Mental health promotion and mental health care in refugees and migrants: policy brief

Policy issues and context

For all refugees and migrants, the process of migration can be complex and stressful as it involves leaving the home country and adapting to a different environment, culture and life situation. Moreover, refugees and migrants can be exposed to stressful events before departure, during transit and after arrival, and they may struggle to fully integrate in the social context of the host countries. All can lead to mental health disorders, although prevalence is highly variable across studies and population groups.
Post-traumatic stress disorder is the only disorder for which substantial and consistent differences in prevalence from host populations have been reported, although this is specifically for refugees; however, it is not the most prevalent disorder in refugees and migrants overall (mood disorders being most prevalent). Refugees living in a host country for more than five years do tend to show higher rates of depressive and anxiety disorders than host country populations. The higher prevalence rates of mental disorders in long-term refugees and migrants are associated with lack of social integration, and particularly with unemployment. While prevalence is an important factor, the total number of refugees and migrants in a country is also critical. If the total number is very high, there are likely to be many with manifest mental disorders, posing challenges to health system capacity.

Policy considerations

Social integration

• Promote initiatives that increase social inclusion and integration, including access to employment and educational opportunities, as these support good mental health.

• Encourage collaborations across health care and social services, as well as with providers of legal and employment support.

• Consider school-based programmes for children, particularly if unaccompanied or separated.

• Encourage volunteer initiatives or training of refugees and migrants as peer supporters.

Information on entitlement to care

• Devise and publish clear information on entitlements to care for each category of migrant to facilitate appropriate access to care.

• Adopt tailored communication strategies that are accessible for all groups.

• Make information available to health professionals, particularly in primary care and emergency services, to help them to refer refugees and migrants appropriately.