Research and analysis

Refugee mental health and employment

Published 26 September 2025

Applies to England and Scotland

Authors

Emma Bowkett, Anita Jeffreson, Naomi Jones, Jamie Roberts, Zara Johnson-Ireland, Allaa Barri

Executive summary

Introduction

Refugees in the UK face a disproportionately high prevalence of mental health issues compared o the general population (Ager and others, 2002; Djuretic and others, 2007). The Home Office commissioned this research project to enhance understanding of the complex relationship between mental health and employment outcomes among refugeed in the UK, to feed into and imporve future integration policies and interventions.

Methodology

This report convers findings from the research, which include:

• desk review of existing literature and policies
• 5 scoping interviews with stakeholders
• 30 interviews with refugees, using a purposive sampling approach, carried out via telephone, online, and in person

Primary quotas for the refugee interviews were based on employment status, gender and age. The severity of mental health challenges (historical and current) was also monitored to ensure the inclusion of a range of experiences.

Key findings

While there is no single refugee mental health journey, refugees’ experience of mental health is often characterised by trauma from displacement, which can continue through the difficulties of resettlement and integration. This research focused specifically on the relationship between refugees’ mental health and employment status. The findings suggest that refugees’ journey can be categorised into 5 non-linear typological stages based on mental health status, engagement with mental health and employment support and engagement with the job market:

1. Mental health prevent job search.
2. Seeking stability first.
3. Actively seeking employment.
4. Seeking better employment fit.
5. Happily employed.

Refugees may transition between these stages depending on life events and support received. This typology provides a lens through which we can explore the findings from this research.

Factors impacting refugee mental health

Key factors influencing refugee mental health relate to incidences of change and instability, both pre- and post-arrival to the UK. The intersect with one another and include:

Exposure to trauma: pre- and post- displacement trauma significantly impacts daily life, triggered by various stimuli.

Experience of the asylum process: the lengthy and unpredictable asylum process creates stress and uncertainty, particularly for those unprepared of its realities. Receiving refugees status can also be overwhelming due to the pressure of immediate self-sufficiency.

Experience of and access to accommodation: secure housing is crucial for mental wellbeing. Temporary or unsuitable accommodation exacerbates stress and hinders integration.

Impact of finances and financial stability: financial instability creates anxiety, while employment and financial security improve wellbeing. The cost-of-living crisis adds pressure regardless of employment status.

Integrating into the UK and forming connections: loss of social networks and challenges building new connections contribute to loneliness. While some refugees prefer solitude, fostering social connections is generally considered beneficial for mental health.

Feeling undervalued: refugees often feel their skills are undervalued, impacting self-esteem and job prospects. Impersonal interactions with government services further contribute to this feeling.

Feeling a lack of control over their lives: the “refugee” label, coupled with a lack of control over housing and other aspects of life, can negatively impact mental health and hinder integration.

Experience of mental health support

Mental health support helped refugees to process past trauma and develop coping mechanisms. In some cases, receiving mental health support provided refugees with the tools and confidence to look for work. Refugees described mental health support as more normalised in the UK. This was felt to be both positive and challenging for refugees from different cultural backgrounds with varying levels of stigma surrounding mental health. However, there were limitations and barriers to accessing this support. Refugees who viewed practical needs like housing and employment as more important prioritised these over mental health support. Additionally, they considered a lack of trauma-informed care, language support and awareness of available services to be considered significant barriers to accessing mental health support, also highlighting long NHS waiting lists and the need for early intervention upon arrival in the UK.

Mental health as a barrier to employment

Refugees in the UK face significant challenges in securing employment. This research found that poor mental health contributes to these challenges by extending the often unexpectedly difficult job searching period. The stigma surrounding mental health within certain cultural contexts may prevent refugees from seeking necessary mental health support, further hindering their ability to pursue employment. Refugees described facing prejudice and discrimination when looking for work, which then worsened their mental health. This inter-connected relationship between mental health and the path to employment resulted in non-linear journeys, with refugees shifting between looking for work, and requiring further support before getting back to it.

Positive impact of employment on mental health

Employment plays a crucial role in enhancing the mental health and wellbeing of refugees by providing financial security, a sense of purpose, and opportunities for personal growth. Refugees who secured employment reported improved self-esteem, reduced stress, and a greater sense of stability and belonging.

However, the positive impact of employment can be contingent upon the alignment of job roles with refugees’ skills and aspirations. Employment that does not match the qualifications or career goals of refugees may lead to dissatisfaction and continued mental health struggles, highlighting the importance of suitable job placements.

Volunteering as a pathway to employment

Volunteering was identified as a vital strategy for improving refugees’ employability and mental health. It helps refugees gain practical work experience, helping them to understand UK workplace norms. It also provides opportunities to enhance their language proficiency and build social networks, which are crucial for integration and emotional support.

Implications

The findings highlight the necessity of a holistic approach to refugee integration. Key implications include the following:

Early and holistic support

The Home Office could consider early interventions that address mental health and basic needs such as housing and benefits upon refugees’ arrival in the UK and before asylum seekers have received refugee status. This includes culturally sensitive screening and services to manage pre-existing trauma and build a foundation for wellbeing. Early intervention could help to prevent mental health challenges from escalating and impacting overall wellbeing, enabling effective engagement with future employment support, and managing anxiety about the asylum process and life in a new country.

Communicating information

The Home Office could consider providing clear and realistic pre-arrival information to those who come on resettlement schemes as well as providing detailed information for those on asylum routes to manage expectations regarding life in the UK including the asylum process, available support, and employment pathways.

Trauma-informed employability programmes

The Home Office could consider developing programmes that are sensitive to trauma, focused on building confidence, providing coping mechanisms, and helping refugees to navigate challenges related to looking for work.

Targeted employment support

The Home Office could continue to offer tailored employment support like the Refugee Employability Programme, maximising the referral pathways. Ensuring that such support matches refugee skills to job roles while fostering strong links with employers in relevant sectors is crucial. Offering specific training and mentorship programmes is also recommended to support career development.

Integrated support systems

The Home Office could also consider offering continued access to integrated services, including mental health care, benefits advice, and housing assistance. Establishing clear referral pathways and strong communication between services is vital to provide seamless support.

Cultural shifts in the employment sector

The Home Office could encourage employers to recognise refugees’ past experiences and qualifications and create a culturally sensitive and supportive work environment. It is also recommended that employers are encouraged to promote practices that reduce workplace discrimination and support refugees’ long-term success.

Overall, the research underscores the interconnectedness of mental health and employment, advocating for policy and programmatic interventions that reflect the relationship between the 2. By adopting a more integrated and responsive approach, there is the opportunity for improved mental health and employment outcomes for refugees, facilitating the successful integration of refugees into UK society.

1. Introduction

1.1 Overview of project

This research project aimed to enhance the Home Office’s understanding of the relationship between mental health and employment outcomes among refugees in the UK. The project explored how refugees who are looking for work, or were in employment, experience both their journey into/through employment and their mental health. The project also delved into the experiences of refugees not currently looking for work and the reasons behind that.

1.2 Wider context

Refugee integration in the UK has been a key area of focus for the Home Office in recent years and was reinforced in 2019 by the development of the Indicators of Integration (Home Office, 2019). There are multiple Home Office refugee integration interventions focused on employment, as this is central to other areas of integration, including building social connections and facilitating a better understanding of UK culture. However, refugees’ experiences of past trauma, the stress of displacement, and challenges integrating into the UK, can lead to a higher prevalence of mental health conditions among this group compared to the wider population. This can create substantial barriers to securing and maintaining employment, hindering successful integration into UK society (Disney & McPherson, 2020).

Mental health is defined as a state of mental well-being that can support people to cope with ‘the stresses of life, realise their abilities, learn well, work well and contribute to their overall community’ (WHO, 2022). If people experience poor mental health, they might find that life feels like more of a struggle; they may feel sad, hopeless, stressed, or exhausted (Mental Health Foundation, 2024a). In the context of this research, however, it is not possible to define mental health and poor mental health consistently, as it meant different things to each participant depending on their background, cultural starting point and circumstance.

Although there is research demonstrating that being in employment can improve mental health (WHO, 2024), mental health conditions can also act as a barrier to employment. For example, Breaking Barriers (2023) found that in the UK, refugees who reported having mental health issues only had a 17% probability of being employed at the end of the research period compared to 24% of those who did not report any mental health issues. However, the relationship between working and mental health is complex, especially for refugees, and requires further research. This research project was therefore designed to help fill some of the gaps in the existing evidence base around the relationship between refugee employment and mental health.

1.3 Existing evidence and desk review

Emerging findings from current Home Office interventions including the Refugee Transitions Outcomes Fund (RTOF) and Refugee Employability Programme (REP) indicate that refugees tend to prioritise stabilisation of housing before securing employment, and that mental health issues pose a real barrier to refugees’ engagement in employment programmes and outcomes. Evaluations of these programmes have noted that addressing mental health issues is complex and time-consuming, delaying refugees’ readiness for employment.

1.4 Research Objectives

Key research questions included:

1. How does mental health status affect a refugee’s route into employment and to what extent?
2. To what extent can employment alleviate or deteriorate mental health issues among refugees?
3. How does a refugee’s mental health change from displacement to integration?
4. Are there specific barriers refugees face when seeking mental health support and/or employment compared to the general population?
5. Do current refugee integration programmes sufficiently address mental health needs and how could future policies better accommodate this?
6. What is needed from stakeholders to improve employment outcomes for refugees where mental health is the primary barrier?

