Clinical Tools

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Immigrants & Refugees

Common Mental Health Problems in Immigrants and Refugees: General Approach in Primary Care
This paper summarizes risk factors and strategies in the approach to mental health assessment, and to prevention and treatment of common mental health problems for immigrants in primary care.

Summary of Clinical Preventive Care Recommendations for Newly Arriving Immigrants and Refugees to Canada
This article (2010) outlines the specific health risks encountered by subgroups of immigrants that are due to different disease exposures and genetic predispositions,  social and cultural determinants, and variation in access to health services. Clinical preventive recommendations covering cervical cancer, depression, contraception, hepatitis B, HIV, iron-deficiency anemia, oral health, pregnancy, tuberculosis and vision health are presented in this article.

Evidence-based Clinical Guidelines for Immigrants and Refugees
This article, prepared by the CCIRH, outlines preventive health care guidelines  for newcomers to Canada in the first 5 years after resettlement. This article discusses clinical preventive care and emphasize the need for informed care based on the person’s region or country of origin as well as migration history (e.g., forced vs. voluntary migration). Health risks are discussed from both physical and psychosocial perspectives that may be unique to immigrants and refugees. These may include limited language proficiency, required vaccination, the need for screening for region-specific disorders, malaria detection, depression, post-traumatic stress disorder, child maltreatment, intimate partner violence, or unmet contraceptive needs.

For guidelines on specific mental health conditions see:


Best Practice Guidelines for Mental Health Promotion Programs: Refugees
Centre for Addiction and Mental Health (CAMH)
This document provides guidelines on the implementation of mental health promotion practices and is intended for service providers working with refugee populations in Canada. It includes reviews of current mental health promotion programs and addresses the experiences of refugees from different countries.

The Refugee Mental Health Online Courses
The Refugee Mental Health Project aims to build health care professionals’ and settlement workers’ knowledge and skills regarding refugee mental health issues. The aim of this initiative is to contribute to an informed, sustainable network of service provision. These courses are intended to enhance service providers’ knowledge, communication, comfort and cultural competence when working with refugee clients. The self-directed courses are free and are offered to  health care professionals and settlement counselors/social workers/social service providers who work directly with refugees.

WPA Guidance on Mental Health and Mental Health Care in Migrants
This paper reviews current evidence on mental health problems in migrants and presents advice to clinicians and policy makers on how to provide migrants with appropriate and accessible mental health services. The three phases of the migration process and the relevant implications for mental health are outlined, as well as the specific problems of groups such as women, children and adolescents, the elderly, refugees and asylum seekers, and lesbian, gay, bisexual and transgender individuals. The concepts of cultural bereavement, cultural identity and cultural congruity are discussed.

Refugee Health Technical Assistance Center (RHTAC)
This U.S. Center consists of five organizations dedicated to improving the quality of health services for refugees. The RHTAC aims to improve the well-being of refugees by providing tools, resources, and support for health and mental health providers.Watch a Webinar on Tools and Strategies for Refugee Mental Health Screening.

Cultural Consultation for Refugees
This chapter focuses primarily on the situation of refugee claimants. After presenting the legal definition of a refugee, there is a brief overview of pre-migratory, transit, and postmigratory factors that may affect refugee claimants’ psychosocial status, including a more detailed discussion of two com- mon postmigratory problems: detention and family separation. The next section examines clinical intervention with refugee claimants, particularly the assessment and treatment of posttraumatic symptoms. Finally, there is a discussion of the ways in which clinicians may act upon the social determinants of refugee claimants’ health, including a detailed explanation of how to write a report in the context of refugee status proceedings.

Role of Psychological Evidence in Refugee Decision-making
The following articles from the Trauma and Mental Health Unit, School of Psychiatry, University New South Wales report on findings from a mental health and legal analysis of a series of refugee decisions involving the submission of psychological evidence.

  • Tay K, Frommer N, Hunter J, Silove D, Pearson L, Roque MS, Redman R, Bryant RA, Manicavasagar V, Steel Z. A mixed-method study of expert psychological evidence submitted for a cohort of asylum seekers undergoing refugee status determination in Australia. Social Science & Medicine. 2013;98:106-115.
  • Hunter J, Pearson L, San Roque M, Steel Z. Asylum adjudication, mental health and credibility evaluation. Federal Law Review. 2014;41(3):471-495.

Mental health professionals,  legal representatives, and decision/policy makers can also access detailed guidelines about improving the quality and interpretation of psychological evidence. These guidelines are especially useful for those involved in providing mental health and cultural assessments of asylum seekers as part of the refugee determination procedure. For more information contact: |

Royal College of Psychiatrists launches new resource to support the mental health of asylum seekers and refugees
The Royal College of Psychiatrists is launching information aimed at health and social care professionals in the UK supporting asylum seekers and refugees with their mental health. Endorsed by the Academy of Medical Royal Colleges, it provides information, guidance and support to help deliver timely, high-quality care.

