Characteristics and needs of asylum seekers and refugees in contact with London community mental health teams

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Abstract
Background Asylum seekers and refugees may have substantial needs for mental health care, to which both pre-migration and post-migration traumas are likely to contribute. However, there is a paucity of data available to guide appropriate service development. Aims To ascertain numbers and describe the characteristics and needs of asylum seekers and refugees in contact with London Community Mental Health Teams (CMHTs). Method Data were obtained from staff and clinical records regarding socio-demographic and clinical characteristics and service use. Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) and Health of the Nation Outcome Scales (HoNOS) were completed. Results A total of 104 (11%) of the CMHT population were asylum seekers or refugees. Co-morbidity was frequent, and psychiatrists reported significant diagnostic uncertainty for 30%. The most common diagnoses were depression (50%) and post-traumatic stress disorder (PTSD) (41%), and just over half had a psychotic diagnosis (53%). Social isolation was common, levels of unmet need were high (mean of 6.8 unmet needs each using CANSAS) and the group used few services other than CMHTs. Conclusions The combination of high levels of need and limited service use suggests a need to develop more effective services. High rates of diagnostic uncertainty suggest a need for a clearer understanding of the complex clinical syndromes afflicting this group.