Refugees and migrants face unique mental health challenges that require accessible, culturally appropriate support. This guide explains what mental health needs are most common in these populations, what evidence-based interventions work, how support is delivered in practice, and what organisations, practitioners, and policymakers need to know to provide effective psychosocial care.

What mental health challenges do refugees and migrants face?

Refugees and asylum seekers experience higher rates of common mental disorders compared with most other populations. The main challenges include:

• Psychological distress: High levels of stress, anxiety, and emotional difficulty that do not always meet the criteria for a diagnosed disorder but still significantly affect wellbeing
• Depression: Persistent low mood, loss of interest, fatigue, and feelings of hopelessness
• Anxiety disorders: Excessive worry, fear, and avoidance behaviours
• Post-traumatic stress disorder (PTSD): Distressing memories, flashbacks, and avoidance of trauma-related situations

These problems stem from stressors before, during, and after migration. Before migration, people may experience violence, persecution, or conflict. During migration, they face uncertainty, danger, and separation from family. After arrival, they deal with language barriers, social isolation, difficulty accessing services, and uncertainty about their future status.

Many refugees show increased psychological distress but do not have a diagnosed mental disorder. This group is important because preventive support can reduce the risk of developing common mental disorders.

Why is mental health support difficult to access for refugees?

Traditional mental health care often does work well for refugee and migrant populations. Common barriers include:

• Lack of specialist services: Most refugees are hosted in low- and middle-income countries where there is a shortage of mental health providers
• Language barriers: Services may not be available in the person’s language
• Cultural barriers: Some people are reluctant to seek help from specialist services due to stigma or different understandings of mental health
• Cost and waiting times: Services may be expensive or have long queues
• Legal uncertainty: Asylum seekers may focus on their legal case rather than mental health, or may not know what services are available

These barriers mean that many people who need support do not receive it. Scalable, low-intensity interventions that can be delivered by non-specialists in community settings offer a practical alternative.

What evidence-based interventions are available?

The World Health Organization (WHO) has developed several scalable psychological interventions designed specifically for populations with limited access to specialist care. The main ones are:

Self-Help Plus (SH+)

SH+ is a group self-help intervention for adults experiencing high psychological distress but no diagnosed mental disorder. It combines a printed self-help book with weekly audio sessions delivered by trained non-specialist facilitators. Sessions run for five to six weeks, with each lasting 60 to 90 minutes.

SH+ has been tested in large randomised controlled trials, including the RE-DEFINE project, which evaluated its cost-effectiveness and acceptability for refugees and asylum seekers across multiple countries. Results show it can reduce psychological distress, disability, and health costs.

Problem Management Plus (PM+)

PM+ is a five-session individual or group intervention that teaches practical strategies to manage stress, solve problems, and reduce symptoms of depression, anxiety, and PTSD. It is delivered by trained non-specialists and focuses on skills that participants can use in daily life.

Step-by-Step

Step-by-Step is a five-session psychological intervention for adults with depressive symptoms. It is similar to PM+ but designed specifically for depression, with a focus on behavioural activation and problem-solving.

How these interventions work

These interventions share key features:

• Structured protocols: They follow clear, step-by-step guides that facilitators can be trained to implement
• Non-specialist delivery: They do not require mental health professionals. Trained community workers, cultural mediators, or volunteers can deliver them
• Practical skills: They teach coping strategies, problem-solving, and stress management techniques
• Group or individual formats: Some can be delivered in groups (providing social support) or individually
• Cultural adaptation: They can be translated and adapted for different languages and cultures while maintaining core content

Who delivers these interventions?

Scalable interventions are delivered by trained non-specialist facilitators. Suitable candidates include:

• Cultural mediators working with refugee communities
• Community workers in refugee support organisations
• Volunteers with a refugee or migrant background from the same or similar culture as participants
• Social workers, caseworkers, or integration support staff
• Healthcare assistants or primary care staff in settings serving displaced populations

Facilitators receive structured training (typically 2–5 days) covering the intervention protocol, basic concepts about stress and distress, group facilitation skills, boundaries and safety, and when to refer to specialist services. They also need ongoing support through supervision, peer groups, and refresher training.

In the RE-DEFINE project, facilitators were specifically chosen to have a refugee or migrant background, or to share the same or similar culture as participants. This helps ensure cultural sensitivity and that participants feel understood.

What does cultural adaptation involve?

Cultural adaptation is essential for interventions to be acceptable and effective across different populations. The process includes:

• Translation: Adapting materials into local languages based on situational assessments of migration flows and needs
• Cultural context: Incorporating local elements, religious perspectives, and linguistic nuances that affect how concepts are understood
• Inclusivity: Ensuring adaptation respects gender, age, language, religion, and regional diversity between ethnic groups
• Systematic process: Following WHO adaptation protocols that ensure the process is well-documented and focuses on understandability, acceptability, and relevance

This adaptation is strongly interdisciplinary, relying on ethnographic input from partners and stakeholders. Local and cultural elements are recognised as key aspects for meeting mental health needs.

What is the evidence for these interventions?

