Refugee Mental Health: What You Need to Know

Globally, over 65 million people are displaced by war, conflict, or persecution. What is the mental health impact, and what can we do about it?

July 15, 2022

The percentage of children, adults, and older adults forced to leave their homes to avoid danger and death has steadily risen over the last several decades.

While many are refugees—those forced to leave their home country—there are many more people who are internally displaced persons, or IDPs. These individuals have not been forced to leave their home country but are still displaced.

Due to the extreme circumstances around the world, displaced populations can often live through a variety of traumatic experiences, such as physical violence, rape, natural disasters, grief around losing a loved one, the breakup of families, and a loss of culture.

Many experience the onset of anxiety disorders, depression, and post-traumatic stress disorder (PTSD). For many reasons, mental health conditions are sometimes hard to diagnose and address among refugees or IDPs.

The life of a refugee or IDP is often filled with many challenges, including those related to their health. However, these struggles do not define who the person is.

Successful recovery is more challenging for some than for others—however, with effective management or treatment, a displaced person can successfully manage their mental health.

Keep Reading To Learn

  • About different types of trauma—and other mental health concerns for displaced persons
  • How to reduce stigma around refugee populations seeking help
  • What we can do to improve refugee mental health

Who Is a Refugee or IDP?

The first step in supporting refugee and IDP mental health is understanding what it means to be a displaced person.

A refugee is a person who has chosen or has been forced to flee from their country. Refugees are also commonly referred to as “displaced persons.” An internally displaced person is displaced from their home but never crosses an international border.

Displaced persons flee for many reasons, including:

  • War and conflict
  • Ethnic oppression
  • Religious persecution
  • Political or social justice beliefs
  • Group affiliation
  • Natural disaster

Some leave because they have no choice. Their home was destroyed or they were forcibly removed. Others leave because the situation is dangerous. They may fear prison, murder, rape, breaking apart of their family, invasion, bombs, or any other source of physical or mental harm.

In cases where an ethnic, religious, or political situation is to blame, refugees most likely won’t stay within their own countries. Their countries have already proven they cannot adequately protect them. In these cases, they leave and request shelter from another government. Refugees are protected by international law.

Understanding Trauma

Patient talks to clinician

While trauma doesn’t always directly lead to post-traumatic stress disorder (PTSD), it is beneficial for those who have witnessed or experienced trauma—as well as their loved ones—to know the signs and symptoms of PTSD, ways to treat it, and how to seek help.

Patient talks to clinician

Types of Displaced Persons

Beyond refugees and internally displaced persons, other categories of displaced persons include:

Asylum Seekers

An asylum seeker is someone who has formally applied for sanctuary in a new country. Like refugees, asylum seekers flee persecution and conflict. However, their applications are not yet processed. They have not yet been granted the legal protection of refugee status and the official approval to stay in a new country.

“Asylum” is a specific term that means a government promises an individual or family they will protect them should their countries of origin try to bring them home. “Immunity” and “amnesty” are words that are sometimes used interchangeably to describe this situation.

Forcibly Displaced Youth

“Forcibly displaced youth” is a term that might apply in a number of situations. Any child who is suddenly and/or violently removed from their home is forcibly displaced.

According to UNICEF, over 43 million children were displaced in 2022—more than double the number of displaced children in 2010.

Separated Children

Refugee children who arrive in a new place without their parents are known as “separated children.” They may be with other adults, such as older siblings or aunts and uncles.

Unaccompanied Minors

This is a subcategory of the above, in which children have been separated from their parents and from other family members. They have no adults with them. The government that takes them in must decide what to do with them without the input of family.

Unaccompanied minors may arrive with siblings or cousins who are also minors. Children may exhibit higher resilience and fewer mental health issues if they have companions from their home country, but it is not a given.

Stateless Persons

Stateless persons do not have a nationality in any country. They lack official paperwork, such as birth certificates and passports. Stateless persons are often marginalized and denied access to health care, education, employment, and marriage.