1.5 Methodology

The research employed a light-touch evidence review and qualitative research with stakeholders and refugees. The evidence review built on an existing evidence review conducted by the Home Office, to further explore the evidence base and identify gaps for this research to explore. Following the evidence review, 5 scoping interviews were conducted with key stakeholders, including Home Office staff and non-governmental organisations (NGOs). These were one-hour virtual interviews and explored the day-to-day challenges experienced by refugees, focusing specifically on barriers to employment and any link with mental health. These interviews supported understanding of the context, background, and objectives of the research, helping to inform the design of research tools (topic guide and screener) for the fieldwork with refugees and to refine the sampling and recruitment approach.

Following the scoping interviews, the main stage of the research involved depth interviews with 30 refugees, which took place during August and September 2024. A multi-modal approach was taken, offering telephone, video or in-person interviews depending on the participant’s preference. Translation services were also provided to ensure the research was inclusive. Interviews lasted between 60 and 90 minutes and participants were given a £40 voucher as a thank you for their time.

A purposive sampling approach was employed to ensure the sample tied to the objectives of this research, and to ensure that the full range of characteristics that may have impacted on refugees’ experiences were captured. Primary sampling quotas were set based on employment status, gender, age and the severity of mental health challenges was also monitored to ensure a range of participants and experiences. Refugees were recruited using gatekeeper organisations. These organisations were approached by the Ipsos research team with information about what recruitment would involve, and an information sheet and consent form to be shared with potential participants. Once potential participants had been identified by one of these organisations, they were contacted to take part in a screening call with the Ipsos research team to provide further information, ensure they could provide informed consent to take part in the research and fit the sampling criteria. If a participant indicated that they currently had very poor mental health, they were excluded from participating so as not to risk potential further impact to on their mental health. Given the sensitive nature of the research, experienced researchers conducted the interviews. Prior to the interviews, participants were informed of their right to withdraw from the research and given the opportunity to take a break from the interview or stop the interview throughout. After the interview, participants were given the option of a free emotional support session from a specialist emotional support provider.

It should be noted that during the fieldwork period, anti-immigration demonstrations and riots took place in the UK between 30 July and 7 August 2024. During this time, active recruitment of refugees was paused as the research team recognised that this was a very difficult time for refugees and that they may have been hesitant to take part in an interview until they felt safe.

A full explanation of the methodology, including the breakdown of the sample for the refugee interviews, and the approach to analysis and methodological limitations, is in Appendix A.

1.6 How to read this report

The remainder of this report is broken down into sections to cover the range of evidence collected. By its nature, qualitative research is not designed to be statistically representative. This report is intended to be illustrative of a range of experiences and viewpoints. However, despite not fully meeting all the desired sampling quotas, the data from refugees is fairly comprehensive, as the sample represents a reasonable level of range and diversity and there was a good level of saturation apparent in the data. Therefore, while we cannot claim to reflect the views of all refugees in the UK, we can be reasonably confident that the high-level themes emerging from the research largely echo those that would be found in the wider population of UK refugees even if the granularity of individual experience differs. More discussion of this and of the report limitations are in Appendix A.

Verbatim quotes have been included to illuminate the descriptive and explanatory data presented. The quotes have not been attributed to individuals or organisations to protect the anonymity of participants. However, verbatim quotes from refugees have been attributed to their employment status.

Throughout the report, stakeholders who took part in the scoping interviews are referred to as ‘stakeholders’ and participants who took part in the depth interviews are referred to as ‘refugees’ or ‘participants’.

1.7 Typology of refugee mental health and employment

In qualitative research, typologies can be used to categorise data into different groups or types based on shared characteristics. They offer a way to organise and make sense of complex datasets by identifying patterns and similarities among participants. For this study, we have developed a typology in order to present the complex views and experiences of refugees in a more structured way, and to create a frame of reference through which to present our findings throughout the report. The qualitative data analysis identified 5 typological categories that refugee participants fell into in relation to their mental health and employment journey. All the refugees we spoke to fell into one of the categories below. Notably, all refugee participants identified they had mental health issues to some degree; however, what this looked like, alongside the severity of their issues, varied widely, dependent on a range of factors including their pre-/post-displacement journey and employment experience.

The identified categories are not static as individuals can, and will, move through them. A refugees’ journey through the categories is not linear depending on events in an individual’s life (for example, loss of a job), as well as the type and extent of support they receive. References to the typological categories and how they apply to the findings appear where relevant throughout the report but are largely found in section 4 since this is where the data on mental health and employment is brought together.

Table 1: Typology of refugee mental health and employment stages

Category name	Overview	Current Mental Health	Employment support
Mental health prevents job search	Participants in this group are suffering from mental health issues related to pre-displacement trauma or challenges with post-displacement integration. Their mental health requires extensive treatment to allow them to feel ready to look for work. They are engaged with mental health support. They are not thinking of employment yet.	Severe to moderate mental health issues	Not engaged
Seeking stability first	Participants in this group are not looking for work because there are practical barriers to address first. Barriers include no access to stable accommodation, no access to childcare, and/or a physical disability. They are not engaged with employment support but express the willingness to look for work once they receive support to overcome these barriers and achieve more stability in their lives.	Moderate mental health issues	Not engaged
Actively seeking employment	Participants face both poor mental health and employment barriers but are able to work through them whilst looking for work. They might be accessing support for their mental health issues, which often include depression, anxiety, low mood and low confidence or they may not be accessing support or be unaware that it exists. They are engaged with employment support, often from several sources. The longer they unsuccessfully look for work in a relevant field the greater impact it has on their mental health.	Low to moderate mental health issues	Engaged
Seeking better employment fit	Participants in this group are in employment which does not satisfy their needs. They are accessing the basic benefits of employment like improved finances and stability, but these benefits don’t extend to personal fulfilment. They continue to look for work. Their mental health is improved to some degree thanks to the stability that the employment provides.	Low to moderate mental health issues	Engaged
Happily employed	This group of participants are in employment that satisfies their needs and have considerably better mental health thanks to the stability of their employment (including financial) and the fulfilment it provides.	Low mental health issues	Not engaged (may be engaged in in-work support)

2. Factors impacting refugee mental health

There is supporting evidence from multiple studies (Boobis and others, 2019); Djuretic and others, 2007; Ager and others, 2002; Mental Health Foundation, 2024b; Teodorescu and other (2012)) that refugees in the UK are likely to experience poorer mental health than UK natives and those who migrated to the UK for other reasons.

This research found that key factors impacting refugee mental health typically relate to incidences of change and instability both pre- and post-arrival in the UK. Refugees and stakeholders described the first few months after arriving in the UK as particularly challenging, especially if support was not in place to support their integration.

“Since day one of arriving in the UK from the place that they have come, they have problems. When they come, they enter a new country, a change in the system, changes in environment, their surroundings all affect them.”

Stakeholder

This section explores the factors that impact on refugee mental health and how they intersect with one another. These factors include:

• exposure to trauma
• experience of the asylum process
• experience of and access to accommodation
• impact of finances and financial stability
• integrating into the UK and forming connections
• feeling undervalued
• feeling a lack of control over their lives

Having explored the factors that impact refugee mental health, the section concludes by exploring how these factors interact to influence refugees’ mental health journey from displacement to integration.

2.1 Exposure to trauma

Refugees and stakeholders highlighted how exposure to trauma can influence refugee mental health

Refugees might experience poor mental health that stems from traumatic experiences in their home countries during their migration journey and even after resettlement. Refugees and stakeholders used the language of trauma to refer to experiences that refugees had gone through pre-displacement, such as war, conflict, torture or persecution, and which influenced their decision to leave their country. The language of trauma was also used to describe experiences considered dangerous or life threatening during refugees’ migration journeys that had impacted on their mental health.

“It’s the trauma that they’ve already experienced in their own home countries and the travel getting from their own country to here.”

Stakeholder

Refugees who experienced pre-displacement trauma mentioned how it impacts their day-to-day lives in the UK. Triggers, such as photos, phone calls or recalling a memory, can unexpectedly cause these experiences to resurface, leading to short-term or long-term mental health challenges. These included isolating themselves from others, including other refugees or UK natives and struggling to engage with job applications or other activities needed to enter the employment market. Additionally, refugees indicated that exposure to news and social media, or communication with friends and family still in their home country, negatively impacted their mental wellbeing. These ongoing stressors were described as exacerbating existing mental health challenges related to their pre-displacement trauma and creating additional barriers to integration and healing.

“Sometimes it can be washing a dish, and you might see a bird. It reminds you of your country, it can be a flower … some little thing just triggers that memory, and it makes your whole day that was going well, to be not good.”

Refugee, not working or looking for work

2.2 Experience of the asylum process

The asylum process emerged as having a significant impact on the mental health of refugees

Refugees who arrived through resettlement programmes shared how receiving refugee status and resettlement support immediately upon arrival alleviated some of the stress and uncertainty associated with relocation. In contrast, refugees who arrived as asylum seekers and who went through the asylum process described a lack of security.

The impact of the asylum process on mental health can be linked to refugees’ prior expectations and understanding of the UK asylum process. While both refugees and stakeholders described the asylum process as lengthy and unpredictable, refugees with self-assessed higher awareness of what support is available to them during the asylum process, as well as the limitations it may place on their lives, experienced less stress and uncertainty. However, these refugees still described the asylum process as challenging due to both how long it takes and the lack of control they had over the process.

