What kinds of mental health support do refugees need beyond short-term trauma therapy?

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The number of refugees worldwide has risen on an unprecedented scale, with the majority located in low-income countries that have limited mental health care resources. This paper is an overview of contemporary issues in refugee mental health, covering developments in research, conceptual models, social and psychological interventions, and policy.

Prevalence data from cross-sectional epidemiological studies cannot clearly distinguish distress arising from a person's circumstances from frank mental disorder. Longitudinal studies may help address this limitation.

An evolving ecological research model examines the dynamic relationships among past traumatic experiences, ongoing daily stressors, and underlying disruptions of core psychosocial systems. Its scope extends beyond individuals to married couples and families.

Brief, structured psychotherapies delivered by lay counsellors have been shown to be effective in the short term for a range of traumatic stress responses. However, questions remain about whether these interventions can be sustained in low-resource settings and whether they meet the needs of complex cases.

Ideally, support should include a comprehensive array of programs: social and psychotherapeutic interventions, general mental health services, rehabilitation, and special programs for vulnerable groups.

Future developments must aim for sustainable services, best practice, evidence-based approaches, and equitable access. This is a daunting challenge because most refugees live in settings where mental health care skills and resources are in shortest supply.