The mental health of asylum seekers and refugees: policy perspective

This short policy summary is part of a series setting out the major changes that are needed to improve mental health in the UK. 

Asylum seekers and refugees are at a high risk of poor mental health. Their experiences both prior to and after their arrival in the UK put them at greater risk of mental health problems. We address the changes that the government need to make to improve the mental health of asylum seekers and refugees in the UK.

Content

• Policy context
• Principles for moving to a mentally healthier system
• Policy recommendations

The mental health of asylum seekers and refugees is influenced by both their pre- and post-migration experiences.

Their pre-migration experiences may include torture, war, imprisonment, physical assault, sexual assault, loss of livelihood, and losing close family or friends.¹ Trauma may also be experienced on migrants’ journeys to the UK, which are sometimes long and perilous.

The social and economic conditions they face post-migration can have an equally powerful influence on their mental health. Experiences of poverty, unemployment, lack of adequate housing, social isolation, loneliness, stigma, and discrimination all carry a higher risk of poor mental health,² and asylum seekers and refugees are at higher risk of experiencing all these inequalities.

Within the UK, there are significant variations in how respective national governments regard asylum seekers and refugees. In England, there is no government-led strategy in place to support the integration of asylum seekers. Policy in Scotland and Wales aims to support the integration of asylum seekers and refugees into communities from the first day of their arrival.^3,4 The Welsh Government declared in 2019 that Wales would become the world’s first ‘Nation of Sanctuary’ and published a plan endorsed by the United Nations.⁵ In Northern Ireland, there is no official government strategy on asylum seekers and refugees. Although a draft Refugee Strategy was published for a consultation in 2021, implementation remains to be seen.⁶ 

A major component of the UK’s policy on immigration is what has become known as the ‘hostile environment’ policy. The UK government introduced measures to reduce the number of migrants in the UK with no right to remain through the Immigration Acts of 2014 and 2016. A stricter asylum system has continued to be reinforced through the Nationality and Borders Act 2022 and the Illegal Migration Act 2023.

To  improve the mental health of asylum seekers and refugees, we need a trauma-informed and person-centred approach to asylum claim processes, housing, education, and the health and care provision they experience. This needs to be delivered across all government departments. 

This would stand in contrast to the current approach of actively introducing challenges to asylum seekers’ and refugees’ mental health. Key changes such as using detention instead as a last resort measure and providing regular updates to asylum seekers about their claim will be instrumental in protecting their mental health. It would also ensure that the asylum system does not retraumatise individuals or create new trauma. 

Asylum seekers and refugees have made and continue to make major contributions to the British economy, culture, and society - and evidence has clearly shown that people want to utilise their skills and give them opportunities to contribute to our economy as they rebuild their lives in the UK.⁷

We need an infrastructure that is able to meet the needs of these aspiring new members of our communities. If we fail to do so, we will see increasing costs to the NHS and risk trapping them  in a cycle of poor mental health, poverty, and discrimination.

This section includes a selection of key policy recommendations from our report The Mental Health of Asylum Seekers and Refugees in the UK. Further detail and additional policy areas where change is needed are set out in the report.

Mental health considerations must inform all policy development

• The current Labour government must fulfil the commitment recently made by the previous government in its interim Major Conditions Strategy report (which covers England ) to develop a mental health and wellbeing impact assessment tool. This will support policymakers to consider the mental health and wellbeing effects of their policies. This should involve full consideration of the likely impact on asylum seekers and refugees, and be applied during the development of immigration policy and legislation. 
• The devolved administrations should develop a similar tool and use it to ensure that new policy initiatives support the mental health and wellbeing of their populations, including asylum seekers and refugees.

Promoting integration, supporting wellbeing, and reducing hostility and discrimination

• The UK government should develop a clear strategy for refugee and asylum seeker integration, working with the devolved administrations, local authorities, the voluntary sector, and people with experience of seeking refuge. 
• The UK government and devolved administrations should invest in peer support programmes and community initiatives for asylum seekers and refugees, including volunteering schemes. 

A trauma-informed approach

• The asylum claim system, UK Home Office immigration agencies, and the wider public sector workforce should become trauma-informed.
• Asylum seekers should not be required to report to immigration officials more often than necessary.
• Detention must only ever be used as a last resort, and for the shortest possible time. Pregnant women and children should never be detained.
• Asylum seekers with health conditions (including mental health conditions) should receive immediate and appropriate treatment.

Reducing financial and housing stressors

• The UK government must take action to alleviate the financial and housing stressors that asylum seekers and refugees often experience.
• The UK government must make sure that financial support available to asylum seekers and refugees keeps pace with the cost-of-living.
• The UK government must abandon the No Recourse to Public Funds (NRPF) policy for asylum seekers.
• The UK government should the quality of hotel and other short-term accommodation, shortening the length of time asylum seekers need to be housed in it, and ensuring that people are not moved multiple times between asylum accommodation locations.

Employment

• The UK government should automatically grant asylum seekers the right to work if they have been waiting for longer than six months for a decision on their claim. 
• The Department for Work and Pensions (DWP), the Economic Strategy and Fair Work Directorate in Scotland, and the Department for the Economy in Wales and in Northern Ireland should ensure that all staff working in government employment services have the knowledge to offer bespoke employment support to refugees and make interpreters available in multiple languages in job centres. 

Education

• The UK government, devolved administrations, local authorities, and schools should reduce the barriers which can prevent asylum seekers and refugees from accessing and thriving in education, by simplifying the education application process for entering education for asylum-seeking and refugee families.
• The UK government, devolved administrations, local authorities, and schools should reduce the barriers which can prevent asylum seekers and refugees from accessing and thriving in education through ensuring that training for teachers and mental health leads in schools includes specific content on supporting refugee and asylum-seeking children.

Healthcare and preventative mental health programmes

• The UK government, devolved administrations, the NHS, and other health providers should reduce the barriers which can prevent asylum seekers and refugees from accessing the services and healthcare that support them to live well. This should include proactively targeting preventative interventions towards asylum seekers and refugees. This will involve supporting and funding asylum seeker and refugee community groups, which will often be best placed to deliver such interventions. 

Improving accessibility of public services

• The UK government, devolved administrations, and metro mayors in England with delegated transport policy powers should provide free bus travel to all asylum seekers. The Scottish Government should deliver on its pledge to provide free bus travel for asylum seekers and this should continue beyond 2025.
• The UK government, devolved administrations, local authorities, and public services (including education, healthcare, employment services and legal services) should increase the availability of skilled interpreters and improve the accessibility of their online and printed resources. 

Suicide Prevention

• The UK government and devolved administrations must deliver on their commitments to improve the data and evidence on refugee and asylum seeker suicides, as a first step to developing a public health approach to tackling them. 
• Integrated Care Systems and other health and care systems in the nations of the UK should take a public mental health approach to suicide prevention, identifying and addressing the drivers of suicidality amongst these groups.