Conversely, those who were less prepared for the reality of the asylum process found their mental health was more negatively impacted. Information that these refugees had received, both in their home country and during their migration journey, led them to believe their lives would get much better once they had arrived in the UK and entered the asylum system. They recalled believing that they would be warmly welcomed into the UK, that it would be easy to achieve refugee status, access stable accommodation and get a relevant job. Instead, refugees highlighted the difficulties in navigating the complexity of the system and the length of the asylum process.

These findings suggest that, while the asylum process is inherently stressful to go through, if asylum seekers were better prepared for what the asylum process might entail, the level of support it offers and the reality of what their lives could look like in the UK in advance, this may help to mitigate some of the stress of the process and in turn reduce some of the negative impact on their mental health. Knowing the likely length of the process in advance might also allow for asylum seekers to plan to use the time while they wait for their case to be reviewed to learn a new skill, volunteer, study or prepare for work, all of which participants in this research indicated had a positive effect on mental health.

Refugees who were waiting a long time for their claim to be processed described how the process put parts of their life on hold, including finding secure housing, entering employment and forming social connections. A lack of communication from the Home Office regarding updates on their status or the next steps also exacerbated the uncertainty associated with the length of the asylum process. This created feelings of stress, anxiety and anger towards the UK government.

“I started this process in 2010, and I only got my status last year. You tell me, how many years I’ve lost? How many years that I will never get back? How many years of rejections, fighting for my rights, my freedom, of going back to trauma, more trauma. And then I came here, and I experienced a very high level of trauma. Now tell me, am I going to be good or am I even going to be more broken than I came.”

Refugee, working

Refugees described a sense of freedom and relief at receiving their refugee status when it came. Being classed as a refugee meant that they could look for work, find housing and prioritise building their lives in the UK. Nevertheless, there were participants who described how receiving refugee status felt overwhelming, as they were expected to be independent immediately. Asylum seekers living in hotels or temporary accommodation were often given a move-on notice by the Home Office days to leave their accommodation within 28 days of being granted refugee status, leaving them little time or support to find a job and secure accommodation. Participants described how receiving refugee status after going through the asylum process had a complex and sometimes detrimental effect on their mental health, especially if they did not have the necessary support in place to build their lives in the UK. This suggests that alongside clearer communication throughout the asylum application process, refugees would benefit from access to support and guidance before they receive their refugee status on what the next steps on their journey might be, such as finding housing and employment, so that they feel prepared.

“It is really challenging that once you get your refugee status, you’re just told that you can do what you want and you’re free, but they give you no support along the way.”

Refugee, looking for work

2.3 Experience of and access to accommodation

Access to safe and stable accommodation is a significant factor that can improve refugee mental health

Refugees who were living in permanent housing that was safe and suitable for their needs noted feeling secure and able to focus on other parts of their lives, such as finding a job, studying or volunteering.

Those in less secure housing indicated that the shortage of affordable and suitable housing (either private or from the council/housing association) led to a sense of uncertainty and anxiety about the future. Refugees were faced with either becoming homeless or having to live in unsuitable housing based on what was available. For instance, one participant explained that his children have accessibility needs requiring frequent, supervised night-time bathroom visits and his family was placed in a council house with only one downstairs toilet. Despite the unsuitability of the accommodation, the family felt pressured to accept it due to the council’s warning that refusal could result in homelessness.

Refugees highlighted the negative impact that living in temporary accommodation, a hotel, or living with friends had on their mental health. Temporary accommodation was associated with feelings of insecurity and stress, especially around being able to plan for the future and feel integrated into the UK. Conversely, having permanent accommodation was felt to be fundamental to improving refugees’ trajectory.

“If I secure my family permanent accommodation, I will be better. Give you a place that’s, like, not a temporary accommodation, a permanent accommodation. It would be fantastic. It would change my life … But now, you know, in terms of no work, no permanent place to live, 2 bedrooms with 6 people inside, with no view when it will be changed, the future is, like, unknown future.”

Refugee, looking for work

The challenges of temporary accommodation that can be smaller and shared by multiple people were highlighted by participants who indicated that such challenges exacerbated mental health issues and sometimes led to tension amongst residents. Refugees spoke about feeling unsafe in their temporary accommodation, particularly if they had been housed with people they did not know or with other residents who were drinking, taking drugs or doing other activities they felt were unsafe. This was especially difficult for refugees with pre-existing mental health issues or experiences of trauma.

Refugees who were in less secure and stable accommodation and who sat within the ‘seeking stability first’ typology group identified they were less focused on finding employment and instead prioritised accessing secure accommodation. They found it harder to tackle the challenges of finding, securing and successfully maintaining employment, as this added to their stress levels. As a result, supporting refugees into finding employment as a solution to improve their mental health without first solving relevant housing insecurities can not only be futile but worsen ill mental health.

2.4 Impact of finances and financial stability

Refugees and stakeholders identified a link between the role of finances and mental health

Refugees who were facing financial instability, caused by the cost of their migration journey, long periods of unemployment or low salaries, reflected on the uncertainty and fear of the future that this caused. During periods of financial instability, refugees indicated they had needed to access benefits like Universal Credit or ask friends and family for financial support. While this support was felt to provide some financial relief, refugees noted that it could also influence their mental health and self-esteem.

“Do you have £10 so I can go somewhere?’ So, imagine an old man asking his father, his old father, for money.”

Refugee, in work

Refugees who were seeking a better employment fit or were happily employed experienced greater financial security, with their employment providing a range of benefits for themselves and their families. These included feeling better able to afford essentials like food, rent and bills, as well as some non-essentials. In these instances, refugees noted that this could alleviate some feelings of stress and anxiety. For example, one refugee reflected that her monthly salary now meant that she could afford to pay for activities (such as swimming classes) and days out for her child. Being able to do this has made her feel like a better mother and happier within herself. Thus, having the financial means to afford, not only the essentials, but enriching experiences for oneself and potential family members was identified as the difference between an income providing material security, which can alleviate mental health problems, and an income improving self-image, which can actively improve mental health. Therefore, the relationship between financial security and positive mental health is not solely a question of being in employment or not being in employment, but also refugees’ disposable income, work-life balance and perception of relative gratification.

It should be noted, however, that when talking about finances, refugees identified that the current cost-of-living crisis is still putting pressure on their finances and their mental health, regardless of their employment status.

2.5 Integrating into the UK and forming connections

Lack of integration and development of connections contributed to poor mental health, especially for refugees who do not speak or were learning to speak English

Refugees reflected on the loss of social networks and support systems when moving to the UK and described how having to leave behind friends and family, often without the reassurance that they will see them again, contributed to feelings of loneliness and stress.

Building adequate social networks in the UK was highlighted by refugees as a challenge. Refugees who struggled to integrate into the UK and its culture spoke about the difficulties of forming connections with people native to the UK or of a different community to them, due to cultural differences and a lack of shared experiences. Refugees who could form relationships outside of their community could typically do so through people they met at work or volunteering. Some refugees articulated it was hard to find people who related to their experiences as a refugee and their home culture. This was especially challenging if they did not have access to the appropriate social infrastructure, like food shops from their home country or social interest groups, to enable connections with their community and those who are also refugees in the UK. Therefore, forming and sustaining long-term connection both with the UK native population and with people who share similar cultural backgrounds is not an easy endeavour.

Although there were refugees who reflected on feelings of loneliness and isolation, it should be noted that this could sometimes be due to their own preference for solitude. There was a group of refugees who reflected that the experience of becoming a refugee profoundly changed their personality, sometimes leading to increased introversion and a preference for isolation. While understandable as a coping mechanism for the trauma and upheaval they have faced, this social withdrawal could potentially negatively impact on refugee mental health as they experience the long-term effects of self-isolation and loneliness. These refugees described that their preference for self-isolation made it difficult for them to enjoy interacting socially and open up to others about their personal challenges; they felt more comfortable alone, managing their difficulties without external input. However, participants did not discuss the longer-term mental health implications of this self-imposed isolation.

“I had friends before but because of my asylum status and things like that, to keep myself safe, yes, I’ve become really, really isolated … I’m quite sensitive and obviously have mental health issues as well. It affects me when I interact with other people. So, my social network is not great, to be very honest and I’m quite happy to be myself. You know, solitude.”

Refugee, in work

However, other refugees also explained that forming social connections between their own and different communities helped to facilitate integration, alleviate loneliness and consequently, have a positive impact on mental health. For these refugees, social connections were felt to have a significant benefit on their mental health, providing a much-needed distraction from present challenges and past trauma. Activities such as volunteering, working and participating in social interest groups were described as creating a sense of belonging and purpose, which helped to facilitate integration and improve mental wellbeing. Refugees who were engaged in refugee-specific online groups for activities, such as volunteering and social activities with other refugees, highlighted how it had helped them to form relationships with like-minded individuals. Ultimately, the effect of social connections on refugee mental health is shaped by individual experiences of becoming a refugee; however, social connections were generally acknowledged for having a positive impact on refugee mental health. Therefore, facilitating social connections between refugees and their wider communities should be a priority offering within the wider mental health support offered to refugees and the social prescribing activities that GPs can offer.

“In psychology, there is a hierarchy of needs for this, from Maslow. The first thing is shelter and eating. That’s good. But I think they have to change that hierarchy. The first thing is to making good social connections because as human beings, we cannot live lonely forever.”

