## **Chair’s Annual Report 2020** For the operating period 1/1/2020 to 31/12/2020 **Due to the current lockdown regulations the AGM was held virtually. This report has been approved by Trustees (31/1/21)** **Charity Name:** Brighton Exiled Refugee Trauma Service (BERTS) ## **Charity Registration Number:** 1188586 **Registered Address:** 15 Herbert Road, Brighton, BN1 6PB. **Trustee Details:** Professor Sally Munt, Tessa Louise Axelrod, Colin Michael Blowers, Dr Amanda Margaretha Flint (until 31/1/21), Catherine Clerkin, Reem Ali Abushawareb. Please note that this report has been compiled in consultation with specific key roles/functions of BERTS staff. ## **The Structure of BERTS** BERTS became a Charitable Incorporated Organisation (CIO) on 17[th] March 2020 and was previously know as The Sanctuary Project which was started in 2016. BERTS is a dedicated trauma service hosted by Brighton & Hove CBT, for refugees, asylum seekers and destitute migrants in Sussex. BERTS is a no-cost service and is a purely voluntary service run for the benefit of the community. BERTS offer free specialist trauma counselling and psychotherapy to local refugees, asylum seekers and/or destitute migrants to help them come to terms with their relocation in the UK. We are a ‘safe’ organisation and do not ask for proof of status. All our staff are unpaid and volunteer their time for free, so that mental health support can be provided free of charge to clients. BERTS is primarily managed by the Chair of Trustees, Professor Sally Munt, who receives referrals from associated organisations and NHS providers. Trustees are primarily recruited from the Charity’s staff – either Therapists or administrative coordinators. ## **Matters Arising** Please feel free to notify the Chair with any matters arising. ## **Activities and objectives** During 2020 we continued to follow BERTS founding principles as written in our Staff Handbook. We do not have specific annual objectives as our work is ongoing and responsive to local need. ## **Achievements and performance** 1 Simply keeping our operations going, consistently and conscientiously, has been the major achievement of 2020 pandemic, on behalf of all of us. We have continued to honour our responsibilities despite staff sickness and complications, including SRM contracting Long Covid in March 2020 which has resulted in her taking early retirement from the university due to ill health. Trustees have also experienced significant personal challenges this year due to illness and personal circumstances, so overall I think maintaining a steady service without interruption during 2020, in the face of unimagined circumstances and personal stress, has been a major achievement. BERTS has grown during the year in terms of demands on our service. During 2020 for example the CD/Chair wrote responses to over 1,000 emails and received over 200 telephone enquiries. At the moment this is a sustainable workload for one person to manage but in terms of the longer term it may be necessary to start to distribute some of these tasks currently managed solely by SRM, to other BERTS officers where possible/appropriate. This year we continued to grow the support worker network and thanks to Hanna have now 13 active befrienders, this is great as some clients need this kind of contact particularly during lockdown and it is much appreciated. Sometimes this is given whilst clients are waiting for treatment and also required during treatment if clients are particularly isolated or vulnerable. Although we are primarily a CBT/EMDR service, we also provide other accredited mental health interventions with other modalities/training where appropriate. ## **Financial Review** BERTS operates as a no-cost service, there is currently no bank account, no income, no fundraising and limited expenditure such as website charges and maintenance, professional indemnity insurance, security checks (DBS), Continuous Professional Development, professional fees and accreditation, transport, office, stationary and so on. These incidental costs are currently covered by Brighton & Hove CBT as a charitable gesture, and by individual psychotherapists as part of their annual professional fees and activities. All staff provide their time for free and cover their own expenses. We continue to have annual professional indemnity insurance with Howden Group Ltd. This covers any student/trainee placement and claims against BERTS: Customer Ref : P20P6338 Client Number : 918611 Insurance/Cover : Professional Civil Liability Insurance Name of Policyholder: Brighton Exiled/Refugee Trauma Service (BERTS) Customer Reference: P20P6338 Policy Period: (both days inclusive) From: 25 September 2020 To: 24 September 2021 Indemnity Limit: £1,500,000 Public Liability Limit: £10,000,000 Professional Services: 2 ## Trauma Service (Counselling, Psychotherapy, Befriending) Annual premium 2020 = £134.50 There are web hosting, telephone and email service costs which are met by SRM personally, although web support and technical support for the database continues to be provided by the generous time donation of David Guest. ## **Chair’s Comments** From March 2017 when we commenced our clinical practice until December 2020 (45 months), BERTS has treated a **total of 63 patients** for mental health trauma, all of whom were refugees, asylum seekers and or destitute migrants in the Brighton & Hove area. **In 2020 we treated 14 patients,** through inperson treatment sessions where possible, but also via video call and telephone. This is a slightly lower annual figure due to pandemic restrictions on clinical space. Most of our patients have significant psychiatric diagnoses with co-morbidities present, including trauma-based psychosis and enduring/severe depression and acute anxiety. These patients are often multiply traumatised and require lengthy interventions. Although referral to IAPT/Time to Talk/Wellbeing can provide helpful short-term interventions, NHS does not provide much locally in terms of specific treatment for this client group which often requires lengthy engagement subject to frequent