This report presents evidence on the circumstances which asylum seekers and refugees in the UK can face, and how these experiences can harm their mental health and even lead to suicidal feelings and actions.
Asylum seekers and refugees are at particular risk of mental health problems. These may develop because of their experiences in their countries of origin, during their journeys, or after they arrive in the UK.
Read our report to understand why asylum seekers and refugees are at particular risk and what we, as a society, can do to protect their mental health once they arrive in the UK.
Context
This report presents evidence on the economic, social, and cultural circumstances which asylum seekers and refugees who seek sanctuary in the UK can face.
We take an approach rooted in the discipline of public mental health. Public mental health is the improvement of mental health and wellbeing through preventative work involving communities, organisations, and individuals.
Evidence is gathered from research, from people with lived experience of seeking refuge and asylum in the UK, and from the Mental Health Foundation’s programmes and other third-sector organisations who work with asylum seekers and refugees.
Read the full research context in our report.
In the report, we set out the UK policy context to shed light on the circumstances which refugees and asylum seekers in the UK can face.
This context includes the international human rights obligations of the UK relevant to refugees and asylum seekers.
We also look at the significant variations within the UK in how respective national governments regard asylum seekers and refugees. For example, in England there is no UK government-led integration strategy, in contrast to in Scotland and Wales.
We also refer to a major part of the UK’s policy on immigration known as the ‘hostile environment’ policy, describing an approach that sought to deter people arriving irregularly from entering the UK.
The UK government introduced measures to reduce the number of migrants in the UK with no right to remain. These pieces of legislation have contributed to the ‘hostile environment’ agenda and have had a profoundly negative impact on the lives of migrants [1].
Read the full UK policy context in our report.
What are the experiences that asylum seekers and refugees can face that affects their mental health?
Asylum seekers and refugees face many barriers to achieving and sustaining good mental health, as their pre-and post-migration experiences place them at higher risk of experiencing mental health problems.
In their home countries or during their journeys
Pre-migration experiences may include torture, war, imprisonment, physical assault, sexual assault, loss of livelihood, and losing close family or friends [2]. Trauma may also be experienced on migrants’ journeys to the UK, which are sometimes long and perilous.
In addition to the distress these experiences cause, they can exacerbate existing mental health conditions and lead to the development of new ones. Exposure to violence and trauma increases migrants’ risk of post-traumatic stress disorder (PTSD) [3][4], they are more likely to experience depression [5][6], and anxiety disorders [7], and are a high-risk group for suicidal ideation [8]. Internationally, around 30% of refugees and asylum seekers have been found to experience PTSD, with the figure for those experiencing depression also around 30%. [9].
On arrival to the UK
The social and economic conditions in which they live post-migration can have an equally powerful influence on their mental health. Experiences of poverty, financial insecurity, unemployment, lack of adequate housing, social isolation, loneliness, prejudice, stigma, and discrimination all carry a higher risk of poor mental health [10], and asylum seekers and refugees are at higher risk of experiencing all these inequalities. Asylum seekers will also often be dealing with stress about the status of their claim and challenges in accessing healthcare.
What can we do?
The UK government, devolved administrations, and local authorities have the power – and the responsibility – to address these social determinants of poor mental health, both directly and through supporting the third sector. This report sets out how they can work together to create a society that respects the dignity of asylum seekers and refugees and provides the building blocks that underpin good mental health.
How can we protect the mental health of refugees and asylum seekers?
In our report, we make the case for a trauma-informed and person-centred approach to asylum claim processes, housing, education, health and care provision experienced by asylum seekers and refugees.
We also address the urgent need for greater support for asylum seekers’ and refugees’ integration into their communities in the UK, and propose changes to existing government policies and public service practices to avoid the risk of re-traumatisation and other harms to the mental health of those seeking asylum and refuge.
Many of the systems and processes in the UK do not work well for asylum seekers and refugees. The report makes policy and practice recommendations as to how systems and processes could be reconfigured to do no further harm to people who have come here to make a new life after fleeing war, persecution, sexual violence, and other deeply traumatic experiences. It sets out how we could take a compassionate approach to better supporting their mental health, limit the severity of the mental health problems many experience, and reduce the risk of them taking their own lives.
Our recommendations
Our policy and practice recommendations for protecting the mental health of refugees and asylum seekers come under these main areas. Read our recommendation in the report.
