Increasing the number of quota refugees would boost rehabilitation for traumatised refugees

Deaconess Foundation in Helsinki has issued a report focussing on the care in Finland of severely traumatised refugee children and youth, and explaining what such care should attend to and how it is done out in practice.

Drawings: Ninka Reittu

The report states that stress factors of integrating into a strange society may burden children to an even greater extent than the war events they have experienced in their country of origin. The care received in their new homeland generally has a greater effect on the wellbeing of children than their previous traumatic experiences. The report “Toivon taimia” is only available in Finnish.

The report compiled by the Children and Youth Team of the Helsinki Deaconess Institute’s Center for Psychotraumatology is also a programme report for period 2016–2018. The target group is made up of quota refugees who are children and youth under the age of 24 and their families, who have been tortured or are otherwise severely traumatised. The work with them involves treatment evaluations for children, youth and families, therapy, rehabilitation and service guidance, as well as training staff from municipalities that receive refugees.

Quota refugee system facilitates integration

Jaana Pajunen, Unit Director of the HDI Center for Psychotraumatology (until 2019), argues that increasing the number of quota refugees is warranted precisely in the context of treating those with traumas. She points out that as soon as quota refugees arrive in the country they know that their residence permit is permanent, what municipality they will live in and about integration services.

“This creates the prerequisites for identifying psychological traumas, and is important not only for reducing human suffering, but also to enable optimal integration,” says Pajunen.

“There is no point in trying to teach Finnish language if there is no help to tackle the barriers to learning caused by trauma. If Finland intends to assume its international responsibility on the issue of refugees – and while we are still able to influence controlled migration – increasing the number of quota refugees makes sense in every way.”

Jaana Pajusen’s view of the opportunities offered by quota refugee rehabilitation is based on the HDI Center for Psychotraumatology’s 25-year experience of providing care and treatment for refugees.

Finland has an annual refugee quota of 750 people. About half of the quota refugees received have been children. In addition to the almost 3 000 quota refugee children, there are about 3 000 asylum seeker minors who have received residence permits via the Finnish asylum procedure.

Treatment needs don’t end when funding ceases

The work of the Children and Youth Team depends on project funding, which will cease at the end of the year. This means that the continuity of the service will be jeopardised by the end of the funding period.

“Because we have operated as a fixed-term project, some of the carer-patient relationships have had to be limited according to the framework conditions of the project, and not according to the need for treatment and care. This is not in the best interests of those receiving treatment”, regrets Project Manager Marjo Neste.

Fixed-term funding and the uncertainty it imposes on the continuation of the work is also detrimental to staff. For nursing staff, it means ethical discomfort and persistent question: will this child’s treatment be interrupted when the funding stops?

“It also runs counter to the essence of trauma therapy. The key duty of the staff is to bring stability, predictability, security and permanence to the lives of patients. It requires robust professional skills to ensure that the uncertainty concerning the continuity of the work is not reflected on the work with patients”, stresses Jaana Pajunen.

Integration policy ignores children and youth

The Children and Youth Team of the HDI Center for Psychotraumatology is the only group in Finland that provides therapy for children and young people with refugee backgrounds. This means that the Finnish integration policy focus on adults renders children and youth invisible.

According to Jaana Pajunen, in refugee families there are increasingly vulnerable children and protracted, difficult family situations. The situation is also evident in child protection services, where there are disproportionate numbers of immigrant children.

“Our laws, guidelines and regulations have been unable to keep up with the demographic changes brought about by immigration, but have been tailored to the circumstances of the majority population. In our society, the interests of the child are unduly under adult control, and children cannot arrange contacts for treatment without having a confidential relationship with their parents”, Pajunen points out.

Traumatised refugees – Nationwide training and consultation

Marjo Neste says that trauma and the need for treatment among refugee children and youth is recognised in municipalities that receive quota refugees, as is the need for training.

“A third of asylum seeker minors and a quarter of minor quota refugees require psychiatric therapy due to traumas to do with being refugees. So we’re not talking about a marginal phenomenon but an issue that is a reality in Finnish society,” explains Marjo Neste concerning the need for the Children and Youth Team’s work.

“The stress factors of integrating into a strange society may burden children to an even greater extent than the war events they’ve experienced in their country of origin. However, it is important to note that the care received in their new homeland generally has a greater effect on the wellbeing of children than their previous traumatic experiences. Children have a desire to move ahead and in this healing process it is essential to support the child’s social wellbeing.”

Developing digital therapy

Over the past three years (2015-2018), the staff of the Children and Youth Team have trained over 2 500 professionals who work with refugee children and youth in 26 regions.

Most of the training courses have been held in the greater Helsinki area. The northernmost training place is Kuusamo, which is also a partner municipality in the project. There have been 10 training courses held in Kuusamo. In addition, work counselling and case-specific consultations by Skype group calls have also been given to staff in Kuusamo. The remote assistance experience has reinforced the need for developing digital therapy for long distances in Finland. Interpreters are not available everywhere, but with digital solutions distances become unimportant and the expertise gets where it is needed.

The Helsinki Deaconess Institute’s Psychotraumatological Centre comprises rehabilitation for the victims of torture and rehabilitation of people traumatised by war, and the Children and Youth Team. Therapy is provided on referral from a healthcare professional, as well as by referral from a social worker for rehabilitation for people traumatised by war.