Refugee, looking for work

2.6 Feeling undervalued

The refugee experience often entails a loss of status and recognition of prior achievements which affect mental health

Refugees reflected that since coming to the UK, their skills and experiences were undervalued by employers or government services, which impacted their mental health, particularly for refugees who had a university degree and a career in their home country. Stakeholders and refugees indicated that qualifications and professional experience earned in refugees’ home countries may not hold the same value in the UK. This was thought to impact on refugees’ self-esteem and future career prospects, particularly with those who were ‘actively seeking work’ or ‘a better employment fit’.

Refugees found that the formal interactions with government services, such as the Home Office, the Jobcentre, or the council to be impersonal and lacking empathy, failing to address their individual needs and experiences. Employment support services like Jobcentre Plus were criticised for their hands-off engagement approach. They often encouraged refugees to apply for any job regardless of it fitting their skillset or qualifications, contributing to the feeling of being undervalued, particularly for their individual skills and experiences. Participants reflected that government services could be improved if tailored more to the individual needs and experiences of refugees. Not only would this likely have a more positive impact on refugee mental health, but it was felt that it would help refugees to access the employment market more effectively.

2.7 Feeling a lack of control over their lives

The imposed label of ‘refugee’ can create a sense of powerlessness and loss of control over refugees’ lives that negatively impacts on mental health

The process of seeking refuge in the UK involves a significant shift in identity, as individuals transition from being migrants to asylum seekers and, finally, refugees. In some cases, this involves leaving large sections of their old identity behind and being forced to reconstruct a new one from scratch.

“Imagine, I was a school manager here and I left my country, I left my passport, I left my language, I left everything in my bank. And I was nothing in one month. Do you understand me? That is why I must construct my identity again.”

Refugee, looking for work

The label ‘refugee’ can be challenging to accept for those who bear it, especially as it can hold negative connotations in the media and amongst some communities in the UK. Participants described how this can negativity affect their sense of belonging and safety. The recent riots and unrest that occurred in summer 2024 were described by refugees as intensifying feelings of insecurity and the sense that they were not accepted by the wider UK population, even among those that had received refugee status, were contributing to the UK economy and had spent time assimilating into UK culture. This feeling of being ‘othered’ by UK natives can significantly affect refugees’ mental health and highlights the importance of creating a welcoming and inclusive environment for refugees to support their successful integration into society.

“During the riots in the UK only earlier this month, my mental health was very, very bad and this is why I decided to go to Wales and just volunteer there away from everything else happening in the world. And that feeling no matter how hard you work, no matter how much you improve your English, you don’t belong to this community, you are still a refugee, and you are still a migrant or you’re still different from us.”

Refugee, looking for work

Refugees who went through the asylum process reflected on the lack of control they had on their living situations and how they were told where to live and the type of accommodation they must live in. After receiving refugee status, refugees also described having to move frequently based on housing availability or having to live in temporary accommodation. Feeling a lack of control over their living situation was felt to disrupt refugees’ ability to integrate into the UK and their local communities. This instability made it difficult for refugees to form roots and long-term connections with people, highlighting the need for refugee integration programmes to connect refugees to local public services, local social activities, social media groups and refugee support services once they have moved to a new area to facilitate integration.

“I would move from one area to another area … in March we came here, and I don’t have any friends, family and no one around in South London.”

Refugee, looking for work

Refugees who felt that they had limited control over their lives highlighted the impact it had on their mental health, that it weakened their confidence for their future, disrupted their feelings of stability, and hindered their ability to integrate, especially when met with hostility. Refugees who had secured stable accommodation in a location where they wanted to live felt as though they had more control over their lives and future. Furthermore, refugees who arrived via a resettlement scheme felt more in control of their living situation because they had not had to live in hotels or move around so frequently. Those with more secure housing were also better able to form longstanding roots and connections in the UK which facilitated better integration.

2.8 How does a refugee’s mental health change from displacement to integration?

As described above, many of the factors influencing refugee mental health are interconnected. While individual journeys were unique, there were some common themes in terms of how mental health changed for refugees from displacement to integration.

All participants began their journey at displacement, which was described as traumatic, leading to poor mental health. The need to relocate affected refugees’ sense of identity, forcing them to leave behind their culture, language and career. However, after this point, the journeys differed for those who came through resettlement schemes versus those who applied for asylum in the UK.

Those coming to the UK through a resettlement scheme described the immediate support provided to them as reassuring, helping their mental health by reducing uncertainty. At the same time, refugees who went through the asylum system described the process as having a considerable negative impact on their mental health. They reflected on how having to prove their experiences, while living in poor conditions and with no financial stability, affected their ability to think about the future.

In the UK asylum system, once an individual is granted refugee status, they are given a 28-day notice to move out of their current accommodation, and their financial support is discontinued. This major change in circumstances led to the initial feelings of relief at being granted refugee status quickly transforming into stress. The subsequent difficulties faced when trying to secure accommodation and access benefits could also have a negative impact on refugees’ mental health.

Those who secured access to housing and benefits spoke of the stability having a positive impact on their wellbeing – something already mentioned by resettled refugees at their arrival in the UK. At this point, the journeys merge again, with all refugees facing similar hurdles on their way to integration including the challenge of forming social connections, feeling undervalued, and experiencing a lack of control over their lives, all of which impact their mental health in different ways. At this stage, there is the potential for mental health to be improved through mental health support for those who access it. Mental health also becomes more closely linked to the refugees’ employment journey at this point, and this is explored in section 4.

In summary, this section reveals a complex interplay of factors that impact the mental health of refugees during their journey to integrate into the UK. Exposure to trauma both in their home country and during their migration to the UK is a central factor influencing refugee mental health. A range of challenges faced post-arrival are also felt to have an impact. This includes navigating the asylum process, securing stable accommodation, and unstable finances. Even after receiving refugee status, the pressure to become self-sufficient with limited support can be overwhelming, and the journey of integrating into the UK can lead to refugees feeling undervalued and isolated both from their own community and others. Ultimately, the cumulative effect of these challenges underscores the need for comprehensive support systems and services tailored to refugees that can facilitate successful integration into the UK both during the asylum process and after receiving refugee status, to help improve their mental health.

3. Experience of mental health support

Refugees and stakeholders acknowledged the importance of free mental health support and its positive impacts on refugee mental health. However, there were some widely recognised challenges associated with mental health support which was felt to impact on the quality of support available. These included long waiting lists, limited awareness of the support available, and cultural barriers that prevented refugees from easily accessing mental health support when they needed it. This section delves into the refugee experience of mental health support in the UK, exploring:

• the benefits and limitations of mental health support
• the barriers to accessing mental health support
• timescales for mental health support delivery

3.1 The benefits of mental health support

Mental health support is a tool to process experiences and support future mental health

Typically, refugees who were accessing mental health support did so by registering with their GP and then being referred to a mental health specialist often for psychotherapy, counselling, or Cognitive Behavioural Therapy (CBT). This type of support was reflected on positively, particularly for refugees who previously lacked the space or opportunity to talk through, understand and process their experiences. Refugees who had friends and family to lean on to help them process their experiences found this type of mental health support less valuable and did not feel the need to access it.

It was also felt that mental health support provided a sense of connection, particularly for those experiencing isolation and that did not have friends or family to speak to about their experiences. Mental health support allowed them to create a connection with their mental health practitioner, but also with themselves and their experiences. Particularly among those in the ‘mental health prevents job search category’, mental health support was described as enabling them to process their emotions and gain a sense of reassurance about their future, equipping them with coping mechanisms and tools to manage their mental health in the long term. Accessing mental health support also supported those who were in the ’actively seeking employment’ category, providing them with the tools and confidence to look for work.

“I thought I was okay but really deep down, inside there was so much happening, so it really does help, was really helping me. Even to go and talk to someone, I felt afterwards, when I came home that maybe in the future will change, things will change.”

Refugee, looking for work

While mental health support was helpful for some refugees in improving their overall wellbeing, in one instance, the support led also to a different diagnosis. The refugee in question had received support from a psychologist who noticed they had symptoms of attention deficit hyperactivity disorder (ADHD). Their psychologist referred them to an ADHD specialist where they received an ADHD diagnosis, providing them with a sense of relief and support to manage this diagnosis and the impact it had on their mental health. Receiving such a diagnosis was a positive and enlightening experience for this refugee, enabling them to understand their feelings and behaviours.

Mental health and support was appreciated for being more normalised in the UK

In general, refugees who benefitted from mental health support in the UK but not in their home country found the UK’s approach to mental health to be more normalised and accepting than what they experienced in their home country. While some refugees were uncomfortable with this more open approach, especially if mental health discussions and support were limited in their home country, others, particularly those with poorer mental health and positive experiences of mental health support, found it to be a welcome and positive change.

Cultural norms surrounding mental health sometimes created a hesitancy to seek help. Stakeholders acknowledged that these cultural barriers could stem from the stigma associated with accessing mental health services. One stakeholder shared an example of working with a refugee for nearly a year before they felt comfortable discussing their experiences and mental health, highlighting the significant impact of these cultural barriers. This underscores the importance of culturally sensitive approaches to mental health support and building trust to facilitate access to mental health services for refugees.

Among refugees who had accessed mental health support, there was a group who described feeling initially uncomfortable about admitting that they might need support and speaking to professionals about their mental health. However, once they gained positive contact with a caseworker or GP that empowered them to access mental health support, they spoke of the positive impact that accessing mental health support had on their mental health and the increased sense of comfort they felt in accessing mental health support.