According to the UN Refugee Agency, statelessness can arise from a number of factors. These include gaps in nationality laws, being born in a country that does not grant nationality based on birth or parentage, changes in borders, and living outside one’s country for a period of time.

Examples of stateless persons include Roma in eastern Europe and Palestinians in Palestine/Israel.


Migrants do not fit the legal definition of a refugee since they do not flee persecution. Migrants leave their countries voluntarily.

However, many migrants face unsafe conditions in their countries of origin. Some migrants leave home because they fear violence and natural disasters, or because they face poverty. Others move for work and educational opportunities, or to join family.

Even though migrants’ situations differ in some ways from those of refugees, Amnesty International underscores the need for recipient governments to protect migrants’ human rights.

Migrants should be shielded from violence and should never be forced into labor. Governments should never detain migrants or send them back to their countries without a legitimate reason.

When people flee their homes, whether they fall into specialized categories or not, they follow the same basic path. Although everyone’s experience is different, the journey has many of the same characteristics for all.

Infographic - 89.3M worldwide refugees

Understanding the Health Impact of Being Displaced

There are significant mental and physical impacts related to having to leave one’s home behind.

There is a good chance that a refugee will have experienced mental health challenges before they were forced to flee home.

Mental health disorders are common throughout all populations, with depression affecting 264 million people globally, according to the World Health Organization.

Unfortunately, many cultures don’t have widely accessible mental health care. It is possible refugees:

  • Aren’t aware that what they are experiencing are mental health challenges
  • Don’t know that mental health treatment exists, and therefore do not try to access it
  • Have a “stiff upper lip” mentality that frames mental health issues as weakness (stigmatization) and prevents them from seeking treatment
  • Do know that treatment exists, do believe in its value, but still do not know how to navigate the system and get treatment for themselves, dependents, or loved ones

85 percent of refugees resettle in developing countries, which frequently lack the infrastructure to support them.

Specifically, low-income countries tend to lack effective mental health care, either through a lack of infrastructure, a lack of national support for mental health, or both.

Overcoming Anxiety

Paper cutout person with words like torn from newspapers

Anxiety disorders are common, treatable, and can be managed. Learn the skills needed to control anxiety and live a healthy, happy life.

Paper cutout person with words like torn from newspapers

The Most Common Mental Health Diagnoses Among Refugees

Many factors affect the experience of a displaced person. For instance, being unable to obtain refugee status—as in, a foreign government does not recognize the individual’s need—is associated with much higher rates of severe symptoms related to mental health disorders.

Displaced persons may experience many mental health disorder symptoms, including:

  • Nightmares or flashbacks
  • Aggression and anger
  • Irritability
  • Psychosis
  • Suicidal thoughts

They may also withdraw from engaging with friends or loved ones or turn to substances in an attempt to cope with the discomfort.

When treating refugees, mental health clinicians must consider the traumas experienced before and during being displaced as well as other illnesses that may have varying causes.

Having a greater number of traumatic experiences also leads to an increase in symptom severity.

Particular types of traumatic stress can create more severe mental health issues. Studies point out that being a victim of torture, in particular, leads to more severe outcomes and requires specialized assessment and treatment.

Older adults find the trauma of displacement to be just as unsettling as young or working-age adults do. Children are most impacted of all. Overall, the trauma of relocation is often something patients have to work through as families.

Providers can learn how to help refugee families. According to the National Child Traumatic Stress Network, clinicians can take the following steps:

  • Learn about the family’s culture
  • Understand that children and parents may adjust to a new culture differently
  • Acknowledge the family’s hardships as well as strengths
  • Use interpreters as often as possible
  • Collaborate with other professionals in the family’s community

The conclusion should surprise no one. The worse a refugee’s situation, and the harder time they have getting officials to recognize their need for help, the greater their symptoms of mental illness will be.

Some of the most common mental health conditions refugees and IDPs may face include:

Post-Traumatic Stress Disorder

PTSD is one of the most common disorders experienced by refugees. Recorded rates of PTSD in refugees varies widely, from 10-40% depending on specific groups.

