The Invisible Struggle: Refugees and Mental Health

A few decades ago, the field of psychotherapy had a much narrower focus—both in terms of who was included in research, theory, and interventions, and whose experiences were considered worthy of study. It is hard to believe that as recently as the 1970s, the field was largely silent on issues such as child abuse and violence against women. Before this period, gender roles within families were rarely questioned, and women were seldom the focus of psychological or health research.
The hard work of feminist mental health pioneers eventually led to recognition of the impact of gender inequality on mental health. Only in the 1980s and 1990s did the field begin to examine the psychological effects of gender reassignment surgeries, or the invisibility of same-sex relationships. It was during this time that mental health professionals also started to consider how social injustices—poverty, racism, classism, sexism, ableism, genderism, colonialism, and other forms of oppression—shape mental health outcomes across diverse communities.
There is much to be proud of in the field of mental health. We have expanded the originally narrow lens, acknowledging how injustice, violence, and inequality affect human well-being, and bringing previously marginalized populations into view.

An Ongoing Blind Spot: Refugees and Forced Displacement

Yet, despite this progress, in 2025 a vast population remains largely invisible: individuals, families, and communities impacted by political violence and forced displacement. There is limited training, little research, and scarce literature focusing on the circumstances, concerns, and mental health needs of this diverse and sizable group.
This is difficult to understand, especially considering that there are currently over 120 million forcibly displaced people worldwide (UNHCR, 2024). To put this staggering figure into perspective:
• Roughly equivalent to the entire population of Japan
• More than three times the population of Canada
• Nearly one-quarter of the entire European Union population, which is around 450 million

The Mental Health Impact: Staggering, Yet Under-addressed

Approximately one in three forcibly displaced individuals suffers from conditions such as post-traumatic stress disorder (PTSD), depression, and anxiety (APA, 2020; Blackmore et al., 2020; Turrini et al., 2017). Refugees face significantly higher rates of mental health challenges compared to the general population—up to ten times more likely to experience PTSD, alongside elevated rates of depression, anxiety, and psychotic disorders (Blackmore et al., 2020; Blackmore et al., 2022; Fazel et al., 2005; Steel et al., 2009).
The impact on refugee children—who make up over half of the refugee population—is particularly concerning:
• 34% of refugee children develop PTSD
• 30% experience depression
(Blackmore et al., 2020)
Some research suggests these numbers may be even higher, with up to 50% of refugee children affected (Bronstein & Montgomery, 2011). Children are especially vulnerable due to several factors: exposure to trauma during crucial developmental years, separation from family members, and the ripple effects of their caregivers’ trauma.

Why the Invisibility?

Given the lack of research, practical training, mentorship, and literature, one can only speculate about the reasons behind the low engagement of mental health professionals with this population. Invisibility itself becomes an obstacle.
It is difficult to ignore the constant images of fleeing families, destroyed homes, and suffering children. Perhaps mechanisms such as habituation—or even a collective dissociation from trauma—have led many caring clinicians to unconsciously avert their focus.
Feelings of powerlessness and overwhelm may also contribute. The absence of government leadership, scarce funding, insufficient resources, cultural and linguistic differences, the need to adapt our approaches to mental health, isolation, and lack of guidance—all of these play a role.
Yet none of these factors fully explain the lack of research, interest, or engagement, especially in a profession filled with compassionate, committed practitioners.

What Needs to Change?

This is not acceptable.
What will it take to bring this vast, yet invisible, population into clear focus for mental health practitioners, researchers, educators, and funders?
How can we, as a field, rise to meet this urgent need?

References:

• American Psychiatric Association. (2020). Mental Health Facts on Refugees, Asylum-Seekers, and Survivors of Forced Displacement.
• Blackmore, R., Boyle, J. A., Fazel, M., Ranasinha, S., Gray, K. M., Fitzgerald, G., Misso, M., & Gibson-Helm, M. (2020). The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis. PLoS Medicine, 17(9), e1003337.
• Blackmore, R., Gray, K. M., Boyle, J. A., Fazel, M., Ranasinha, S., Fitzgerald, G., Misso, M., & Gibson-Helm, M. (2020). Systematic Review and Meta-Analysis: The Prevalence of Mental Illness in Child and Adolescent Refugees and Asylum Seekers. Journal of the American Academy of Child and Adolescent Psychiatry, 59(6), 705-714.
• Bronstein, I., & Montgomery, P. (2011). Psychological distress in refugee children: A systematic review. Clinical Child and Family Psychology Review, 14(1), 44-56.
• Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet, 365(9467), 1309-1314.
• Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. JAMA, 302(5), 537-549.
• Turrini, G., Purgato, M., Ballette, F., Nose, M., Ostuzzi, G., & Barbui, C. (2017). Common mental disorders in asylum seekers and refugees: Umbrella review of systematic reviews. International Journal of Mental Health Systems, 11, 51.
• United Nations High Commissioner for Refugees. (2024). Global Trends: Forced Displacement in 2024.