This book is a practical guide for mental health professionals working with people seeking asylum.

Often ‘refugees’ and ‘asylum seekers’ are spoken of together, as if they are almost the same. But they are not.

If you are a ‘refugee’, it will have been accepted that you can’t go back to the country that you fled, that you need safety, protection and a chance to build a life somewhere else, at least for the time being. You can then set about that rebuilding.

If you are an ‘asylum seeker’, your needs have not yet been recognised – and they may never be. You live with minimal resources, on the margins of a strange society, subject to hostile scrutiny from both those around you and the asylum process itself.

People seeking asylum are at increased risk of mental ill-health compared to refugees and other migrants, which is one of the reasons we are writing this book. They are also in a very particular predicament, which is not always recognised – another reason for the book.

They are in limbo, needing to move across borders. No longer physical borders – they have arrived here, after all – but legal, social, and cultural ones. Once you are a refugee, you’ve reached the safer side of these borders and are trying to take stock. You may share some needs and experiences with those still seeking asylum, or ‘status’, but your position is fundamentally different.

Seeking asylum, you need to move on, but you may never be able to. You can’t work. You have probably lost contact with family and friends. Much – if not all – that gave meaning to your life has been lost. You fluctuate between relief at having arrived safely and despair at what you have lost. And the process of having your claim for asylum considered moves slowly. Very slowly. Often inexplicably so.

Further developments often occur by chance or circumstance, rather than for good reason or because things are well organised. It’s often a surprise to those who first encounter the court system to discover how much weight experienced legal teams give to who the judge is on the day. This applies equally to Home Office asylum decision-makers – and also to who you might see in a clinic, or which care team or organisation you get referred to. If you are seeking asylum, you may be seen in crisis by someone who understands your predicament. Or not. You might find an empathic key worker, who understands your practical needs and empathises with your cultural stance. Or not. You may have a decent flat provided as part of your asylum support package, or not, and you may have kindly neighbours, or not. And all this comes on top of the many twists of fate that have led you to the United Kingdom.


Whilst writing, we have had to think a lot about words.

The term ‘asylum seeker’ is problematic on two counts. It defines the whole person by one aspect of their predicament, and nowadays it carries negative connotations, largely by virtue of its use in emotive, oppositional stories (usually in the press) and other hostile narratives

This first problem is an important and enduring one, and can be attended to. The second is not so easily put right. Any new term, as it becomes widely adopted, can be used in the same prejudicial way. For these reasons we have tried to avoid using any one specific term for people in the predicament of seeking safety – but we largely avoid ‘asylum seeker’.

In any health text there is another issue: what do we call the person who we are trying to help? ‘Patient’, ‘client’, and ‘service user’ are frequently used. Each term has both advocates and those who view them as demeaning. Often, the preferred usage is also a matter of professional background: psychotherapists may be happier with ‘client’, GPs largely hold on to ‘patient’. But should we use a term that defines a person solely by their being in receipt of ‘care’? Packaging too many considerations into the terms we use risks them becoming unwieldy. Throughout the book we will use a plurality of accepted terms, with the main proviso being that their meaning is clear in context.

Chapter 3 takes issue with the paradigm of ‘trauma’, and we often use the term ‘adversity’ instead, as will be explained. The word ‘symptom’ is also problematic – it implies pathology and so may not be the right word for what might well be part of an overall healthy response to a horrible experience. In the absence of a better, more concise alternative, we have stayed with ‘symptom’ as it is so widely used, but we are not presupposing pathology.

Some terms are used in the broader discourse to justify policy, and they also fuel hostility: ‘illegal immigrants’, ‘ foreign criminals’, ‘sovereign borders’, for example. National borders, however, can still be maintained effectively while treating people with respect and humanity. Vilification and punitive self-righteousness can ‘up the stakes’, provoke confrontation and make a difficult situation worse. How readily might the ‘hostile environment’ become the ‘sadistic environment’?


This is not an academic text, and it is not about the process of therapy, least of all ‘trauma therapy’. But it is about questioning the way we go about our work, and the assumptions we often make whilst doing so.

The authors have a range of professional backgrounds, and theoretical, moral and political positions, held with a range of intensities. Sometimes views have conflicted and have needed negotiation and compromise. This echoes how much of what we write about involves encounters between different value systems, and finding ways to respect and work creatively with this difference. What seems ‘common sense’ to one person may be contentious to another. As an example, one discussion that runs through the book is about the implications of using conventional psychiatric models to capture the complexities of human experience and how these both help and hinder us.

All the chapter authors share some important perspectives. We believe that in any difficult situation, all involved need to respond with kindness and respect. We do not think that this compromises any decisions or actions that are needed. Our experience is that relating to each other in this way helps make most situations better for everyone.

All of us are professionals, all of us are immersed (like it or not) in ‘Western’ understandings of mental health and almost all have no first-hand experience of seeking asylum. We have been interested in how our shared positions influence our thinking and approaches. However, there will still be assumptions of which we are unaware, because we all share them. We are therefore especially grateful to the people with first-hand experience of the asylum system who have allowed us to include their words.

Where people contributing from first-hand experience have wanted us to give their real names, we have done so. If they preferred pseudonyms, they have chosen them themselves. Other quotes are composites of things people have said to us over the years. If these relate to people seeking asylum we have attributed them to ‘Noa’.

We are all UK practitioners, and the book relates to the asylum system in the United Kingdom at a particular point in time (2022). However, we have aimed to discuss and illustrate general principles, and ways of thinking and asking questions, rather than provide information relating to a single time and place. Because of this, we trust that the book will be useful in other countries, and in years to come.

Chris Maloney

Julia Nelki

Alison Summers

Buying the Book

Seeking Asylum and Mental Health can be bought direct from the publishers using this link

A 20% discount is available using the code SAMH2022

It is also available through Amazon.

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