DNAs due to the challenges of asylum seekers’ daily lives. We also occasionally end up treating more than 1 member of a family where there are systemic presentations. Treatment durations have been from 6 weeks to 24 months+, depending on clinical need. The typical PTSD treatment is to follow NICE guidelines and be 18+ sessions, we find however that this duration is not long enough to address multiple and complex instances of trauma and allow for cultural differences in delivering multicultural psychotherapeutic delivery. In addition, due to frequent problems of insomnia, chaotic night/day rhythms due to night terrors, disorientation, and the unpredictability of UKHO appointments, our DNA/discharge policy is significantly looser/more generous than most mental health services. A consistent pattern on DNA and disengagement must be observed before consideration of discharge. Treatments in 2020 were largely online/phone due to pandemic restrictions although we do have access to the Brighton Library room without charge because of their commitment to refugee community in the city. We continue to be very grateful to Brighton Library for their ongoing donation of space to BERTS. The room is available on Tuesdays for our clinical placement Giulia G to use, when we are not in full lockdown locally. (Medical appointments are allowed during national lockdown). Moving to predominantly remote delivery also addresses our critical shortage of donated clinical space, which had become urgent since local churches etc are now charging for use of rooms and no longer offering voluntary services no-fee use of their premises. Despite us treating NHS patients for free, it has been impossible for the CD to persuade the NHS to provide us with like-for-like exchange 3 of resources, despite multiple requests to different NHS staff. As we don’t have facilities to pay for clinical space, remote delivery may end up being our primary mode in the future which does provide other problems in terms of digital poverty and lack of access to broadband in our client group. We continue to receive most of our referrals direct from NHS and Social Services. Statutory Services provide the bulk of our referrals although local NGOs and housing associations also refer. Most of the referrals are discussed with the Clinical Director first (SRM), we continue to refuse clients who do not have sufficient language proficiency and refer them first to Migrant English Project for social integration and English Language Fluency, and suggest re-referral in 6 months. There has been a noticeable increase in referrals since the pandemic, specifically from statutory services. Statutory Services/NHS (Sussex Partnership Trust) mental health lead commissioner has now (late 2020) formulated a new mental health strategy for local provision which explicitly shifts responsibility onto local NGOs for mental health support. This has significant implications for our service and others such as Refugee Radio (who offer mental health support) going forward in terms of burden/resource criticality and expectations re our capacity to fill this gap. It would be good for local key NGOs to liaise and discuss the implications of this shift (ACTION SRM) Wait times for patients on our list has varied from 2 weeks to 6 months. Patients are allocated a therapist mainly in order of referral date, however if there is a patient with urgent or acute need they are moved up the queue with the Clinical Director’s discretion, in consultation with the referrer. Currently we have 3 patients waiting for allocation to a therapist (Jan 2021). We are seeing an increase in patients who are actively suicidal, and highly vulnerable, due to the pressures on NHS primary care, Assessment and Treatment Service and CAMHS. We continue to be all too aware of the lack of available treatment options in NHS mental health services for asylum seekers and refugees in the city. We have also observed continued reluctance by some primary care providers to refer complex/acute cases for psychiatric evaluation or prescribe appropriate psychopharmacology where needed. We continue to know of patients with severe PTSD, confusion, disorientation, and trauma-based psychosis being prescribed inappropriately (such as Hydroxetine for acute, incapacitating insomnia, or presentations of severe, enduring depression or patients with torture-related disability being advised to ‘exercise’). The council initiative commenced 3 years ago for NGOs and NHS providers to meet with the Clinical Commissioner to re-evaluate refugee mental health needs has stalled as NHS staff have moved posts, which is regrettable. The 2020 Covid19 Pandemic has seen a rise in anxiety presentations in our clinical demographic. More Police on the streets, particularly in the March-June lockdown created an increased sense of threat for many refugees/asylum seekers who have often been the victims of state violence. Additionally, we know that the lockdown has led to acute isolation for some of our clients who rely on regular social contact delivered via dedicated and essential NGOs locally, such as Migrant English Project, Voices, 4 and Refugee Radio who provide vital opportunities for connection and enhance a sense of community/new start. The increased isolation has led to more rumination, paranoid ideation, depressed mood, and loneliness for our clients, which has made the intervention provided by our befriending service even more necessary and appreciated. Clinical Director provides direct, regular supervision to the 2 clinical placements (G. Giansiricusa and A. Lesley) and also deals with regular enquiries from trainees looking for suitable placements. We are currently negotiating a third qualified clinical psychologist placement from Italy who is seeking UK accreditation. For obvious reasons we have not been able to meet in person as a governing body during 2020 due to government restrictions. We will continue to communicate with each other via digital/online presence for the foreseeable future during 2021. The Chair wishes to formally thank all the people who make our work possible