In 2020, 82 million people worldwide were forcibly displaced. In the same year, the UK received applications for asylum from over 37,500 people. Over 40% of those were women and children, and 8% were children who had arrived in the UK alone without a parent or guardian.

Dr Adrian James, President of the Royal College of Psychiatrists, said: “Refugees and asylum seekers from Ukraine, Afghanistan or anywhere in the world where there’s a humanitarian crisis and ongoing conflict, might have faced the trauma of violence, danger, exploitation and loss of their loved ones.”

“Harrowing experiences before, during and after migration can make them more likely to develop significant mental health problems like anxiety, depression and post-traumatic stress disorder (PTSD). These risks are even greater in women and. children, including those that are unaccompanied, the elderly, disabled and LGBTQ+ people.”

“Not only that, but once they arrive in the UK, uncertainty around housing, finances and employment paired with the challenges of accessing healthcare in a foreign country, can make existing mental health problems worse.”

“For this reason, it’s absolutely critical that we do not medicalise their distress and instead help refugees and asylum seekers to come to terms with, and eventually recover from, the trauma they’ve experienced. There will also be some refugees and asylum seekers that may develop a mental illness, and for those we will need to identify the additional specialist mental health support that is needed.”

“This resource looks at the basic principles of supporting the mental health of displaced people and is aimed at GPs and other health and social care professionals working with them. It looks at the experiences of mental disorders in asylum seekers and refugees, approaches to assessment, and when to triage to specialist support.”

A more comprehensive version of this advice can be viewed on the College’s website:

Syrian Refugees

The ongoing Syrian civil war ranks as the worst humanitarian catastrophe in modern times. More than half of the citizens of Syria have been forcibly displaced, with nearly 8 million people internally displaced and 4.5 million refugees, most having ed to the neighboring countries of Jordan, Lebanon and Turkey. More than half of forcibly displaced people are children, and of these, nearly 75% are under the age of 12.

Citizenship and Immigration Canada country profile for Syria

Culture, Context and the Mental Health of Syrian RefugeesA Review for Mental Health and Psychosocial Support Staff Working with Syrians Affected by Armed Conflict
This report, prepared for UNHCR in 2015, provides information on the sociocultural background of the Syrian population as well as cultural aspects of mental health and psychosocial wellbeing relevant to care and support. it is based on an extensive review of the available literature on mental health and psychosocial support, within the context of the current armed conflict in Syria (MHPSS).

Welcoming Syrian Newcomer Students & Families to School – INFO-SHEET
This Info-Sheet from School Mental Health ASSIST is designed to provide introductory information for educators in supporting the mental health and well-being of newcomer students.  This will be a reminder for some, but may be new information for those working in schools that are less accustomed to welcoming immigrant and refugee families.  The resource is organized to support a planful, whole school approach that recognizes that (1) good settlement experiences are essential for good mental health, (2) newcomers from war-torn countries are typically resilient and possess many intrinsic strengths that they can draw upon as they transition to their new life in Canada, and (3) in spite of best efforts, some students will experience mental health difficulties, so we need to be ready to notice the signs and to ensure seamless pathways to specialized support in the school board and community.  All school staff and students have a role to play in helping newcomers to feel welcome and supported.

Caring for a Newly Arrived Syrian Refugee Family
This practice article discusses preventive primary care for a newly arrived Syrian refugee family. The recommendations for preventive interventions have been adapted for newly arriving asymptomatic Syrian refugees from the Canadian Collaboration for Immigrant and Refugee Health (CCIRH) guidelines and other guidelines.  They take into account the findings of European surveillance reports, as Europe has received nearly 600,000 Syrian refugees in the past year alone. [CMAJ February 16, 2016 vol. 188 no. 3 

Mental health and psychosocial wellbeing of Syrians affected by armed conflict
Based on the report commissioned by the United Nations High Commissioner for Refugees, this paper aims to inform mental health and psychosocial support (MHPSS) staff about some of the main issues related to mental health and psychosocial wellbeing faced by Syrians who are internally displaced and Syrian refugees. [G. Hassan, P. Ventevogel, H. Jefee-Bahloul, A. Barkil-Oteo & L. J. Kirmayer (2016). Epidemiology and Psychiatric Sciences, 25(2):2129 – 141 DOI: 10.1017/S2045796016000044, Published online: 01 February 2016.]

Resources for clinicians caring for Syrian refugees

Network of physicians offering medical aid to Syrians

Syrian Telemental Health Network
The Syrian Telemental Health Network is an international collaboration between institutions and NGOs to help deliver mental health consultations, education, and training to enhance capacity-building efforts for health care workers in the Syrian conflict setting. This website includes information about the network, and resources for active members and partners, in addition to connections for institutions who would like to join this non-profit effort.