Scalable psychological interventions have been tested in multiple randomised controlled trials. Key findings include:

• SH+ reduces distress: Trials show SH+ can reduce common mental disorders in asylum seekers and refugees, with effects mediated through reduction in psychological distress
• Cost-effectiveness: Health economic evaluations aim to determine whether implementation reduces the economic burden of common mental health symptoms, including costs related to distress, disability, and health service use
• Acceptability: Trials assess whether interventions can be implemented within mental health systems and are acceptable to participants
• Scalability: Research shows these interventions can be delivered at scale in low-resource settings where specialist providers are scarce

While results are promising, these interventions are not cures for severe mental illness. They are preventive interventions aimed at reducing distress and preventing the onset of common mental disorders. People with severe depression, PTSD, or other conditions need specialist mental health care.

How does this fit with policy and funding?

Mental health for refugees and migrants is a priority in international health policy. The WHO Global Action Plan on promoting the health of refugees and migrants, extended to 2030 by the Seventy-sixth World Health Assembly in 2023, focuses on improving health outcomes for these populations. This includes promoting access to mental health support that is accessible, culturally appropriate, and scalable.

The European Union Agency for Asylum (EUAA) has also highlighted mental health conditions and needs in the asylum procedure as an important issue. Their guidance includes practical guides on mental health and well-being for applicants for international protection, reflecting the ongoing need for accessible psychosocial support.

Funding for refugee mental health programmes comes from various sources including EU instruments, national government budgets, charitable donations, and international donors. Organisations implementing scalable interventions need to demonstrate cost-effectiveness and impact to secure ongoing support.

What does this mean in the UK context?

In the UK, refugee and migrant mental health support is provided by the NHS, local authorities, refugee councils, and community organisations. While WHO scalable interventions like SH+ are not yet widely implemented in mainstream NHS services, the principles they embody align with approaches used in talking therapies and community mental health initiatives.

UK organisations working with refugees may consider training staff or volunteers to deliver similar interventions as part of:

• Refugee support programmes run by local authorities or integrated care boards
• Community mental health initiatives in areas with high refugee populations
• Voluntary sector programmes funded by grants or charitable donations
• Integration support services that include psychosocial elements

The approach could be considered for refugee and migrant support services as part of broader mental health strategy, particularly given NHS priorities around expanding access to talking therapies and reducing waits.

Common misconceptions

There are several misunderstandings about scalable psychological interventions:

• “They replace specialist services.” Scalable interventions complement specialist services, not replace them. People with severe conditions need specialist care.
• “They are therapy.” These are structured interventions following a protocol. Facilitators do not provide open-ended psychotherapy.
• “They work for everyone.” They are designed for people with high distress but no diagnosed disorder. They may not be suitable for all populations or contexts.
• “Anyone can deliver them.” Facilitators need structured training and ongoing support. Poorly implemented programmes may not achieve expected outcomes.
• “They are a quick fix.” While they are lower-intensity than specialist therapy, they still require commitment (5–6 weeks for SH+) and follow-through.

FAQs

What is the difference between psychological distress and a mental disorder?

Psychological distress refers to high levels of stress, anxiety, or emotional difficulty that affect wellbeing but do not meet the criteria for a diagnosed disorder. A mental disorder (such as depression, anxiety disorder, or PTSD) is a clinically recognised condition that requires assessment and often specialist treatment. Scalable interventions like SH+ are designed for people with distress but no diagnosed disorder.

Can refugees access NHS mental health services?

Yes, refugees and asylum seekers can access NHS mental health services if they meet the criteria. However, barriers include language, cultural differences, long waiting times, and difficulty accessing information. Scalable interventions delivered in community settings can provide accessible support alongside NHS services.

How do I find support for a refugee or migrant?

In the UK, you can contact local refugee support organisations, community health services, or the NHS for advice. Local authorities often have information on available services. For immediate support, organisations such as refugee councils, mindout, or local mental health charities may be able to help.

Are these interventions free?

WHO materials (self-help books, audio recordings) are generally available free or at low cost. Implementation costs include training facilitators, running group sessions, and adapting materials. Organisations typically fund these through grants, donations, or government budgets.

How long does it take to implement a programme?

Setting up a programme involves training facilitators (2–5 days), recruitment of participants, running sessions (5–6 weeks for SH+), and monitoring outcomes. Full implementation from planning to first sessions typically takes 3–6 months depending on organisational capacity.

What if someone needs more help than the intervention provides?

Facilitators should have clear protocols for referring participants to specialist services. Organisations need to ensure there is an accessible pathway to specialist mental health care for participants who need it beyond what the scalable intervention provides.

Refugee and migrant mental health requires accessible, culturally appropriate support that can be delivered at scale. Scalable psychological interventions like SH+, PM+, and Step-by-Step offer practical models for reaching people who need support but cannot access traditional specialist services. They are evidence-based, cost-effective, and designed to work in low-resource settings where mental health providers are scarce.

Implementing these interventions requires training non-specialist facilitators, adapting materials for different cultures, providing ongoing support, and ensuring pathways to specialist care for those who need it. With proper implementation, they can reduce psychological distress, prevent common mental disorders, and reduce the economic burden of mental health symptoms in refugee and migrant populations.