“We don’t believe in counselling, we believe if you have problems, go to your mum. Cry, go to your sister, doing something, talk to you friends, that’s it … when I found it the first time, to be honest, I said, ‘I’m not crazy, why do I have to go to a mental health doctor?’ My case worker really helps. She said, ‘No, no, you’re not crazy, I know you are not crazy, but you saw a lot of things that happened, so you need to visit a specialist … ‘ I said, ‘Why do I need to go to the doctor to tell her my secret when I don’t like my secret shared anywhere?’ She said, ‘No one will share it anywhere.’ So, I understand, she was so simple to explain it, and later, I studied counselling and I-, diploma level 3 in counselling now, yes, because I love it.”

Refugee, in work

This evidence suggests that the normalisation of mental health as a concept and the support that sits around it in the UK enabled some refugees to recognise the importance of, and access to, support when needed. There is, therefore, value in ensuring that refugees have positive contact with caseworkers who are trauma-informed and understanding of their experiences as a refugee to facilitate the initial referral for mental health support.

3.2 Limitation of mental health support

There was a desire for more holistic mental health support that addresses practical needs

While there were refugees who reflected positively on the mental health support, there were others who found it less valuable. Those in the ‘seeking stability first’ group, for example, considered support that primarily focused on listening and not facilitating concrete changes in their lives less valuable. This group was focused on addressing the key barriers to improving their mental health, such as being unemployed, experiencing financial insecurity or living in unsuitable housing. They therefore felt that mental health support was of limited use to them until what they saw as their more fundamental needs had been addressed. While this group did not articulate exactly what more practical support could look like, this finding suggests that there may be value in mental health providers being more closely aligned with other support services so that they can effectively signpost and refer refugees to services that can support them in addressing their most practical needs while providing focused mental health support themselves.

“’We are just here to listen to you,’ but that doesn’t help anything because they are all just talk and these issues around me, but they forced me and my mental health to get worse. As somebody who only listens to my issue, and there is no solution for that, then for me, like, it doesn’t work.”

Refugee, looking for work

Stakeholders also highlighted the need for a more structured approach to refugee integration that starts with mental health support to stabilise refugees, then moves to integration support including employment support at the point that refugees are in a stable position to access and benefit from it. Stakeholders prioritised addressing refugee mental health needs first, recognising the impact of available mental health services and their positive effect on refugee integration and mental health. Their view was that employment becomes easier to secure once refugees’ fundamental needs are addressed and therefore suggested a more structured and sequential delivery of support services. Conversely, refugees, particularly in the ‘seeking stability first’ category, tended to prioritise practical integration support first; however, this was often because they had limited awareness of available mental health services or experienced cultural barriers to accessing mental health support. These refugees had to be supported to understand the availability and value of mental health support in order to access it.

A lack of trauma-informed mental health support can negatively affect refugee mental health

Refugees and stakeholders highlighted that if mental health support was not tailored to the needs and experiences of refugees, it might lead to deteriorated mental health. Stakeholders emphasised the need for trauma-informed mental health services tailored to refugees with more pressing mental health concerns. They felt that mental health professionals need to be aware of refugees’ potential past trauma to avoid re-traumatisation but indicated that sometimes the necessary training and support is not in place for mental health professionals to deliver this.

Stakeholders suggested that if mental health services do not take a trauma-informed and culturally aware approach, it could negatively impact a refugee’s experience of the mental health service as well as their mental health itself. One refugee participant felt as though they were treated differently because of their refugee status and that their mental health practitioner did not understand their needs or experiences as a refugee. Despite trying to book in further appointments multiple times, they never heard back from their mental health practitioner. They described feeling ignored, leaving them apprehensive about accessing mental health support again in the future. This reflects the need for mental health support to be both trauma-informed, culturally aware and responsive to the specific needs that refugees might have.

“I would train people working in this area to make sure that they understood what’s happened to these people, so that they can make sure that they can shape those foundations appropriately.”

Stakeholder

3.3 Barriers to accessing mental health support

Mental health support can be challenging to access due to a lack of language support

Both stakeholders and refugees observed that limited translation support creates significant barriers for refugees to access and benefit from mental health services. Stakeholders acknowledged it is particularly challenging for refugees to discuss sensitive experiences when communication is hampered by language differences and a lack of translation support. Stakeholders also highlighted that language barriers can impact the efficacy of the mental health support, as open communication and trust are essential for successful therapeutic outcomes. As a result, ensuring that mental health services can provide interpreters should be a priority to ensure services are inclusive and facilitate the best therapeutic outcomes for refugees.

“Wherever they go, most of them need interpreters … GPs try and not use them as it takes about 10 minutes to get someone on the phone, which is not helpful to the individual, which causes a lot of anguish.”

Stakeholder

Demand for mental health services is currently very high affecting access to support

Refugees and stakeholders acknowledged the strain that long NHS waiting lists place on mental health services. Refugees who had been or were currently on NHS waiting lists for mental health support discussed how extended waiting times exacerbated existing mental health conditions, especially for those already struggling. One stakeholder explained the reality of NHS waiting lists, sharing that none of the refugees they had been working with had received free NHS therapy^{[footnote 1]}.

Refugees who had been on waiting lists described how unless it was an emergency they were told they would need to remain on the waiting list, one refugee spoke of having to process trauma alone, feeling broken and struggling with being unable to access support.

Stakeholders and refugees observed that there is a high demand for services across the UK. This demand can vary across different locations, with some areas seeing extremely high demand, particularly where the number of refugees is high. This means that refugees experience unequal levels of support based on location.

The frequent relocation experienced by refugees, particularly by those in the ‘seeking stability first’ group who were grappling with insecure accommodation, often led to inconsistent access to mental health support, which negatively affected their mental wellbeing. For example, one refugee shared the experience of losing access to mental health services after relocating to a new area, requiring them to register with a new GP and experience another long waiting period for support, which they found particularly challenging. Refugees acknowledged that little could be done about the long wait times for support; however, having to wait a long time without hearing from mental health services can make them feel forgotten. As such, it would be beneficial for mental health services to provide updates to refugees during the waiting periods, ensuring that they are acknowledged and know who to contact in the case of a mental health emergency.

Lack of awareness of mental health support is a key barrier to the uptake of support

A key reason cited by refugees for not accessing mental health support was a lack of awareness about its availability or where to find it. This was especially true for those from countries where such services were not readily available or accessible for free, leading to the assumption that they would not be freely accessible in the UK.

“I grew up in the Middle East and in the Middle East … We don’t have access to mental support, so it’s not intuitive for us to seek mental health support. I wasn’t aware that I could access mental health support other than if I go and pay for it, in a way, like, seek private psychologists or psychiatrists.”

Refugee, looking for work

Stakeholders also observed that refugees might not yet be registered with GPs, which can affect their awareness of what support is available to them. Enabling early registration with GPs was seen as especially important by stakeholders, as refugees often receive referrals to mental health support via their GP. Our wider understanding of the context would also suggest that, not only do refugees need to be registered with a GP as early as possible, but that for referrals to happen seamlessly, local GP services and caseworkers need to work together in a consistent and joined-up way to support refugees to access mental health support.

3.4 Timescales for mental health support delivery

Mental health support is more needed when refugees arrive in the UK

Refugees and stakeholders acknowledged the benefits of mental health support being advertised and made available for refugees soon after arriving in the UK to prevent the deterioration of mental health. Refugees, particularly those in the ‘mental health prevents job search’ group, highlighted how experiencing trauma in their home country or during their migration journey can affect them and that upon arriving in the UK, mental health support had a role in helping them to process such trauma.

As discussed in section 2, stakeholders and refugees observed that often the first few months in the UK are very challenging for refugees. This is linked to various factors, including adapting to the UK culture and navigating the asylum process, which often involves a loss of control over certain elements of refugees’ lives. Therefore, both stakeholders and refugees emphasised the need for early intervention, explaining the sooner refugees and asylum seekers are made aware of and receive mental health support, the better their chances of successful integration and improvements in their overall wellbeing.

“From the very first moment they get over here, they should be assessed, and then if they’re in that category, they should be given the appropriate, sort of, mental health support that’s needed.”

Stakeholder

There were refugees in the ‘seeking stability first’ group who sought to address practical needs rather than mental health support. Therefore, it may make sense for mental health support to also focus on signposting refugees to practical support such as access to local public services to ensure refugees’ mental health and basic needs are addressed in tandem.

To summarise, refugees and stakeholders recognised the benefits of mental health support, for providing a space to process trauma, foster a sense of connection and offer coping mechanisms. However, they also acknowledged significant limitations and barriers. Refugees often desired more holistic support that addressed practical needs. Furthermore, access was hampered by long waiting lists, limited awareness of available services, language barriers, cultural stigma and a lack of trauma-informed care. For mental health services to better support refugees there is a need for early mental health intervention and assessment upon arrival in the UK and for mental health support to be well advertised to refugees, given the challenges faced by refugees during their first few months in the UK. Mental health services should also offer provision for refugees to speak in their own language so they can get the most benefit from support. There is a need for mental health services to be refugee trauma-informed and provide specific training for mental health professionals to understand the experiences of refugees and improve support provision. Ideally, mental health services also need to connect with other support services to create clear pathways to addressing their pressing practical needs.

4. Refugee mental health and employment

Refugees and stakeholders identified a complex relationship between mental health and employment status. It was evident that experiences of poor mental health can prevent a refugee’s entry into employment, and that the length and experience of the job-seeking process can in turn negatively impact mental health. This section explores the relationship between mental health and employment from the perspective of stakeholders and refugees.

