How shocking that at the end of life no one seems to care enough to find out if ethnicity and discrimination could be important to consider? (Picture: Getty)
Twelve years ago, I was travelling weekly to visit coroners’ offices all over the country, from Bristol to Bradford, Lewes to Leeds.
Leading a team of doctors at a charity that provides clinical and welfare help to survivors of torture who are rebuilding their lives in Britain, a lot of my work crosses over with the UK asylum system.
I was struck by the number of recent local news stories I had seen reporting deaths of asylum seekers by suicide. I decided to probe further.
Some were in immigration detention, in fear of removal back to the country from which they escaped torture or persecution. Others had taken their own lives while in the community, waiting for the decision from the Home Office on their fate.
I wanted to know if these suicides were isolated cases. Surely those who had survived against all the odds – torture, perilous journeys, war and conflict – to get here should not succumb so close to reaching a secure future?
When I started looking into the matter, I assumed there would be a centralised record of these cases. We live in a data-rich world where our lives are measured and tracked constantly, from birth to death. If you live in the UK, a lot of this information will be held by the Office for National Statistics (ONS).
So it was surprising to learn that there was no central collection of data on suicides in this group of people. From speaking to coroners across the UK, I discovered they were not allowed to put in their return form to the ONS if the deceased was an asylum seeker. There was no box to tick.
There was other information they could give such as ‘occupation’, but asylum seekers are not allowed to work. One coroner told me they had written ‘asylum seeker’ in that space, but the form was returned to them with the instruction that they should enter ‘unemployed’ instead.
The coroner, like her colleagues, felt this was wrong. But there was nothing else she could do.
So, I investigated further. The only way to find out what was happening was to follow up local news reports and ask the coroners’ permission to research each case.
Some files that I read were pitifully thin, with too few people to stand up and bear witness to what had happened. The person usually had no relatives in this country, and friends were often untraceable by the time the inquest took place.
The UK spends £25m on its suicide prevention strategy – but how do we know it’s reaching the most vulnerable?
I felt heartbroken for their family, who would never really know the full story about their loved one. And I was furious at a system that didn’t think these details about their lives mattered.
Every incident where a person takes their own life is subject to an inquest. This identifies who died, how, and when. It also ensures that the cause of death does not need further investigation – that they did, indeed, intend to take their own life.
Some of the files made for bitter reading. In one case, a person ended his life after a meeting with local council officials, believing he was about to be returned to his country, when in fact they had been informing him of a need to move accommodation because his asylum was granted.
The officials did not use an interpreter, and he had fatally misunderstood their instructions to pack up his things.
Reading this, I felt sick and hollow. In fact, I found that failure to provide an interpreter when in contact with Home Office officials, local council services or healthcare workers was a factor in a number of cases leading to critical misunderstandings or escalating mental health conditions going unrecognised.
The untold stories in these files painted a picture of fear and despair. It also chimed with my experience of working with asylum seekers who were desperately trying to prove to a sceptical asylum system that they were worthy of help and safety in the UK. It is tough to survive a bureaucratic system such as the Home Office when you’re already living with trauma and intense loneliness. For many, it was simply too much.
My research ended with the conclusion that too little was known about how such deaths might have been prevented, and how people could have been helped. What is the point of an investigation into such tragedy if not to try to reduce the risk of it happening to others?
And 12 years on, in the midst of the Covid-19 crisis, I found myself once again reading news reports that asylum seekers are taking their own lives. I checked with the Chief Coroner’s office, and was horrified to learn that coroners still can’t report these deaths to the ONS as asylum seekers. Worse, I then learned to my shame that they do not even report on ethnicity.
At a time when we record ethnicity in countless forms throughout our lives, to check that we are working towards equality and not discrimination, how shocking that at the end of life no one seems to care enough to find out if ethnicity and discrimination could be important to consider?
The UK spends £25m on its suicide prevention strategy and uses data from NHS mental health services. But how do we know it’s reaching the most vulnerable? It’s hard for asylum seekers to access healthcare. Some are charged for using NHS services. Others have justifiably lost trust in the authorities altogether.
I wrote to the ONS to request they pilot a programme to capture ethnicity and asylum status information. I received a short response from them to say that they do not have ‘the authority’ to set up such a programme, and that while existing data collection methods are ‘not (at present) suitable for calculating reliable mortality rates for most ethnicities’, it is the only currently available approach that ‘avoids substantial and potentially misleading bias’.
They did state that ‘work is in progress across government to develop a practical solution for the recording of ethnicity data for all deaths as part of the death certification process, taking into account legal, digital and methodological processes.’ In other words, it’s hard. When I wrote to the Coroner’s Office, understandably, they said they can only fill in the boxes on the form sent by the ONS.
But we know it can be done so why isn’t it being implemented quickly? In 2019, Ireland was concerned about the high numbers of suicides in their Traveller communities, so the decision was made to start recording this data.
The treatment of asylum seekers in the UK is another example of how Covid-19 has polarised our society. Those who have fled torture and persecution are ghettoised in former military barracks, without mental health support. People are self-harming in their distress.
Last year, 29 asylum seekers died in Home Office accommodation. But without knowing each person’s name, and without the press reporting the outcome of their inquest, we have no way to know how they died.
Data is vital to us because it tells a story about the lives of people who live among us but are marginalised and voiceless. This absence of information tells us that even in death, they are not counted.
For me, this is particularly hard to swallow given that it was only last summer when the Black Lives Matter protests filled the streets of London, highlighting the institutional ways that Black people are treated differently and left behind. Let’s not forget, most asylum seekers in the UK are ethnic minorities, suffering a ‘doubling’ of stigma and bias. At a time when we are acknowledging these failures, ‘not (at present) suitable’ feels like it really means ‘we don’t care.’
How hard can it be to add two more boxes for ethnicity and for asylum status? Two more boxes. Not a big ask. Not if Black lives matter.