Written evidence submitted by Mental Health Foundation (AAC0017)

Introduction

The Mental Health Foundation (MHF) has been the UK’s leading charity dedicated to improving mental health for all since 1949. Our charity aims to find and address the sources of mental health problems so that individuals and communities can thrive. In addition to programmatic and research work, we advocate for policies that support better mental health, with a particular area of focus being asylum seekers and refugees. Members of these groups are at heightened risk of mental ill health due to their experiences both before and after arriving in the UK. The quality of asylum seekers’ accommodation is a critical factor for their mental health, which is why we are contributing evidence to this inquiry.

Summary

Our evidence to the Home Affairs Select Committee highlights the urgent need to improve the quality of asylum accommodation and its related healthcare and support services to protect the mental health of asylum seekers. Cases of poor-quality, unsafe, and overcrowded accommodation are too common and exacerbate mental health challenges like depression and isolation, while frequent relocations disrupt education, healthcare, and integration efforts. Barriers such as unhelpful staff, lack of internet access, and poor transport arrangements have also threatened the wellbeing of asylum seekers. Vulnerable groups, including LGBT+ people, disabled people, and pregnant women, face heightened risks due to harassment, inaccessibility, and inadequate care. The Mental Health Foundation is calling for systemic reforms across these multiple areas to ensure safe, stable, and supportive accommodation for asylum seekers.

Poor Quality Accommodation:

Poor-quality accommodation, and housing that is unsafe and insecure, is a risk factor for mental ill health and can exacerbate existing mental health problems amongst asylum seekers.[1] More than a quarter of asylum seekers in the UK are housed in hotel accommodation, the quality of which varies greatly.[2] While some are of an acceptable standard and have sparked no specific complaints, many others have been the cause of great concern and risked having a detrimental impact on their mental health and wellbeing.

A 2024 research study conducted by the Helen Bamber Foundation (HBF), found a number of problems concerning the quality of their hotel accommodations. The majority of the participants reported a range of issues relating to poor conditions within these hotels such as unhygienic and dilapidated living conditions, including rooms with mould and the presence of mice and bed bugs.[3] Others have reported overcrowding,  sharing rooms with multiple strangers and lack of privacy. Furthermore, there have been reports of poor-quality food provided by some hotels, both in regard to their content and preparation. Many asylum seekers described the food as low quality, unhealthy, inadequate in portion size, repetitive and frequently inedible.3

These issues have also been echoed by Migrant Voice’s 2023 study of 170 asylum seekers housed in asylum hotels and other contingency accommodation. It found that the quality of accommodation, services and support varied greatly from hotel to hotel. While some were of a reasonable standard and did not prompt specific concerns, some hotel rooms were similarly described as overcrowded, unsanitary, and lacking privacy, and the food as being of poor quality (for example, out of date and mouldy).[4]

Due to the lengthy amount of time that many asylum seekers spend in hotel accommodation, averaging over six months to even more than a year, it is inevitable that mental health problems are more likely to arise.3,4 The Helen Bamber Foundation found, through their analysis of clinical data from 110 participants, higher levels of mental health difficulties for people seeking asylum living in hotels compared to those living in alternative housing.3 Many asylum seekers reported feeling a lack of safety and autonomy, as well as social isolation. These issues have been linked to problems such as feelings of imprisonment and feelings of disconnect from their communities and peers. Migrant Voice has also highlighted the significant negative impact on their mental health with participants reporting depression and even suicide attempts.4 It is important to highlight that these stressful experiences also put asylum seekers at risk of retraumatisation due to most likely having experienced trauma already in their countries of origin and/or during their journeys to the UK.[5]

We welcome the closing of the Bibby Stockholm barge in January 2025 .[6] Nonetheless, it is vital to stress that accommodations similar to this and former military barracks are likely to result in “warehousing” and measures should be put in place ensuring that they are not used again or phased out due to putting asylum seekers at a clear risk of retraumatisation and preventing them from being able to integrate into local communities.

Policy Recommendations:

•          The Home Office should introduce regular formal third-party inspections at all asylum accommodation sites to ensure any concerns over the quality of accommodation are identified. This should be followed up with publicly available reports, setting out what actions have been taken to remedy issues.

•          The Home Office should ensure that all asylum accommodation sites have a dedicated mental health team to regularly screen the mental health of asylum seekers and offer appropriate mental health support.

•          Asylum seekers should be housed in community-based accommodation. Settings far away from communities like former military barracks and barges are likely to result in “warehousing” and should not be used.