PTSD manifests in an inability to control upsetting memories, becoming triggered by similar situations, and perhaps even losing touch with reality. Untreated, PTSD is tough to manage and can lead to severe depression, substance use, or suicidal behaviors.

Talking About Suicide Is the Best Way To Prevent It

Find access to suicide prevention resources, including international support.

Suicide Prevention

Anxiety and Depression

Both anxiety and depression are extremely prevalent in refugee communities.

Displaced persons may fear that they will experience their trauma again, worry obsessively about their home or children, or see danger around every corner. Anxiety can interfere with daily activities and make life incredibly challenging.

Depression can be equally debilitating. Many refugees lose interest in activities they once enjoyed, and even the people closest to them can’t make them feel better.

“What’s the point?” and “I hate everything” are common refrains for those who experience depression, a disorder which may be situational or biological.

Obsessive Compulsive Disorder

Some individuals who lived through a traumatic event may end up engaging in obsessive-compulsive behavior. “Obsessive” means thinking about something without control. “Compulsive” means taking obsessive action, sometimes even when the individual doesn’t want to.

The OCD cycle involves a trigger, causing the person to think an unpleasant thought, after which they take action to soothe themselves. It can involve tics, repeated handwashing, religious obeisance or confessing, among many other symptoms.

Substance Use Disorder

Research shows that substance use among refugees is growing in the U.S. Because of trauma histories, refugees may be especially vulnerable to developing substance use disorders and they may turn to drugs and alcohol at various stages of their experience.

Refugees may use substances to cope with trauma symptoms related to war, displacement, and violence. In refugee camps, people may turn to drugs and alcohol to numb feelings of isolation and uncertainty.

Once resettled in new countries, they may use substances to cope with separation from family, the stress of finding employment, as well as adapting to a new culture.

According to a 2016 study, refugee populations face the following challenges in connecting with substance use treatment:

  • Lack of awareness of substance addiction treatment
  • Navigating a treatment system in a new country
  • Lack of culturally informed treatments
  • Language barriers/lack of interpreters
  • Mistrust of authority figures, including medical providers

Health professionals routinely screen refugees for mental health conditions. Addiction disorders are often not included in such screenings, and culturally informed addiction treatment is often unavailable.

The lack of appropriate treatment options can prevent clinicians from making referrals. When treatment does exist, providers are likely not able to easily accommodate patients who do not speak English, as interpreter services can be expensive.


Displaced persons are often impacted by grief. Many refugees have lost loved ones or are uncertain of the fate of loved ones. Others have lost their homes and ways of life, at least temporarily.

Without support, they may experience complicated bereavement or prolonged grief reactions. Such unresolved grief can lead to worse mental health outcomes.


Many displaced persons feel a sense of extreme alienation, living in a new place and sometimes forced to interact with people who speak a language they may not understand.

Displaced persons often face all these challenges without the family, jobs, and pets they left behind, as well as possessions and other trappings of a life well-lived. They require solid support while they are rebuilding their lives.

Chronic Stress

Chronic stress can worsen mental health issues and strain family systems. A 2017 article in World Psychiatry points out that adverse conditions imposed on refugees, including prolonged detention and insecure residency status, can compound past traumas.

Even outside detention centers, refugees face daily stressors. These include separation from supports, difficulty finding employment, inadequate food and water, as well as potential negative interactions from people in the community.

Physical Symptoms Related to Mental Health Disorders

Poor mental health doesn’t always manifest in psychological ways. Mental health conditions can have both mental and somatic (physical) symptoms. Many cultures only acknowledge the physical symptoms of psychological conditions.

Many refugees are unable to accurately express how they’re feeling. This is especially true for those without significant language skills, or who did not grow up in cultures that talk about mental health,

Their physical symptoms may include:

  • Headaches
  • Stomachaches
  • Muscle tension
  • Pain
  • Restlessness
  • Insomnia
  • Fatigue
  • Gastrointestinal issues

When patients present with what seem to be only physical issues, their underlying psychological issues may not be addressed.

