1. Return of vulnerable persons Belgian Immigration Office Coordinating psychologist of Detention Centers Maïlys Dereymaeker The project is co-financed by European Return Fund and Estonian Ministry of Interior

2. Content Introduction Belgian detention centers + Mission Monitoring humane return of (vulnerable) persons: our best practices: - Humane policy - Implementing humane policy: Staff and projects => Extra Care project => Special Needs project - Conclusion and risks Psychological impact 2

3. Belgian Detention Centers Directorate for Control at the Territory and Border Control 5 Detention centers - different target groups Mission: Detention of irregular migrants in a humane manner in order to achieve their return within the shortest period possible or the provision of access to the territory whenever this proves necessary and when stipulated by the regulations, in respect of the existing regulatory, legal and international determinations and standards. 3

4. Monitoring humane return in detention centers – Humane policy -Systematic detection and signalisation of specific problems or vulnerabilities -‘Made to measure’ care and assistance: during detention, during return and after return -Close follow-up by the administrative services who are responsible for organising return 4

5. Implementation of humane policy: Staff In each center: => A director (+ assistant-managers) => A multidisciplinary professional staff: -Medical service: physicians and nurses -Clinical psychologist -Social team: educators, social assistants, teacher -…-… Coordinating clinical psychologist for overall monitoring 5

6. Implementation of humane policy: developing projects on humane return Motivation for creating specific projects: -Difficulties to provide adequate and continuous care and assistance for residents with psychomedical problems and / or extreme behavioural problems -Difficulties to organise a return for these residents Projects: -Extra Care project (since 2009) -Special Needs project (since 2009) 6

7. Extra Care project: Our intentions 1.A more adequate approach in detention centers 2.An improved coordination / communication / information flow between centers and administrative services responsible for organising return 3.A systematically signalisation of ‘Extra Care’ residents 4.An improved coordination / communication / information flow with external partners 7

8. Extra Care: 1. Approach detention centers – Internal -Collective approach of groups of residents vs a customized approach of each individual Extra Care resident -Training our staff members -Extra Care Information Sheets -Introducing regular multidisciplinary meetings on Extra Care residents 8

9. Extra Care: 1. Approach detention centers – External admissions -Existing collaboration with hospitals nearby -Development of a systematic co-operation with psychiatric institutions nearby: Temporary transfer (a priori max. 14 days):  On the advice of our psychologist + doctor  (Indication of) diagnostics / adaptation of medication / assessment on possibilities for return (specific needs during return… Person remains “detained” – costs of psychiatric admission paid by Immigration Office 9

10. Extra Care: 2. + 3. Coordination / Information flow and Signalisation Creating a common Immigration Office database – Detention Centers and administrative services responsible for return Extra Care list (EZA) => Residents who need Extra Care are listed in the database on the advice of our multidisciplinary teams in the detention centers Extra Care: residents with medical and / or psychological problems / vulnerabilities, behavioural problems + residents who need extra monitoring, e.g. residents on hunger strike, residents with a special needs file, … 10

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13. Extra Care: 2. + 3. Coordination / Information flow and Signalisation Introducing regular multidisciplinary meetings on Extra Care residents in the detention centers Introducing weekly meetings on Extra Care residents with administrative services who are responsible for organising the return Prioritising these cases (case management): => Outcome is variable: fast identification and return, temporary or long term placement in a hospital / psychiatric institution, to end the decision of detention, or sometimes also temporary right to stay 13

14. Extra Care: 4. Coordination / Information flow and Signalisation Collaboration with Social-Psychological team of the Federal Police of our national airport (continuity of ‘made to measure’ care and assistance): -Training of police escorts -Information flow to the Social-Psychological team of the police -Development of a joint approach 14

15. Special Needs project: Aim and target group Aim project: Providing financial support for the organisation of ‘made to measure’ care and assistance of vulnerable persons with regard to their forced return (during detention, during return and after return). Target group (vulnerable persons): -Non accompanied Minors (+ Aged-out minors) -Persons with specific needs (psychological or physical) -Pregnant women -Elderly persons -Persons who need a ‘made to measure’ follow-up for other reasons 15

16. Special Needs project: during detention During detention: -Urgent psychiatric admissions of residents -Purchase of medication or other necessities (such as wheelchair, hearing device, …) -(Training for staff of detention centers with regard to vulnerable persons) 16

17. Special Needs project: during return During return: -Assistance of a physician, a specialist, a (psychiatric) nurse, a psychologist, a confidant, a liaison officer -Up to the airport of arrival (e.g. when pick-up by family) or up to the arrival of the returnee at his / her home, … 17

18. Special Needs project: After return After return: Post-arrival assistance and / or reintegration trajectories made to measure the needs of vulnerable persons : -Reintegration period is limited to 12 months after return -Based on estimated expenses a maximum budget is fixed -Medical follow-up (e.g. residential or ambulatory psychiatric follow-up, follow-up of general medical treatment, appointments with specialists), … -Other follow-up… 18

19. Special Needs project: After return Monitoring after return: -Monitoring by local partner (check of invoices after appointments etc., assist the returnee with his appointments, …) -Monitoring by liaison officers of Belgian Immigration Office General remark: Finding family / relatives (informal care givers) of the returnee and involving them in the return process is important for the durability of the follow-up 19

20. Conclusion and risks Organising the return of vulnerable persons in general and more specific of persons with a psychiatric disorder, is a very complex process Risks: - Finding no local partner in home land / No family (dependance on returnee) - Loss of information / Bad communication - (Interpretation of the) behaviour of the returnee - Dependance on goodwill of authorities + local partner - … 20

21. Psychological impact on returnees In general, when detained in a detention center: -Different psychological processes come at a crosssection and are meeting each other: migration process, asylum process, detention process and return process… -Specific context of detention -Specific context of different cultures and living in a group All have a impact on the mental health of our (sometimes already psychological vulnerable) residents 21

22. Psychological impact on returnees In our experience: General psychological impact related to procedure: - General complaints of (acute) distress and tension - Difficulties adapting to detention - Difficulties facing a (forced) return - Feeling angry (because of the procedure) - Feeling depressed and fearful… 22

23. Group sessions 23

24. Psychological impact on returnees In our experience: Psychologically vulnerable persons: -Are in a very emotional state (high emotional distress) -Have a vulnerable personality structure or low IQ -Decompensate / establish a great psychological suffering (presence of a psychiatric disorder) 24

25. Individual sessions with psychologist 25

26. Psychological impact on staff In our experience: -Adaptation period (learning to cope with extreme behaviours, …) -Working in a very specific context => match or not? -Developing a follow-up for our staff with regard to the specific stress level of working in this context: creating Stress Teams (STEAM) as a part of this 26

27. Stress Teams (STEAM) Selecting teams of volunteers who own certain competences to care for their collegues after a crisis Different levels of follow-up: STEAMmembers, coordinator (psychologist of the center), supervising team Training by an expert in trauma and crisis psychology Actions of STEAM: after a big crisis (possible traumatising), loss of collegues or residents 27

28. Questions? Thank you for listening!! 28