Access to Healthcare:

Lack of access to healthcare whilst in asylum accommodation is another problem that has been reported. This was also discussed in the Migrant Voice study where almost a quarter of survey respondents highlighted difficulties accessing a doctor or receiving treatment.4 Some of these participants reported struggles in registering for a GP or other forms of healthcare support due to unhelpful accommodation staff. Some recorded examples included staff refusing to help asylum seekers in booking their health appointments.4 This may indicate that there is a clear lack of quality training and hiring for staff in asylum accommodation, increasing the risk of mistreatment, neglect and discrimination.

Some accommodations also make it difficult for asylum seekers to access quality healthcare due to the poor quality of the internet connections they provide. This issue was discussed in a 2023 study conducted by the British Red Cross which found that asylum seekers experienced multiple barriers when using online platforms for booking and attending medical appointments, one of them being the lack of Wi-Fi access in their accommodation. The study’s findings suggested that there was little consistency in the availability and quality of internet connection amongst accommodation provided by the Home Office.[7] This means that there is a type of ‘internet access lottery’ which, as asylum seekers have no choice in where they are placed, only increases their stress and anxiety. This type of digital exclusion also means that asylum seekers have often delayed booking appointments or had to rely on booking appointments in-person which will usually require money for transport which is already restricted by their asylum support allowance.

The lack of quality support services from asylum accommodation has also been recorded by local authorities. An example of this is Hounslow Council, which in 2023 published its annual public health report highlighting the critical health and wellbeing issues faced by asylum seekers living in the borough. The report identified barriers to local health services, including insufficient information provided to asylum seekers during their compulsory local orientation upon arrival at Hounslow hotels.[8] Other potential obstacles reported were the perception of discrimination relating to their race, religion, and their status as an asylum seeker and the lack of efficient organisation of transportation from hotels to health centres.8 All these findings underscore the urgent need for better coordination and communication amongst asylum accommodation services to ensure that asylum seekers can access the essential health and wellbeing support they need without unnecessary delays.

Policy Recommendations:

•          The Home Office should work with private accommodation providers and NHS services to develop and deliver training for asylum accommodation staff on the healthcare rights and entitlements of asylum seekers and refugees.

•          The Home Office should work with private accommodation providers to improve internet services and combat digital exclusion.

Housing Instability:

Asylum seekers also face issues with housing stability, sometimes being moved multiple times between different types of accommodation.[9] The experience of being repeatedly moved from one type of accommodation to another has a significant mental health impact.

The Mental Health Foundation has heard from its work with asylum seekers in Scotland that the experience of constant accommodation changes while waiting for their asylum claim to be processed is particularly distressing for families with children.5 The negative impact on children specifically has been discussed in a study conducted by Human Rights Watch (HRW) where constant relocations have been detrimental to not only the progress of their education but also in the development of friendships which are so essential to their personal well-being.[10]

The negative mental health outcomes of such instability in accommodation has also been found in the 2024 report published by the No Accommodation Network (NACCOM) and the Good Faith Partnership. Participants in their study reported that the constant movement between regions of the UK while seeking asylum was one of the biggest barriers to feeling settled and part of the community.[11] These barriers not only increase feelings of isolation and anxiety for individuals but also impede integration efforts as a whole.

As these findings show, moving is associated with severe strain on people’s mental health, and reduces asylum seekers’ ability to build and maintain social connections and to learn about the area they live in and what services and facilities are available. Having a clear sense of belonging is integral to our mental health and wellbeing; asylum seekers who are moved constantly without any choice are at clear risk of loneliness and isolation.

Policy Recommendations:

•          The Home Office should ensure that people are moved between asylum accommodation locations only with good justification and with reasonable notice. This will reduce mental stress and help people to build and sustain social support networks.

•          The Home Office should prioritise moving asylum seekers into long-term, community-based accommodation in order to promote stability, wellbeing and better integration.

Vulnerable Groups:

LGBTQ+ people

Wider research has documented numerous instances of LGBTQ+ asylum seekers experiencing verbal and physical harassment in asylum accommodation. As accommodation is provided for all asylum seekers on a no-choice basis, the personal safety of LGBTQ+ asylum seekers is often overlooked. A 2024 study conducted by the organisations SEREDA and Rainbow Migration explored the dangers faced by LGBTQ+ asylum seekers living in multi-occupancy accommodations. The study identified several key factors that increased the risk of abuse, including the physical conditions of the accommodations themselves.

