International migration is not a single “event”. In many cases, migration is a voluntary decision, due to social, economic and political contexts in the home country, or perceived opportunities in the destination country. Nearly one billion people (12.5% of the world's population) now live in a country other than the one in which they were born. In other cases, migration is involuntary or forced, i.e., aimed to escape persecution, harassment or danger, or due to displacement or expulsion. At mid-2023, there were 110 million refugees, asylum seekers, and people who were internally displaced. Up to 80% of these refugees live in low- and middle-income countries, which have limited capacity to provide housing, education, and general health and mental health services¹.

Some migrants and most refugees moving across international borders face adverse conditions before, during and after migration². Prior to migration, these conditions include deprivation, persecution, violence, imprisonment, and human rights violations such as sexual harassment and torture². Forced migration, greater exposure to pre-migration traumatic experiences, and the travel phase of the migration journey are associated with depression, post-traumatic stress disorder (PTSD) and anxiety among migrants and refugees².

Post-migration stress factors may have an even greater impact on mental health than pre-migration ones, for example on risk of psychosis and depression³. These include family separation, language difficulties, limited educational opportunities, limited social integration and acculturative stress, social exclusion, unemployment, stigma and discrimination. Many of these factors continue to impact mental disorder risk in the offspring of migrants. The post-migration environment, acculturation difficulties and a lack of social support can contribute to worsening mental health^{3, 4}. On the other hand, social-group participation is crucial for enhancing ethnic-minority and migrant mental health^{3, 4}.

The prevalence of mental disorders may be twice as high in refugees than among economic migrants⁵. There is an increased incidence of non-affective psychotic disorders among migrants from developing countries^{3, 4}. While the lifetime risk of affective or non-affective psychosis in Europeans is about 1-2%, this risk could be as high as 3-6% in migrants from outside Europe. The lifetime prevalence of PTSD (31%) and depression (31.5%) in refugees and asylum seekers is much higher than in the general population (respectively, 3.9% and 12%)⁶, and this increased prevalence persists for many years post-displacement⁷.

Large-scale interventions are urgently needed to address psychiatric disorders in refugees and forcibly displaced persons⁷. Cultural competence, a key component of good clinical practice, emphasizes clinician skills for understanding the cultural values, attitudes and behaviors of patients, respecting and bridging differences and making sure that these differences do not negatively impact the diagnostic and therapeutic process⁸. Anti-racism and diversity training are also sometimes offered.

Attention to patients’ cultural concepts of distress in clinical care can clarify the social construction of psychopathology, reduce over-medicalization, help trace a path from distress to resilience, guide research on mechanisms and markers of morbidity, guide cultural epidemiology by identifying those most at risk, and clarify cultural conflicts feeding social inequities⁹.

Most psychiatric medications have been developed in the West. Despite their global use, there is limited research on their pharmacodynamic and pharmacokinetic profiles across diverse ethnic groups. In addition to ethno-biological determinants of drug response, there are significant cultural factors, including the concurrent use of pluralistic health systems, alternative therapies, and folk remedies that might support, hinder or complicate pharmacotherapy efficacy and adherence.

The WPA Working Group on Providing Mental Health Care for Migrants and Refugees was tasked with the following objectives: a) to identify issues relevant to provision of mental health care for forcibly displaced people, refugees and migrants across the world, and to develop recommendations for WPA's involvement in forcibly displaced people, refugee and migrant mental health research, education, and mental health system development; b) to identify Member Societies, institutions and individuals interested and willing to participate in WPA's programs of forcibly displaced people, refugee and migrant mental health research, education, and mental health system development; c) to liaise with the other WPA Action Plan Working Groups^9-11 with a view to promoting the inclusion of forcibly displaced people, refugee and migrant mental health in the work of those groups.

In pursuit of these objectives, the Working Group has conducted several scientific and training initiatives at the international level. These included symposia on “Racism and Mental Health” at the World Congress of Psychiatry in 2021, and on “Racism and Mental Health of Vulnerable Groups and the Role of Mental Health Professionals” at the World Congress of Psychiatry in 2022. We also or-ganized a webinar on “Racism and Discrimination in Mental Health Care of Migrants, Refugees and Forcibly Displaced People”, with the participation of experts in the field. Further symposia dealt with “Transcultural Aspects of Mental Health” and “Transcultural Psychiatry and Mental Health of Migrants, Refugees and Forcibly Displaced People”. Additionally, we were invited to participate in a panel discussion on “Migration, Refugees, and Mental Health”.

At the World Congress of Psychiatry in 2023, we ran a course on “Forced Displacement, Refugees, and Mental Health”. We also prepared educational course materials in six languages on “Transcultural Psychiatry and Mental Health of Migrants, Refugees and Forcibly Displaced People”.

A further webinar organized by the Working Group was entitled “Working with Migrants and Refugees – Why Do We Need Cultural Competence?”. In this event, experts highlighted the importance of cultural competence in providing appropriate care for migrants and refugees, overcoming socio-cultural differences and other systemic challenges to reduce inequalities in mental health care.

The fact that the COVID-19 pandemic has had a greater impact on mental health of vulnerable groups of migrants, refugees and asylum seekers than many other populations has been a focus of the Working Group. A State-of-the-Art Symposium reported on “Understanding the Variation and Complexity of the Suicidal Process during the COVID-19 Pandemic” at the World Congress of Psychiatry in 2021. At the World Congress of Psychiatry in 2022, we presented a State-of-the-Art Symposium on “COVID-19 and its Impact on the Mental Health of Migrants, Refugees and Asylum Seekers”, and joined the Presidential Symposium on the same topic. To take up the handling of the pandemic, the Working Group developed a position statement on “COVID-19 Pandemic and Mental Health of Migrants and Refugees”.

Addressing a topical issue, the Working Group invited experts to a webinar on “War in Europe and Mental Health of Refugees and Forcibly Displaced People from Ukraine”. Europe is once again confronted with a dramatic emergency, which has already caused many civilian victims and mass displacement, and worsened the economic and energy crisis. Finally, a meta-analysis and systematic review on “Psychotherapy Interventions in Migrants and Refugees” is in progress.

Mental health education and interventions that are adapted to the linguistic, cultural and social circumstances of marginalized groups are crucial. The capacity of mental health professionals to provide quality services to migrant and refugee patients and communities must be substantially improved. It is essential to ensure effective and equitable professional help and humanitarian assistance to migrants and refugees who make up an ever-increasing proportion of the world's population.