fear of being reported. COVID-19 further compounded these issues, as remote services are less accessible for non-native English speakers and those digitally excluded.
Thesh, Lambeth Community Embedded Worker says:
We're trying to take people for who systems were not set up before and who have not been considered… trying to give them a voice and to get to them.
Community-Driven Solutions
Through South London Listens, we engaged with over 10,000 people across south London, revealing a widespread lack of trust in services among migrant, refugee, and diaspora communities. To address this, we co-developed the Community Embedded Worker (CEW) pilot with Citizens UK, focusing on trusted organisations to bring NHS services closer to those in need.
In June 2021, we secured public commitments from NHS leaders and funding for three one-day-a-week roles in Lambeth, Lewisham, and Southwark, across five community organisations for 18 months. These included two refugee and migrant support organisations, a food bank, a school, and a youth violence prevention service.
Building Trust and Capacity
CEWs spent the initial months building relationships, listening, and joining existing groups to foster trust. This involved conducting one-on-one sessions, group advice, and support referrals to mental health services. They also created culturally relevant resources and trained existing staff, expanding local capacity.
Our goal was to build trusted, equitable relationships between the NHS, communities, and VCSEs. We co-designed our evaluation framework with communities, focusing on outcomes that mattered to them, such as increased access to timely and appropriate mental health support. This pilot project has facilitated mental health referral and support to almost 200 migrants and refugees, including establishing pathways for people who, as Lewisham, Migrant and Refugee Network note “otherwise would have found themselves locked out of healthcare services.”
CEWs supported 86 clients through one-on-one sessions, with 40 referred to mental health services. Additionally, over 100 clients received support through group activities, including an online session for 65 undocumented migrants in Lambeth and mental health workshops in Arabic for a women’s group in Lewisham.
Overcoming Barriers
CEWs also contributed to addressing structural barriers and reducing inequalities in access. For example, in Lewisham, the CEW collaborated with the local NHS Talking Therapy service to create a new pathway for 30 clients to access therapies and relevant services for the first time. The CEW role has been crucial in enabling NHS services to quickly respond to community needs. For instance, South London and Maudsley NHS Foundation Trust's Critical Incident Support service collaborated with community leaders to provide mental health support after a stabbing in a south London estate.
CEWs have become integral to their organisations, enhancing staff understanding of NHS services.
Alan Robertson, CEO at LRMN said:
Having Laura embedded in LRMN has given refugees and migrants a direct, compassionate and effective route into mental health services. Many of our clients have concerns about accessing health, particularly mental health, services. Laura has been a friendly and approachable face for them to have initial contact with and discuss options, dispelling concerns and giving them faith that statutory mental health services are open to them. Laura has also offered invaluable advice and guidance to caseworkers supporting clients with mental health problems.
Training has also been developed for NHS staff on the needs of migrant and refugee communities. In Lewisham, 18 NHS colleagues attended training, improving their knowledge of the legal processes and experiences of their clients.
Laura Parson, the Community Embedded Worker in Lewisham said:
Although I have worked in Lewisham for several years and have known about LRMN I did not know all the different services and support they offer. From my experience, LRMN colleagues and myself have been able to identify challenges for clients from refugee, migrant and diaspora communities within Lewisham, this includes access to healthcare especially mental health services. I am working with LRMN to build trust with these communities; breaking down barriers, screening mental health needs and looking at what support these clients need. I will also be exploring mental health pathways such as access to therapy, groups, and the Primary Care Mental Health Teams. South London and Maudsley staff have come to meet with me at LRMN – building better relationships. I now feel much more confident working with this client group and have been able to bring this back to my team and Lewisham colleagues.
Future Directions and Expansion
The impact of the pilot has been significant, enabling services to reach previously inaccessible individuals and families. It has fostered strong relationships across five community organisations and prompted NHS innovation and adaptation. The success of the pilot has led to a full-time role in Lewisham, with plans to expand this approach across all four South London and Maudsley Boroughs.
For more information about the Community Embedded Worker initiative, visit the South London Listens site.