Some housing facilities were reported to have a lack of functional locks on doors which made it difficult for residents to maintain privacy and protect themselves from potential assailants.[12] One respondent stated that he slept with a knife under his pillow for self-defence due to being unable to lock his door, despite repeatedly requesting repairs.12 Additionally, policies such as Operation Maximise, introduced in 2023 by the Conservative government to reduce hotel accommodation costs, forced asylum seekers to share rooms with others; a practice that was reported to be particularly unsafe for LGBTQ+ individuals due to cases of abuse from other residents.[13]

SEREDA’s study also found that sexual and gender diversity was not included in risk assessments for accommodations and there were no clear policies or procedures for addressing homophobic or transphobic hate crimes.12 Service providers reported that when a safeguarding concern or hate crime was escalated to Home Office housing contractors, there were no clear timeframes for resolution.12 The lack of safeguarding has also led to many LGBTQ+ asylum seekers feeling unsafe or neglected by accommodation staff because of their identity. A 2024 study published by African Rainbow Family found that over 65% of survey respondents shared instances where accommodation staff’s treatment of them made them feel unsafe and disrespected.[14] These systemic barriers only leave LGBTQ+ asylum seekers feeling unsafe and fearful of reporting any instances of abuse and discrimination.

Policy Recommendations:

•          Asylum accommodation sites must have safeguarding protocols in place to protect asylum seekers from discrimination and harassment from other residents and from staff.

•          Private accommodation providers must deliver training to its staff which promotes anti-discriminatory attitudes towards asylum seekers and refugees.

•          The Home Office should apply stronger checks on the allocation of accommodation with clear sensitivity and consideration towards the individual’s sexual orientation and/or gender identity.

•          The Home Office should also apply stronger checks on private accommodation providers ensuring that they provide good living standards including privacy. It should also apply severe penalties or terminate contracts for providers who repeatedly fail to meet these standards.

Disabled people

Asylum seekers living with disabilities have been housed in unsuitable accommodation without access to adequate support or services.15 Reports have included such asylum seekers being trapped in inaccessible accommodation where they have struggled to reach bathroom facilities, or were unable to go outside for days because of accessibility issues.[15] Furthermore, the dispersal of asylum seekers between accommodation has been found to disrupt continuity of healthcare, particularly for those living with disabilities.[16] The combination of disabling barriers and lack of social networks can lead to feelings of extreme isolation.[17]

Policy Recommendations:

•          The Home Office must ensure that asylum seekers with physical disabilities are housed in suitable accommodation based on their accessibility needs.

•          The Home Office should restrict movement/dispersal of asylum seekers living with disabilities to ensure continuity of care.

Pregnant women

Pregnant women are among the most vulnerable groups requiring specific attention in the asylum system. Consistent medical attention, adequate nutrition and good quality accommodation are essential to their wellbeing and mental health. However, these critical needs are often unmet. A 2021 report by the Helen Bamber Foundation highlighted several case studies of pregnant asylum-seeking women suffering from malnutrition due to their respective hotel accommodations failing to meet their dietary needs.[18] A key case involved one client who was heavily pregnant with severe anaemia and had strict instructions from her doctors about her dietary requirements, which were not met by the hotel.18

The lack of stable accommodation also exacerbates these challenges. As previously discussed, housing insecurity has been linked to missed or delayed medical appointments thus disrupting the continuity of care.[19] This instability heightens the risk of mental health problems including anxiety, stress and depression which adversely affect the health of both the mother and the unborn baby. 

In some cases, these challenges can have extreme consequences. A joint investigation by ITV News and Liberty Investigates revealed that between October 2017 and May 2022, eight babies born to asylum seekers in Home Office accommodation died before reaching their first birthday.[20] Charities such as Birth Companions have warned that the true number of deaths may be higher, as the Home Office does not collect data on miscarriages and stillbirths among asylum-seeking women living in accommodation.20

Policy Recommendations:

•          The Home Office should place clear restrictions on the movement of pregnant women between different accommodations in order to maintain continuity of care.

•          The Home Office should ensure that hotel accommodations provide meals that meet the nutritional needs and specific dietary requirements of pregnant women and families. It should implement robust monitoring systems to ensure compliance and apply severe penalties or terminate contracts for providers who repeatedly fail to meet these standards.

•          The Home Office should ensure that providers of asylum accommodation secure timely medical support for pregnant women if they experience medical complications.

•          The Home Office should ensure that any women who experience pregnancy complications or the death of a child whilst in asylum accommodation are provided with mental health support.

•          The Home Office should collect data on miscarriages and stillbirths among women living in accommodation along with supporting transparent investigations into each case.