1. Mental health considerations must inform all policy development.
2. Promoting integration, supporting wellbeing, and reducing hostility and discrimination.
3. A trauma-informed approach.
4. Reducing financial and housing stressors.
5. Employment: reducing barriers to work and training.
6. Education: reducing barriers to thriving in education.
7. Healthcare and preventative mental health programmes.
8. Improving accessibility of public services.
9. Suicide prevention: making asylum seeker and refugee suicides visible.
Everything is stressful. You can't sleep at nighttime, always thinking about the Home Office, maybe they want to send you back home, today or tomorrow, you never know.
I’ve experienced mental health professionals being desensitised to asylum seekers and refugees and not having knowledge of how to help them.
I would feel that I'm alive and happy when I am volunteering and helping others.
Authors:
Leeza Ah-Wan (Policy and Public Affairs Executive, Mental Health Foundation).
Oliver Chantler (Head of Policy and Public Affairs in England, Mental Health Foundation).
The Mental Health Foundation would like to thank the following for sharing their lived experience and insights to inform this report:
- The Foundation’s Young Leaders Group (hosted by Leaders Unlocked).
- Participants from the Foundation’s Perthyn (“Belonging”) programme in Wales.
- Participants in Scotland who attended our focus group on transport in Glasgow.
- Participants in Scotland who attended the focus group we held in collaboration with Mental Health Network on experiences of mental health services.
- Participants in Scotland who attended our focus group on Let’s Talk Scottish Education.
- Participants in Scotland who attended our focus group on public transport in Edinburgh and Perth.
- Participants who attended our focus group on exploring the experiences of seeking refuge and asylum in Scotland, and its effects on mental health.
We would like to thank the following for reviewing this report:
- The Mental Health Foundation’s Young Leaders Group (hosted by Leaders Unlocked)
- Participants who attended our focus group on exploring the experiences of seeking refuge and asylum in Scotland, and its affects on mental health.
- Lucy Thorpe (Independent Policy and Public Affairs Consultant)
- Refugee Action
- City of Sanctuary UK
- Refugee Council
- Royal College of Psychiatrists, Working Group for Mental Health and Forced Migration
- Samaritans
- Rethink Mental Illness
[1] House of Lords Library. (2018). Impact of ‘Hostile Environment’ Policy. Retrieved November 29, 2023, from https://lordslibrary.parliament.uk/researchbriefings/lln-2018-0064/
[2] Refugee Health Technical Assistance Center. Traumatic Experiences of Refugees. Retrieved November 8, 2023, from https://www.refugeehealthta.org/physical-mentalhealth/mental-health/adult-mental-health/traumatic-experiences-of-refugees/
[3] Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & Van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA, 302(5), 537–549. https://doi.org/10.1001/JAMA.2009.1132
[4] Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet (London, England), 365(9467), 1309–1314. https://doi.org/10.1016/S0140-6736(05)61027-6
[5] Tempany, M. (2009). What research tells us about the mental health and psychosocial wellbeing of Sudanese refugees: a literature review. Transcultural Psychiatry, 46(2), 300–315. https://doi.org/10.1177/1363461509105820
[6] [9] Blackmore, R., Boyle, J. A., Fazel, M., Ranasinha, S., Gray, K. M., Fitzgerald, G., Misso, M., & Gibson-Helm, M. (2020). The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis. PLoS Medicine, 17(9). https://doi.org/10.1371/JOURNAL.PMED.1003337
[7] Hameed, S., Sadiq, A., & Din, A. U. (2018). The Increased Vulnerability of Refugee Population to Mental Health Disorders. Kansas Journal of Medicine, 11(1), 20–23. https://doi.org/10.17161/kjm.v11i1.8680
[8] Haase, E., Schönfelder, A., Nesterko, Y., & Glaesmer, H. (2022). Prevalence of suicidal ideation and suicide attempts among refugees: a meta-analysis. BMC Public Health, 22(1), 1–12. https://pubmed.ncbi.nlm.nih.gov/35365108/
[10] Mental Health Foundation. (2020). Tackling social inequalities to reduce mental health problems: How everyone can flourish equally. Retrieved November 8, 2023, from https://www.mentalhealth.org.uk/sites/default/files/2022-04/MHF-tacklinginequalities-report.pdf