4.1 The relationship between mental health and the job seeking process

Poor mental health leads to longer periods of job searching

While poor mental health was not perceived to be the biggest barrier refugees face when seeking employment, stakeholders linked it to a longer period of job searching. Refugees identified clinical symptoms as the root cause of this. They spoke of low mood leading to a lack of motivation and poor concentration, making applying for jobs a demanding task. Additionally, refugees who were actively seeking employment reflected that having poor mental health can mean it takes longer to recover from the hurdles of job searching (such as rejection), with the stress associated with looking for work felt more strongly. Likewise, stakeholders linked poor mental health to low confidence, which they saw as impeding refugees’ ability to seek employment effectively, making refugees feel unprepared for job interviews and anxious about workplace interactions.

The extent to which mental health affected refugees’ route into employment depended on the severity of their mental health condition, and whether they were receiving treatment. This was particularly apparent for refugees in the ‘mental health prevents job search’ group for whom the nature of their mental health challenges, which included diagnoses such as social anxiety, meant that medical professionals advised refugees to engage with treatment before seeking employment. However, those who successfully sought treatment spoke of a noticeable improvement in their readiness for work. For one participant, depression medication took them from not being able to get out of bed, to being “neutral”, able to apply for jobs and continue their day-to-day lives. For another participant, engaging in mindfulness workshops helped them to feel like themselves again, reviving their desire to look for employment.

“I attend various, kind of, workshops with Mind … I did art class, just doing some art, creative writing class … it just made me feel alive, feel curious again. If you think, like, everything has finished, if you look at the outside and if it looks grey, you won’t be able to open your laptop and apply for some jobs. You have to have that mental energy, so that kind of distraction, that, kind of, creative things helped me to focus on, ‘Okay, I have done that. Now I want to apply for some jobs which is good.’”

Refugee, in work

This evidence suggests that, as touched on in section 3, more readily available mental health support, which is culturally sensitive and accessible to refugees, can help to shorten and accelerate refugees’ employability journey.

The barriers faced by refugees during job searching can exacerbate mental health issues

Those actively seeking employment found the process unexpectedly challenging. Alongside barriers such as physical disability, poor mental health and childcare, refugees faced unique barriers to securing employment linked to their specific circumstances. These barriers included lack of UK qualifications and experience, hostility, discrimination, cultural differences, language skills and gaps in their CV due to the asylum-seeking process. There were 2 key ways in which encountering these barriers was considered to impact on refugee mental health.

First, prejudice was the common link between many of the unique barriers refugees faced when looking for employment. Refugees spoke about how experiencing discrimination made them feel unwelcome and, like employers, did not trust them because they were from abroad, or because they were refugees. This affected refugees’ mental health by making the job-seeking process longer, but also by making them feel overlooked, undervalued and resigned. This added to their negative thoughts and affected their mood and concentration.

“It makes me sad because, for example, I went to a charity and I said I’m ready to help you in terms of financial affairs, and they said, ‘Have you got any IT skills?’ … I don’t have any problems to manage myself in IT stuff. But you know what, I think they thought because I come from a different country, a part of Europe, I don’t have any experience, I don’t have any qualifications, I don’t have any skills.”

Refugee, looking for work

Second, having to resolve these interrelated barriers extended the period of job searching. Often, refugees faced many unsuccessful applications. Constant feelings of rejection and disappointment were singled out as one of the main reasons for the worsening of mental health as a result. One participant described that the repeated rejection deteriorated his mental health to the point of wanting to isolate himself, removing all contact with the outside world.

“To be honest, when I was sending applications and was not receiving answers, or if I was receiving negative answers, it heavily had, still having negative impacts on my health and it makes me so sad. Always worried about what will happen tomorrow, how I would get a job. I was not willing to talk to somebody. Mostly I just switch off my phone, I don’t want to have contact with anyone, I just want to sit alone, separate from all.”

Refugee, looking for work

The constant rejection particularly affected the mental health of refugees actively seeking employment who had work experience in their home countries and wanted to remain in their career. They described how, even with a Statement of Comparability^{[footnote 2]}, employers can be hesitant to offer refugees roles at a level equivalent to their experience. This means that refugees resorted to applying for entry-level positions that did not match the level of their skills and aspirations. Consequently, they were often rejected from these positions for being “overqualified”. Having to look for a job that was below or outside of their skill set, coupled with feelings of rejection and disappointment, was identified as further compounding poor mental health.

“I’ve got a master’s degree in business master administration, and I was a financial advisor, business advisor in my country. But it’s really hard to find someone to trust you in this country without any British experience, and that’s why sometimes I’m suffering from mental health because, these jobs are very far from my previous career.”

Refugee, looking for work

These findings suggest that targeted employability support designed to help those refugees who are trying to continue their careers in the UK would help to support their mental health and potentially prevent it from deteriorating due to stresses of repeated rejection. This could be achieved through stronger links with employers within key career paths, such as law, healthcare and education.

Volunteering was considered to enhance refugees’ job seeking prospects and improve their mental health

Volunteering was perceived to enhance refugees’ job-seeking prospects and was unanimously described as a positive experience. Four key benefits of volunteering were identified. First, it allowed refugees to gain work experience which could be used when applying for jobs, especially if an individual had aspirations within a specific field. Second, participants also described how it helped them to gain knowledge of UK workplace culture and ways of communicating within the workplace, which led to higher confidence and self-belief. Third, volunteering was felt to provide refugees with an opportunity to improve their English and create connections with others, thereby ultimately allowing them to strengthen their social networks.

“At first, I tried to speak with people, I struggling to speak on the phone with British people. And, [volunteering] gave me confidence to speak with people, to communicate with them on the phone, to manage myself in my daily activities such as, I don’t know, GP. I think after 2 or 3 months, I called my GP, and I said, ‘I don’t need any interpreter, I can manage myself’.”

Refugee, looking for work

Finally, refugees could use the organisations they volunteered at as reliable references for future job applications, vouching for their skills to the potential employer. On rare occasions, refugees could also secure direct employment from the organisation who provided the volunteering opportunity.

Overall, volunteering was presented as improving refugee mental health in 2 key ways. First, it helped refugees to overcome the barriers to employment mentioned above, such as lack of UK experience or knowledge of UK work culture, accelerating their job searching process, and improving their independence and confidence. Second, it made them feel wanted, useful and happy. The latter was particularly salient for those with a previous career but still within the ‘actively seeking employment’ category, as they saw it as helping them to get closer to their goal.

“[Volunteering is] so helpful … whoever meets a problem and I feel that I’m able to help, so, that makes me so happy and I feel so glad that at least I’m someone that can help. … So, it makes me very happy and besides it’s a good practice for me. I can practise with English. I can get familiar with lots of things and lots of new things and I learn lots of things.”

Refugee, looking for work

Ultimately, those who moved into the ‘actively seeking employment’ category, thanks to mental health or other support and felt ready to apply for jobs, described how applying for work can positively impact their mental health by building confidence and providing a sense of purpose. At the same time, encountering barriers, especially unexpected ones, counteracted these positive impacts. This shows how the job-seeking process can lead to changes in mental health, which in turn can affect an individual’s readiness to look for work.

4.2 The impact of employment on mental health

‘Happily employed’ refugees and those ‘seeking a better employment fit’ unanimously agreed that securing employment had a positive impact on their mental health. They felt the strongest benefit of employment was financial stability, as it added a layer of security and allowed refugees to relax, feel safe and think about the future. This was particularly salient for those with a family (male and female) – providing for their children and/or spouse made them feel like a good parent and partner. Both those happily employed and those seeking a better employment fit expressed feeling thankful for having the job, even if they continued to face challenges (for example, a difficult workplace environment). This indicates the stability that employment brings to someone’s life is a powerful driver of improved mental health.

Other benefits of working described by refugees focused on personal growth (feeling accomplished, having a purpose, working towards goals), social integration (feeling included, interacting with people), and stability. Refugees and stakeholders reflected on the sense of hope that a job can provide, giving refugees the space and confidence to think about the future.

“My job gives me purpose. It actually introduced me to a lot of people. It taught me, interacting with people, having emotional awareness, understanding different types of capacities, of mental capacities. It helped me mentally, on a personal level. It really changed my view on how I see the world now. To be fair, without this job, right now, I don’t know what I’d do, because this job really saved me.”

Refugee, in work

While those seeking a better employment fit still experienced benefits of financial stability and enhanced feelings of security, they did not speak of feelings of fulfilment or personal growth. Often, they did not feel their job-seeking journey was over yet and continued to volunteer or study to enhance their opportunities in their desired field.

“I don’t know if I have to be happy, they accepted [my application], or I have to be sad because I’m working in something I don’t really like, I don’t want it.”

Refugee, in work

However, there were refugees who continued to face difficulties while in employment. Alongside complications faced by the general population (such as the cost of living or contractual issues), some continued to face stigma in their workplace. One participant described feeling stressed at work, as people she worked with were rude to her and made assumptions about her based on her background. Another participant reflected on how the lack of common cultural references and her limited understanding of the slang her colleagues used made her feel uncomfortable at work. The stability of the job and improved finances made it easier for these participants to deal with adversities, but ultimately a hostile workplace environment hindered them from making connections and seeing the employment as an opportunity for growth.

Overall, the evidence shows that there is a clear link between refugee mental health and their employment status. A range of factors influence where they sit in our typology and how they move between the various categories within it. While their journeys are not linear, they often start in the ‘mental health prevents job search’ and ‘seeking stability first’ categories before moving to ‘actively seeking employment’, often with the help of mental health and/or employability support. Those actively seeking employment continued to struggle with their mental health and sometimes fell back into the ‘mental health prevents job search’ category. Those who found work experienced improved mental health thanks to improved stability and finances. It also brought them feelings of accomplishment, productivity and inclusion. Participants who spoke of a job loss, or a contract ending, mentioned a deterioration in mental health.

