Access to mental health care for migrants and refugees must be strengthened, says WHO report

Health workers need support to provide culturally sensitive care for refugees and migrants, says a new wide-ranging policy report from the World Health Organization into the mental health of migrants and refugees.

A lead author of the report, Dr. Kelly Rose-Clarke, senior lecturer in global mental health, says policies are also urgently needed that safeguard human rights, including the right to health, for all one billion of the world's refugees and migrants, regardless of their legal status. "We also need policies that reduce anti-migrant stigma and discrimination, and that recognize the social determinants of mental health by prioritizing basic needs, such as housing, safety, education and employment."

Overall, the report paints a complicated picture of what policies are required to provide better care at the individual, family, community and national government levels.

Dr. Rose-Clarke said, "Migration represents a major life transition that may benefit mental health and well-being among some migrant and refugee groups. Yet, for other groups, migration may adversely affect mental health—refugees and migrants may be at an increased risk of anxiety, depression, psychosis and suicide. They may be excluded from society because of stigma and discrimination and denied their human rights. They may also be subject to physical and sexual abuse."

"In addition, they may face significant barriers that hamper the availability, accessibility, acceptability and affordability of health services," she said.

Co-written with Dr. Gracia Fellmeth from Oxford University, the report says in 2020 there were approximately one billion migrants worldwide, representing about 1 in 8 of the global population.

These include 281 million international migrants and 82.4 million forcibly displaced people. "Forcibly displaced" people includes the world's 48 million internally displaced persons, 26.4 million refugees and 4.1 million asylum seekers.

The findings of this report are fundamental to developing better policies and practices to ensure that refugees and migrants receive their rightful mental health care and support, says Dr. Rose-Clarke. "As a starting point for more effective policy and planning, a better understanding is needed of what factors place refugees and migrants at risk of mental health conditions and what helps and inhibits their access to mental health services."

Dr. Rose-Clarke added that global evidence on the health of refugees and migrants is limited and governments worldwide often grapple with developing and implementing legal frameworks and policies that address the needs of these populations.

Access to mental health care must also be improved she said, by engaging with refugee and migrant communities and offering choices and pathways regarding care and providers.

"Care itself needs to be strengthened through improving the capacity of health care workers to assess and treat mental health conditions among refugees and migrants from diverse cultural backgrounds," she said.

Aimed at policy makers, the report Mental health of refugees and migrants: risk and protective factors and access to care, identifies key areas such as cultural concepts of mental health and related stigma, and issues arising from navigating mental health and other services.

Self-identity and community support, basic needs and security, and potential exposure to adversity or traumatic events were also shown to be important.

The report is the fifth of the Global Evidence Review on Health and Migration (GEHM) series launched by the WHO's Department of Health and Migration in June 2021. The GEHM series is a collection of global and national synthesis reviews answering policy questions identified as priorities by summarizing the best available evidence worldwide. The series' reports provide policy-makers with evidence-based policy considerations to help them address the health aspects of global migration.