Can’t Stay. Can’t Go. Refused asylum seekers who cannot be returned   23 and what’s realistic. (Red Cross staff member, Birmingham) The Leicester Red Cross staff member felt that disputing someone’s nationality can have an effect on his or her mental health: Yes and I think this also has a huge impact on the mental health…. It’s like a huge identity crisis. (Red Cross staff member, Leicester) The Red Cross staff member in Leeds felt destitution can worsen mental health issues: A lot of the people in this group that we’ve come across over the years, some of them have had quite evident mental health issues, which I think destitution is a big factor in worsening the mental health issues that they’ve faced. (Red Cross staff member, Leeds) 3.7.3 Access to health services Access to primary healthcare in England, Wales and Scotland is available to refused asylum seekers as to any other patient, regardless of immigration status. In Scotland and Wales, asylum seekers and refused asylum seekers are entitled to free secondary healthcare on the same terms as other ordinary residents. In England, only refused asylum seekers who receive Section 4 from the Home Office or Section 21 support from a local authority are entitled to free secondary healthcare. However, all refused asylum seekers can continue, free of charge, with any course of treatment already underway before their application was refused. Hospital treatment that has already started should continue until the person leaves the country. The Glasgow staff members reported that people will often use a friend’s address so they can register with a GP. Alternatively, they can access Hunter Street homeless health services. Besides a GP service and nurse team, Hunter Street has a mental health team and an addiction team. The Red Cross can also refer people to charitable organisations like Lifelink, which offers counselling and stress management. Similarly, the Red Cross can refer to Freedom from Torture, which offers counselling and psychotherapy to survivors of torture and organised violence. NHS Greater Glasgow and Clyde Psychological Trauma Service is also available but has a three-month waiting list. The Leicester staff member reported that they are “very lucky” when it comes to physical health, since they have the Leicester City Assist Practice, which offers a full GP service specifically for asylum seekers and refugees. It is much more difficult to get help for people with mental health issues. Red Cross staff try to get patients into the Open Mind service in Leicester, but there is usually a six-month wait. The Birmingham Red Cross staff member reported that they can signpost people who are lonely to befriending organisations. They can also refer people to Healthy Minds for counselling. Helping people access a GP is generally not a problem and the Red Cross will help people to complete an HC1 form so that they can get an HC2 certificate. They will also inform people about their rights with regard to healthcare. The staff member in Leeds expressed concern about this group of people lacking access to secondary healthcare in England. He also felt that, even when mental health services are available, accessing them can be difficult for street homeless people: It’s quite hard to actually be in the mind frame to go somewhere every Tuesday and access a service and get help. That’s actually quite tough and people’s priorities often get quite muddled as well…. If they’re street homeless it can become difficult for them to prioritise their health. (Red Cross staff member, Leeds) None of the refused asylum seekers we interviewed reported any difficulties in accessing a GP service. 3.8 Social support We asked our refused asylum seekers whether they have friends who can listen to them and provide emotional support. Six of our refused asylum seekers reported that they have no friends nor anyone else who can listen to them: I have no one to talk to [starts to cry]. (Qareen, Palestine) I don’t have friends, because friends you need to have contact. So how can you contact this friend if you don’t have anything? (Anwar, Somalia) Two of the six (Anwar and Dawit) said that, although they do not have friends, they can talk to their Red Cross caseworker.