Children are especially likely to present with the above symptoms. Young people are still developing and are vulnerable, so it is especially important to care for their mental health.

Impact of Refugee Situations on Childhood Emotional Development

The data is clear: a traumatic past irrevocably shapes a child’s future. How it is dealt with will impact them through childhood, adolescence, and the rest of their lives.

Maintaining positive child and teen mental health is already a challenge for parents and guardians of well-adjusted children who haven’t experienced trauma. We must give children a sense of self and a sense of security, expose them to enough adversity to grow, and help them adapt to change in healthy ways.

When a child is displaced, all of these challenges become much harder. Leaving home puts children in a vulnerable position. They are at risk of:

  • Hunger and deprivation
  • Religious or ethnic persecution
  • Discrimination and racism
  • Sexual and physical violence
  • Getting lost or separated from family
  • Frequent moves and school changes
  • Culture shock

Children who encounter such events are likelier to develop mental health conditions including PTSD, anxiety, depression, grief, and stress.

Symptoms of underlying mental health conditions include:

  • Academic problems
  • Trouble paying attention
  • Behavioral difficulties
  • Attachment issues
  • Isolation and alienation
  • Difficulty making friends
  • Invasive memories and nightmares
  • Sadness and irritability
  • Becoming triggered by events similar to the trauma

Also, children are very likely to manifest physical symptoms of their trauma, known as “somatization.” In children, this often includes:

  • Headaches and stomachaches
  • Continual crying
  • Unexplained pains in the body
  • Insomnia
  • Constant sleepiness or lethargy

Refugee children often do not come from populations that have access to evidence-based mental health care. They may also not trust authority figures, and may underreport their symptoms in order to avoid treatment.

It’s critical that doctors, nurses, teachers, administrators, and caregivers learn to recognize symptoms so they can request an assessment, if necessary.

Mental Health Assessments for the Refugee Population

Due to the unique nature of their experiences and trauma, typical mental health screenings are generally unhelpful in assessing refugees. Luckily, a number of refugee mental health guides and screenings are currently available.

Examples include:

CDC’s Guidance for Mental Health Screening During the Domestic Medical Examination for Newly Arrived Refugees
CDC guidelines help health care workers determine which newly arrived refugees require mental health care and support.

Steps in the process include reviewing refugees’ overseas documentation for signs of trauma and illness, asking directly about symptoms, screening for mental health and substance use, and developing an action plan and/or referral.

The Comprehensive Trauma Inventory – 104 (CTI-104)
The Comprehensive Trauma Inventory helps clinicians assess levels of war-related trauma experienced by refugees. The inventory consists of 104 statements about war experiences (e.g., “fleeing or hiding from soldiers or enemies”). Participants fill out the form by indicating if each event happened to them, and if so, how severely they were impacted.

It is also worth noting that most refugees, even adults, present first with somatic (physical) symptoms. It is important to screen each patient in order to discover if there are mental health issues. If we fail to do so, we miss opportunities to help.

The New Mexico Refugee Symptom Checklist – 121 (NMRSCL – 121)
Clinicians use the New Mexico Refugee Symptom Checklist to assess the health of refugees on a broad range of psychological and somatic symptoms. The checklist was developed with refugee populations and includes 121 symptoms (e.g., “fear or jumpiness at loud noises,” “rashes on your skin”).

Participants rank their experiences on how much each symptom has bothered them in the past year. Clinicians organize the number of symptoms into 12 different scales of mental and physical health conditions.

Online screening is one of the quickest and easiest ways to determine whether you are experiencing symptoms of mental illness. Take the Test

Stages of the Refugee Journey

Refugees go through many changes before they find a place to settle. They typically experience trauma throughout their journey. The nature of that trauma and any resulting mental health disorders may change over time.

From the preflight period to migration itself to post-migration, refugees are typically unable to find stability until they settle permanently. Even then, life poses challenges that native-born people in any given country do not experience. The settlement period can sometimes be as difficult as the three preceding stages.