and whom have given so generously of their time during what has been a difficult period for us all. This is a big thank you to all Trustees and offices of BERTS, all of our volunteer support workers, to Hanna, Bigem, David and all those who remain committed to supporting members of our community who are struggling with trauma as a result of seeking asylum in Brighton & Hove. ## **NHS Training Partnership** NHS Woodfield Trauma Service, the specialist trauma service for refugees and asylum seekers in London, invited our therapists to participate in their CPD training for clinical psychologists in September, and also have kindly sent us a number of very long annotated (2 x 4 hour, and 2 x 8 hour) ppt presentations on complex refugee trauma which were designed with the Helen Bamber Foundation. BERTS CD is delivering a training in Spring 2021 to Woodfield Trauma Service on delivering multicultural psychotherapy as a quid pro quo. This skills exchange is a productive new collaboration that we hope will continue as specialist services/organisations can benefit hugely from such peer training exchange and support. ## **Social Prescribing** One thing that would help our patients manage the isolation and the mental health exacerbation that comes with that is what is known as social prescribing. This means engagement in social activities such as learning English (MEP), garden projects for mental health, cooking, reading groups, walking groups etc. One helpful thing to develop in 2021 might be to have a list on the website that offers local resources to patients that are free to participate in and would help them overcome loneliness and also create meaningful relationships through social engagement. (ACTION: TRUSTEES/SUPPORT WORKERS) 5 Our befriending service could assist in supporting clients pursue this. ## **Technical Support** In 2020, the production platform for patient records was successfully migrated to the main BERTS web host by David Guest, where the data could be secured with commercial SSL encryption. The former system was set up on a platform that required very specialist knowledge so this transfer was necessary to a more widely-used data management system. The code base was updated and is maintained at a current release in order to take advantage of security improvements and a regular back-up programme was also put in place. We continue to use password protected Googledocs for patient flow systems as these two software systems are most flexible and safe for multiple users to access and update. CD/Chair has observed the necessity to have a better communication strategy within the organisation, currently communication between BERTS staff is very ad hoc and perhaps leads to a sense of incoherence or isolation amongst BERTS members. We will be piloting a new email group system for information management and exchange to increase openness and improve communication during 2021. CD/Chair has requested our IT Officer David Guest to look into the practicalities of setting up two dedicated email groups BERTSall@ and BERTStrustees@ to enhance organisational communication and increase openness. ## **Recruitment and Staff Changes** We urgently need at least one more cognitive psychologist or psychotherapist, or a senior/experienced psychotherapist in another modality to offer 1-2 hours per week. Please could all therapists consider asking their colleagues to donate a small amount of clinic time if appropriate. Geography not necessary now as we are largely providing online therapies for the foreseeable future until the pandemic situation is under control. Note that our community is low priority in terms of vaccination and so this situation is not changing soon. Amanda Flint will step down as a Trustee and as Secretary from 31.1.21 and we thank her for her help in setting up BERTS as a charity. Catherine Clerkin (currently Vice-Chair) will fill the Secretary role until a new Trustee is appointed to fill this role (ACTION CC/SRM) Bigem Aksel has kindly taken over as Patient Records Manager from December 2020. Cemre and Mert Demir designed us a new logo for the transfer of name and status to legally registered charity. We are grateful to them for their ongoing gift of design work to BERTS (and Mert for his dedication as a support worker). Jane Traies has agreed to be a Trustee, subject to existing committee approval, Jane is a retired headteacher, academic and local writer who has authored a book on UK lesbian refugee experience called “Free to Be Me” https://www.tollingtonpress.co.uk she also previously worked as research 6 assistant on two research council funded research projects with women refugees and asylum seekers based at the University of Sussex. We are grateful to Barbara Bush, HR specialist, for her detailed advice and consultation concerning the new BERTS staff handbook, which we submitted to the Charity Commission in support of our application for charity status. The staff handbook should be distributed to all personnel involved in the charity’s work. All other posts remain stet. ## **BERTS Support Worker 2020 Report** Hanna Randall - Support Worker Coordinator has been doing a terrific job recruiting support workers, interviewing them and checking their credentials. Hanna also found us another patient data management officer, Bigem Aksel. To see about our new staff please go to https://brightonandhovecbt.com/about.html BERTS currently has 13 support workers, one of whom left at the beginning of 2020. I have interviewed 6 applicants for the role of support worker and appointed 5 of them over the past year. BERTS currently has thirteen clients that are seeing a support worker and no clients waiting to be assigned. The only issue so far has been restrictions on meeting locations and social distancing due to Covid, but the support workers and clients have been very adaptable. If it were possible to arrange some sort of training (listening, the UK asylum process) for the support workers so that they feel more equipped to support their clients, that would be wonderful. (ACTION SRM) ## **Any Other Business** SRM 22/1/21 7