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There is a distinct need for mental health support amongst young refugees and asylum seekers. Refugees and asylum seekers are at increased risk of mental health difficulties due to pre-displacement experiences, which often include persecution, war and other interpersonal traumatic events. This can be compounded following migration, as they face additional stressors, such as uncertainty surrounding legal status, language barriers, stigma and discrimination, separation from family members, financial instability and limited social support. 

However, evidence suggests that despite this, there is an underutilisation of mental health services in this group.  

Academics from Kings College London and University College London, in collaboration with Helen Bamber Foundation, conducted a systematic review of the quantitative evidence about how young refugees and asylum seekers are accessing mental health services globally to better understand this disparity. 

Key Research finding: 

This review identified a consistent pattern of underutilisation of mental health services among young refugees and asylum seekers globally, in stark contrast to the established elevated rates of mental health difficulties in this population.  

This seemed to be a result of both individual and system level factors. Individual factors included differing conceptualisations of mental health, language barriers and limited knowledge of mental health systems. At a system level, a lack of cultural understanding and competence within services may prevent the adequate identification and treatment of mental health difficulties.  

Young refugees were more likely to seek mental health care through emergency departments, suggesting that support may only be access only at crisis point. This may reflect delayed or inadequate recognition of mental health difficulties prior to this, particularly as we know there is reduced use of outpatient services in this population. 

Additional findings highlighted importances differences in access across groups: 

• Young refugees from low- and middle- income countries were even less likely to access support than those from high-income countries. This may be a due to limited psychiatric services in countries of origin, resulting in reduced exposure to and familiarity with mental health services prior to resettlement. 

• Some studies found an increased use of mental health service among unaccompanied refugees, which is consistent with their increased and often persistent mental health needs. 

• Trauma-related disorders and schizophrenia were the most common reasons for seeking care. However, service use for depression and anxiety was comparatively low, despite their high prevalence in this population, and there was a notable lack of service use for neurodevelopmental conditions such as ADHD and autism. 

Implications for policy and clinical work: 

The disparity between the need for and access to mental health services highlighted in this review emphasises the urgency of improving mental health service accessibility for young refugees and asylum seekers.  

• Timely and appropriate screening for mental health difficulties is essential, alongside efforts to identify and reduce barriers to accessing care. It is important to improve the knowledge of mental health services amongst refugees and asylum seekers and understanding of mental health in their new country, to empower them to navigate the systems of which they are now part. 

• Healthcare professionals should be supported to develop greater cultural awareness and understanding of mental health presentations in this group. This includes recognising potential biases and avoiding the underdiagnosis of certain conditions, particularly neurodevelopmental disorders.  

• Finally, given the importance of basic services and security in supporting mental health and psychosocial wellbeing, there is a need for policies that ensure legal protection, safe and appropriate accommodation, access to resources, education, and integration opportunities for this vulnerable population. 

Read the full article in the BJPsych Open.