In this phase, also known as “premigration,” life in the refugee’s home country becomes increasingly difficult. They may lose jobs, family members may leave, violence could rise, children may leave school, or persecutions may increase.

For refugees who plan to relocate (as opposed to those who are forcibly displaced without warning), planning happens in this phase.


Also known as the “flight” period. This is a time of active travel for refugee individuals and families. The journey is often dangerous. Not everyone is allowed to leave their country, so some must do so in secrecy.

Risks such as exposure, unreliable or nonexistent transportation, detention, and medical emergencies are very real. Many people die during migration, especially children and older adults.


When refugees finally resettle, which sometimes takes years, they often face challenges in accessing care and social services.

Although the physical journey is over, getting what they need in their new community can pose a challenge to refugee mental health.


Also called the “integration period,” settlement is when a refugee permanently settles down in their new home. Now they must acquire work and housing, get children into school, and learn to navigate their new neighborhood, among other concerns. These steps require language skills, money, and other resources that are often hard to come by.

Each of these stages impacts refugee mental health differently. Preflight and migration are frightening, creating trauma for children and adults alike. The post-migration and settlement periods bring relief from imminent danger, but not from uncertainty. Any stage of the journey can have repercussions.

Supporting Refugee and Immigrant Youth

Young boy in green and white striped shirt.

Dr. Margarita Alegria discusses the effects of trauma on immigrant and refugee children, including trauma-related behavioral health issues, and how health professionals can use trauma-informed approaches to support children.

Young boy in green and white striped shirt.

Addressing Stigma and Other Barriers to Care in Displaced Populations

As already discussed, stigma is a huge problem for displaced communities. Many people do not understand the truth about trauma, and believe that talking about it is weak or unhelpful.

Deconstructing stigma is a long and delicate process, but mental well-being relies on it. To do so, it helps for health care providers to:

  • Go slowly and treat physical issues first
  • Share facts and statistics about mental health when the patient is receptive
  • Make resources apparent for the patient or loved ones
  • Create prevention programs in community centers, schools, and career centers that support mental health

It is also important to address basic needs first. When people remain unsettled, transitory, or without essential care, the trauma continues.

Unfortunately, even the settlement period does not put trauma to rest. Navigating potential racism, housing and employment difficulties, political animosity, changing services, medical problems, or other adverse conditions can perpetuate trauma for years.

Mental Health Solutions and Treatment for Displaced Persons

Any type of therapy should be aligned, whenever possible, with each individual’s culture of origin to prevent clashing mindsets that might poorly affect treatment. There is no one-size-fits-all approach for helping refugees or IDPs. Treatment for trauma and mental health in this population takes many forms.

Trauma-focused talk therapy is effective for treating both adults and children with PTSD symptoms. Therapists often use cognitive behavior therapy (CBT) and narrative exposure therapy (NET) when working with these patients.

Cognitive Behavior Therapy

With cognitive behavior therapy (CBT), therapists help patients challenge negative beliefs related to trauma. For example, a patient may believe she did not deserve to survive a bombing since her parents were not spared.

A therapist can help the patient understand that this situation was not within her control. Through CBT, therapists can guide patients through traumatic memories while letting patients know they are now safe.

Narrative Exposure Therapy

With narrative exposure therapy (NET), therapists help patients reframe and understand their traumatic experiences. The idea behind NET is that we tend to believe the stories we tell ourselves.

In NET, patients focus on their entire life story. They are encouraged to talk about their trauma, while also incorporating positive memories and beliefs. By doing so, they can bring together parts of themselves that have been fragmented by trauma. NET can be applied in both individual and group settings.

Group Therapy

Group therapy may be particularly effective for refugees. In this form of treatment, participants share daily challenges and past traumas with each other under the guidance of a trained facilitator.

Through group therapy, individuals build connections, receive support, and feel less isolated.

Treatment for Children

In addition to the trauma-informed treatments mentioned above, trauma systems therapy for refugees (TST-R) is another effective treatment for refugee children.