“When I was employed in this organisation, my mood was very good, because I was working towards something, not just sitting, not knowing what will happen.”

Refugee, looking for work

The findings point to some specific points of change in refugees’ lives, as well as enablers to a better and faster employment journey, including volunteering, alongside employment and wider integration support. While this project focused on the link between refugee mental health and their employment status, as part of the interviews with refugees, participants also shared their experiences of employability and the integration support they received. The data from these discussions corroborated the findings of RTOF and REP evaluations, with refugees favouring more holistic support. Stakeholders reflected that culturally sensitive mental health training would help them to support service users better. Overall, the complex relationship between mental health and employment points to the need for more holistic and integrated support for refugees that links up mental health and employment with support for practical issues such as housing and benefits in a more systemic way.

5. Implications

The analysis of the factors that impact refugee mental health reveals a complex interplay between pre-displacement traumas and post-displacement challenges. Refugees face unique stressors such as navigating the asylum process, securing stable housing, and integrating into a new culture while managing financial instability and feeling undervalued. Limited access to mental health support and employment opportunities compounds these challenges, which can exacerbate feelings of isolation and loss of control.

This research has revealed a clear link between refugee mental health and employment outcomes. The journey for refugees to access employment is challenging. They might encounter numerous barriers during the application process alongside challenges in finding employment that is relevant to their experiences and skill set while also securing tailored employment support. This journey can be further impeded by experiences of poor mental health that can prevent refugees from prioritising looking for work. Nevertheless, entering employment can have a positive impact on refugee mental health, providing structure, financial stability and a sense of hope.

The insights from this research suggest a holistic, sequenced approach is most effective, recognising that refugees’ needs change over time. Key implications from this research include the following.

5.1 Initial arrival and stabilisation

Early mental health support is fundamental. Screening and assessment upon arrival, coupled with accessible and culturally sensitive services (including interpretation), are vital for addressing pre-existing trauma and building a foundation for wellbeing. This, in turn, allows individuals to engage more effectively with later employment support. Simultaneously, addressing basic needs like secure housing, benefits support, and access to essential services (such as GP registration) reduces stress and enables a focus on both mental health and future job prospects. Clear pre-arrival information that sets realistic expectations about the asylum process, available support and life in the UK (including employment pathways) is also essential for managing anxiety and preparing for the journey ahead.

5.2 Building skills and confidence

Employability support must be trauma-informed, recognising the profound impact of past experiences on an individual’s ability to seek and maintain employment. This involves building confidence, addressing anxieties related to workplace interactions, and providing coping mechanisms for the inevitable setbacks in the job search process. Volunteering emerges as a powerful tool during this stage, offering valuable UK work experience, improving language skills, expanding social networks and boosting self-esteem. All of these benefits contribute to both improved mental wellbeing and stronger employment prospects. Continued access to culturally sensitive mental health support remains essential as individuals navigate the challenges of job searching and cultural adjustment.

5.3 Targeted employment support and integration

As refugees move towards employment, targeted support tailored to their existing skills and career aspirations becomes paramount. This includes specialised training, mentorship programmes, and strong links with employers in relevant sectors. Critically, recognising foreign qualifications and experience is essential for valuing the skills refugees bring. Support should not stop at job placement. Addressing potential workplace challenges, such as discrimination or cultural misunderstandings, through ongoing mentorship, advocacy, and continued access to mental health support is vital for long-term success. A truly holistic approach requires continued access to integrated support services, including mental health care, benefits advice and housing assistance, to maintain wellbeing and navigate any setbacks. Clear referral pathways and strong communication between services are crucial for ensuring that individuals receive the right support at the right time.

To conclude, the experiences of refugees underscore the importance of tailored mental health and employment support that acknowledge cultural differences and provide practical assistance. Ultimately, addressing the multifaceted needs of refugees holistically is essential for improving refugees’ mental health and employment outcomes. The above suggested approach, moving from initial stabilisation and support to skill-building and finally targeted employment assistance, recognises the evolving needs of refugees and offers a more effective pathway to integration. This framework is focused on the interconnectedness of mental health and employment and has the potential to significantly improve outcomes for refugees in the UK. To enhance our understanding of this area, future research could focus on the long-term mental health trajectories of refugees’ post-integration, examining how holistic integration support can create more inclusive environments for refugees.

Appendix A: Methodology

Overview

The methodology comprised 2 key approaches: a light-touch evidence review, which was built on a review already carried out by the Home Office team, and qualitative depth interviews with stakeholders and refugees.

Sampling and recruitment

There was no sampling criteria applied to the stakeholder interviews since these were scoping interviews, designed to develop the research team’s understanding of the context, background, and objectives of the research, helping to inform the design of research tools (topic guide and screener) for the fieldwork with refugees and refine the sampling and recruitment approach. The recruitment approach involved the Home Office team identifying key stakeholders both from the Home Office and from wider organisations delivering services for refugees, contacting them to get consent for Ipsos to get in touch with more information.

To explore the range and diversity of refugees’ experiences of mental health and employment, the Ipsos research team developed a purposive sampling strategy that included a range of key characteristics that might influence refugees’ views. This included setting quotas for some characteristics, and monitoring for diversity with others. Refugees were recruited via organisations that support refugees; those involved were Refugee Action, British Red Cross, Maximus, International Rescue Committee, Migrant Help and Breaking Barriers. The research team approached these organisations with information about what recruitment would involve and an information sheet and consent form to be shared with potential participants. They also gave organisations the option of an introductory call to inform them about what the research would entail. Organisations then circulated the information sheet, privacy notice and consent form to participants who emailed Ipsos directly if they were interested in finding out more or in taking part in an interview.

Once potential participants got in touch with Ipsos, they were contacted to take part in a screening call to share more information, ensure they could give informed consent, were comfortable to take part in the research and aligned with the sampling criteria. The Ipsos research team conducted the screening calls due to the sensitive nature of the interviews, which were designed to be as unintrusive as possible, asking participants only for high-level information and emphasising the research process and what it would entail to enable participants to make an informed decision about whether to take part. If a participant reported that they currently had very poor mental health, they were screened out of taking part in the interview due to concerns it may negatively impact their mental health further.

Additional information about participants’ characteristics was also collected through a short series of questions asked at the end of each depth interview. Additional consent was sought before asking these questions.

In total, 5 stakeholder scoping interviews were conducted, and 30 interviews were carried out with refugees.

Table 2 below sets out the quotas and achieved profile of the refugee interviews. Despite the fact that not all the quotas were met, there was still considerable diversity in the sample overall. Table 3 shows the monitoring criteria.

Table 2: Primary sampling criteria

Primary sampling criteria		Overall sample of participants (n=30)
		Target number of Participants (where relevant)	Actual number of participants
Employment Status	In Work	At least 8	12
	Looking for work	At least 8	14
	Not Looking for work	At least 8	4
	Female	At least 10	11
Gender	Male	At least 10	18
	Non-binary		1
Age	16 to 24	At least 8	3
	25 to 44	At least 8	19
	45 to 64	At least 8	8
	1 - Very Poor (Excluded from sample)	Excluded from sample	0
Severity of mental health challenges (now)
	2 - Poor
	3 - Fair		13
	4 - Good	Kept in sample if previously had poor mental health	10
	5 - Excellent	Kept in sample if previously had poor mental health	0
Severity of mental health challenges (in past)	1 - Very Poor		11
	2 - Poor		11
	3 - Fair		8
	4 - Good	Excluded from sample	0
	5 - Excellent	Excluded from sample	0

Table 3: Monitoring criteria

Monitoring criteria		Overall sample of participants (n=30)
		Actual number of participants
Length of time in the UK	Less than a year	3
	1 to 5 years	4
	5 to 10 years	19
	10+ years	4
Reason for being in the UK	To seek asylum	23
	Accessed a resettlement scheme	7
Receiving/received employment support	Currently receiving formal employment support (for example, from DWP, REP, RTOF, or refugee charity like Refugee Action, Breaking Barriers, Refugee Council	20
	Currently receiving informal employment support (for example, from friends, neighbours, social media)	0
	Received formal employment support in the past but not currently(for example, from DWP, REP, RTOF, or refugee charity like Refugee Action, Breaking Barriers, Refugee Council	5
	Received informal employment support in the past but not currently (for example, from friends, neighbours, social media)	0
Receiving/received mental health support	Currently receiving mental health support (for example, therapy/counselling, GP support, medication, online services, support ground)	5
	Received mental health support in the past but not currently (for example, therapy/counselling, GP support, medication, online services, support groups)	11
	Never received mental health support	10
Timing of mental health challenge	Experienced a mental health challenge before arrival to the UK	9
	Experienced a mental health challenge post arrival to the UK	18
Educational attainment	No formal education	12
	Primary education	0
	Secondary education	7
	Undergraduate degree	13
	Post-graduate degree	8
	Unknown/did not answer	2
Region	London	9
	South East	0
	South West	5
	East of England	0
	West Midlands	3
	East Midlands	2
	North West	2
	North East	2
	Yorkshire and the Humber	5
	Scotland	2
	Wales	0
	Northern Ireland	0
Area they live	City	22
	Town	8
	Village/countryside	0
Sexual orientation	Heterosexual/Straight	25
	Lesbian/Gay/Bisexual	1
	Unknown/did not answer	4
Physical disability	Have a physical disability	8
	Don’t have a physical disability	22
Strength of social networks in the UK from same community or background	1 - very weak (rarely/never engage with people)	9
	2 - weak (engage with people monthly)	2
	3 - moderate (engage with people weekly)	5
	4 - strong (engage with people several times a week)	5
	5 - engage with people daily)	5
	Unknown/did not answer	4
Strength of social networks in the UK from host community or different background	1 - very weak (rarely/never engage with people)	2
	2 - weak (engage with people monthly)	8
	3 - moderate (engage with people weekly)	9
	4 - strong (engage with people several times a week)	5
	5 - engage with people daily)	2
	Unknown/did not answer	4

Fieldwork approach

The stakeholder scoping interviews were carried out online at a time convenient to each stakeholder and lasted around an hour.

