MIST: Guided Self-Help Movement-Based Intervention to Improve Physical and Psychological Outcomes in Survivors of Torture and Trauma in Wales and Beyond

Guided self-help movement-based intervention to improve physical and psychological outcomes in survivors of torture and trauma in Wales and beyond.

Background

In 2019 the Welsh government committed to ensure all refugees and asylum seekers (RAS) had access to health services that addressed their complex needs. At least a third of refugees and asylum seekers experience both mental and physical health issues due to torture and trauma experienced in their home country and during their flight. It is established that mental and physical symptoms can create a feedback loop, limiting the effectiveness of treating mental or physical symptoms separately.

In Wales there is no one health service that can address their mental and physical health together. This means refugees’ health needs may not be adequately addressed. In addition, many RAS are being supported within peer-led, community organisations, that are more culturally appropriate than formal mental health services. This study will apply established principles of guided self-help (GSH) to adapt an existing physiotherapy led intervention that combines physical movement, relaxation techniques, and goal setting to improve outcomes for trauma and torture survivors. The new intervention will address both mental and physical health issues, and will offer an intervention that can be delivered within community and peer-led organisations.

We will work with both refugees and asylum seekers who have experienced torture and trauma, and a range of people who provide support to refugees and asylum seekers. Through a series of interviews, we will ask supporters of refugees and asylum seekers, and refugees and asylum seekers themselves, about their experience of the current supportive interventions for both psychological and physical symptoms, their experiences with guided self-help programmes, and how these concepts could be embedded within an existing movement-based intervention.

The information gathered will be used to design a prototype combined intervention, which is likely to include participant resources to support them in a guided self-help approach. This may for example be a workbook and other training documents. The documents will be presented at 2 half day workshops with refugees and their supporters for refinement. At the end of the study, the team will have co-designed a guided self-help movement-based intervention and accompanying material. This study represents the first step in a larger plan to develop and evaluate the intervention.

Aims

The aims of the study are to:

1. To co-design an integrated GSH movement-based intervention and related documents (workbook, training manual etc.) to reduce physical and psychological distress and to improve functioning, which can be delivered by a range of individuals who have experience in physical movement or in mental health (such as physiotherapists, occupational therapists, sports medicine graduates, or mental health staff)
2. To understand and describe current RAS peer-led support networks and how these networks interact with both informal and formal services, to facilitate an understanding of the current pathway between community-led organisations and formal health services, as well as understanding the barriers and facilitators to accessing services.

Design and methods

Using established experience-based co-design (EBCD) principles and the intervention, we will interview a range of individuals who provide support to refugees and asylum seekers, and refugees and asylum seekers themselves. The interviews will inform the development of an integrated movement-based intervention and related documents (workbook, training manual etc.) for survivors of torture and trauma set within a GSH framework. The study will last 8 months.