TST-R targets the social and environmental factors that contribute to the distress these children experience. Therapists provide TST-R alongside individual therapy for children aged 10-18.

TST-R is often provided in school settings, where children and families are more likely to engage in care. A “cultural broker” (someone from the culture involved) is part of the treatment process. TST-R aims to reduce distrust in authorities, mental health stigma, language and cultural barriers, and resettlement stressors.

Treatment includes:

  • Engagement activities to promote trust between communities and providers
  • Skills groups that increase self-regulation, increase social support, and decrease stress related to new culture and surroundings
  • Individual and/or home-based support

Treatment for Substance Use Disorders

The concept of addiction treatment may be completely new to refugees. According to the previously mentioned 2016 study on connecting refugees to substance misuse treatment, providers should inform patients about substance use disorders, treatment models, and the recipient country’s legal system regarding drug and alcohol use.

When treating refugees for substance use disorders, providers should take time to build patients’ trust. This process can take several months.

Patients are more likely to engage in the recovery process when providers prepare them for treatment and help them through the process. This can include reminding patients about appointments, following up on treatment, and arranging interpreters.

Other Forms of Treatment

Other forms of mental health treatment for displaced persons include:

  • School-based interventions
  • Mindfulness practices
  • Medical interventions, including the use of medication
  • Lay counselor programs for large refugee populations
  • Movement and art therapy
Girl hugging older woman

Building Supportive Communities for Refugees

Increasingly, advocates recommend that communities focus on the issues at hand, rather than assuming every refugee needs psychological treatment.

We all have basic needs of human connection, purpose, and safety. This is especially true for refugees, who are often deprived of these basic needs, and who have often experienced much hardship.

Refugees can feel demoralized because of lack of employment and social connections. They can feel lost when navigating the social services of a new country.

Communities can support refugees by offering:

  • Interpreter services
  • Guidance around job seeking
  • Help navigating social services
  • Support groups
  • Child-friendly spaces
  • Opportunities to engage in religious/cultural practices

When communities provide refugees with pathways to well-being, fewer refugees may require individual treatment.

Many communities that work with refugees provide a stepped care model that provides essential services and gives specialized treatment to those who need it. Stepped care is efficient, cost effective, and avoids pathologizing refugees’ experiences.

For example, a 2017 article in the American Journal of Public Health highlights the Mohawk Valley Resource Center for Refugees in New York. The center provides job placement services, free adult learning courses, as well as mental health care as needed. It is one of many similar organizations in the U.S. supported by activist organizations, such as the International Refugee Assistance Project.

The Future of Refugee / IDP Mental Health

Refugees may face extreme hardships: the violence, loss, and isolation they often experience is traumatic. Such trauma can compound individuals’ existing mental health issues and past adversities.

While many people are resilient, even in the face of extremely stressful circumstances, others require mental health treatment. All displaced persons deserve support as they resettle in their new homes. As a society, we need to welcome them. This begins with understanding their experiences and knowing how to help.

When To Seek Professional Help

Whether you are a refugee or displaced person, have a loved one who is, or are providing the best treatment you can to refugee communities, you shouldn’t have to go it alone.

McLean Hospital is here to help. If you have questions about refugee mental health, we invite you to get in touch to do your part for yourself or your community.

If you or a loved one need help managing mental health symptoms, call McLean today at 617.855.3141 to learn more about treatment options.

Want More Information?

You may find these resources helpful:

Amnesty International
An international nongovernmental organization focused on human rights.

An organization that provides humanitarian assistance to people worldwide by providing basic needs and opportunities to build fulfilling lives.

Doctors Without Borders
An international humanitarian medical non-governmental organization that provides emergency aid and medical care around the globe.

International Refugee Assistance Project
A program that organizes law students and lawyers to develop and enforce a set of human rights for refugees and displaced persons.

Refugees International
A global, independent advocacy organization that challenges governments, policymakers, and administrations to provide lifesaving assistance and improve human rights.