Refugee participants could choose whether their interview was conducted online, by phone or in person. The interviews were carried out at a time convenient to the participant and lasted up to 90 minutes.

Translation services were made available for both the screening calls and depth interviews themselves to ensure that the research was as inclusive as possible. In total, 5 participants out of the 30 took up the offer of having a translator present or native speaker conducting the interview.

Interviews were guided by a pre-agreed topic guide. The topic guide set out the key areas to be covered in the interviews with no pre-scripted questions, allowing the interviewer to frame the question in the moment and reflect the participant’s language. This not only helped the participant to feel more comfortable but enabled them to feel more deeply listened to and gave the researcher flexibility to explore key areas of interest and unanticipated subjects. The topic guide was trialled during the first couple of interviews and minor changes were made to make it more effective. Interviews were audio recorded with the participants’ permission to allow for accurate and robust analysis. All participants were told that individual views and quotes would be anonymised and that they had the right to change their mind about participating at any point up until the analysis phase started. All recordings were sent to a professional transcriber to be transcribed.

Throughout the interviews, refugee participants were reminded of their right to decline to answer any questions or to stop the interview completely. Following the interview, the interviewer checked with each participant that they were still happy for their data to be used and for what they had shared to be anonymously quoted in the report. At the end of each interview, every participant was offered a free emotional support session from a specialist emotional support provider, to enable them to discuss anything that taking part in the interview might have raised for them. These emotional support sessions were provided by Hestia, lasted one hour and took place by phone. In total, 14 out of the 30 refugees who took part in the research took up the offer of an emotional support call. After the interview, all refugee participants were sent a leaflet detailed sources of support that they could turn to if needed and a £40 high street voucher as a thank you for their time.

Data management and analysis

Following the fieldwork period, data management and analysis took place. The data from the interview transcripts was analysed using the framework method of analysis. This involves summarising the data from each research interview into a thematic framework. Columns represent themes and each participant’s data is summarised (charted) across a row. The strength of this approach is that it enables systematic and comprehensive analysis of the complete data set in a manageable way and that analysis can be done both thematically and individually. Once the data had been charted into the framework, the analysis phase followed. This began with several team analysis sessions to identify themes emerging from the data to explore in more detail. Following this, different sections of the data were allocated to the team, who then undertook various stages of analysis. This included descriptive analysis, which involved looking at each research question or theme in turn and exploring the range of views held under that theme to develop categories. Following this, the team looked for patterns and linkages in the data exploring whether characteristics, experiences or circumstances of the refugees might link to particular views or experiences of mental health and employment. The outputs of this analysis were used to develop the typology that is presented in this report.

Interpretation of the qualitative data

Despite not all the sampling quotas being met, the data from refugees who took part in the research is relatively comprehensive, as the sample represents a reasonable level of range and diversity, and there was a good level of saturation apparent in the data. In addition to this, the findings were reviewed by researchers who had worked on the evaluations of REP and RTOF. They indicated that the findings from this research chimed heavily with what had been found during those evaluations. We can therefore be reasonably confident that the high-level themes emerging from the qualitative research largely echo those that would be found in the wider population of refugees in the UK, even if the granularity of individual experience varies. However, there are some caveats to this which are explored in the limitations section below.

Ethics

At the start of the project, the research team put together an ethical review form identifying the key areas where there might be ethical challenges. This was then reviewed by 2 members of our internal Ipsos ethics group and 2 members of the RIMA Ethics Advisory Board, put together to oversee the wider contract with the Home Office. Following these processes and in line with good social research practice, the team implemented a range of measures to ensure the informed consent and wellbeing of both refugees and researchers throughout the project. This included (but was not limited to):

1. All potential participants were given access to an information leaflet and privacy notice prior to deciding whether to take part, explaining what their participation would involve, how their data would be used, stored and destroyed, that the interviews would be recorded, the voluntary nature of participation and how to get in touch to ask any questions or to opt out of the research.

2. All refugees invited to undertake the full interview were emailed a consent form to complete before the interview that reiterated the voluntary nature of participation and details about the research process and how data would be used and stored.

   • both at the screening call and the interview itself, researchers checked participants had engaged with the information and could give fully informed consent
   • participants were reminded throughout the research process that they could withdraw consent at any time before the analysis stage started

3. The possible impact of the research on participants was reflected in the sensitive manner in which interviews were carried out, the reiteration of participant control of the interview, ongoing consent and the structure of the topic guide. Participants received example phrases they could use to stop the research at any time, or decline to answer questions should they wish to.
4. The burden placed on participants was minimised by conducting interviews in a manner and at a time chosen by the participant – the interviews were designed to last no more than 1.5 hours to keep the time commitment of participation to a minimum. However, the interviewer also checked the time that each participant had available and was responsive to that so, in some cases, the interview was significantly shorter than 1.5 hours.
5. The interviews were made as inclusive as possible through the provision of translators or interviews taking place in the participants’ preferred language. Emotional support was also offered to each participant after the interview.
6. Researchers working on the project received a full briefing ahead of the fieldwork starting, including refresher training on Ipsos’s safeguarding and disclosure policy and were encouraged to check in with someone after each interview for a debrief where needed.
7. A limit was placed on the number of interviews researchers could complete in a day, and a buddy system was also implemented for in-person interviews.

Challenges and limitations

As already identified, there were 2 sampling quotas that were not met. These were refugees who were currently not looking for work and younger refugees in the 16 to 24 age bracket. While this limits the diversity in the sample, there were still participants from each of these groups included in the research. It should also be noted that the recruitment approach of contacting refugees through gatekeeping organisations will also have had an impact on the data in that only those refugees who were either engaged with a support organisation/charity or receiving support took part in the research, and it is therefore possible that the sample lacks refugees who were either more disengaged or disenfranchised. Likewise, for ethical reasons, the team decided not to include anyone who rated their current mental health as being very poor. This also may have impacted the data, although it is important to note that the sample did include refugees who felt that their mental health had been very poor in the past but no longer was, so the experiences of those who had experienced very poor mental health previously were captured.

This research was also taking place when the anti-immigration demonstrations occurred across the UK between 30 July and 7 August 2024. Although we postponed recruitment of participants during this time period, the demonstrations may have negatively impacted the mental health of refugees that engaged in this research. This could have had an impact on their involvement in the research and the information that they shared with the research team, potentially having an impact on the research findings.

Despite the above, there was still considerable diversity in the sample and a good level of saturation in the themes emerging from the data and so with the exception of the above issues, we can be reasonably confident that the themes identified in the research would largely be echoed in the wider population of refugees in the UK.

References

Ager A, Malcolm M, Sadollah S, & O’May F (2002) Community Contact and Mental Health amongst Socially Isolated Refugees in Edinburgh. Journal of Refugee Studies, 15(1), 71–80. https://doi.org/10.1093/jrs/15.1.71

Boobis S, Jacob R and Sanders B (2019) ‘A home for all: understanding migrant homelessness in Great Britain’ Crisis (viewed on 17 February 2025)

Breaking Barriers (2023) ‘Reaching meaningful employment Understanding the impact of Breaking Barriers’ one-to-one model of employment support for refugees’. (viewed on 17 February 2025)

Disney L and McPherson J (2020) ‘Understanding Refugee Mental Health and Employment Issues: Implications for Social Work Practice’. Journal of Social Work in the Global Community, volume 5(1), pages 19-30 (viewed on 17 February 2025)

Djuretic T, Crawford MJ and Weaver TD (2007) ‘Role of qualitative research to inform design of epidemiological studies: A cohort study of mental health of migrants from the former Yugoslavia’. Journal of Mental Health, volume 16(6), pages 743-755 (viewed on 17 February 2025)

Home Office (2019) ‘Home Office Indicators of Integration framework 2019’. (viewed on 17 February 2025)

Mental Health Foundation (2024a) ‘About Mental Health’. [online] (viewed on 17 February 2025)

Mental Health Foundation (2024b) ‘The Mental Health of Asylum Seekers and Refugees in the UK’. (viewed on 17 February 2025)

Teodorescu D, Heir T, Hauff E, Wentzel-Larsen T and Lien L (2012) ‘Mental health problems and post-migration stress among multitraumatized refugees attending outpatient clinics upon resettlement to Norway’. Scandinavian Journal of Psychology, volume 53(4), pages 316-332 (viewed on 17 February 2025)

WHO (2022) ‘Mental Health’. World Health Organisation (viewed on 17 February 2025)

WHO (2024) ‘Mental health at work’. World Health Organisation (viewed on 17 February 2025)

1. The stakeholder did not refer to how many refugees they had been working with or the time period that they had been working with the refugees on their case load. ↩

2. A certificate provided by the UK European Network of Information Centres (ENIC) which compares overseas qualifications to the UK educational system, at both qualification and framework levels. ↩