Perceived barriers to access mental health services for refugees and asylum seekers: a systematic review of qualitative studies

BACKGROUND: Previous experience of violence and other traumata as well as post-migration stressors affect the mental health of refugees and asylum seekers. There is a fundamental gap between mental health needs and care utilization. To address this gap, it is important to understand the perceived access barriers to mental health care among refugees and asylum seekers. This review analyzed the barriers using Penchansky and Thomas’ (1981) concept of access. METHODS: A systematic review of qualitative studies was conducted in April 2024 by two independent reviewers. The search included three databases: PubMed, Web of Science and PsycINFO. Studies published since 2013, with self-reported barriers or hurdles to access mental health services by legal adult refugees or asylum seekers were included. Information about the study design and setting, participant characteristics, and reported barriers to mental health care utilization were extracted. Risk of bias was assessed by the Mixed Methods Appraisal Tool. Due to the high heterogeneity, a narrative analysis was chosen. RESULTS: 25 studies were identified. Barriers were social and cultural factors as well as a lack of awareness. Here, most prominent was the negative stigmatization of mental health and misinformation about mental health services. Furthermore, language barriers hinder refugees and asylum seekers to seek help. Accommodation was a rarely mentioned barrier. DISCUSSION: The reported access barriers occurred in a specific combination of country of origin and destinations. In contrast to previous studies, we identified the refugees’ and asylum seekers’ fear of experiencing discrimination and the perceived lack of benefits of therapy as barriers. Refugees and asylum seekers had a preference to solve mental health problems by getting support in their social environment. Epistemic injustice and the relationship between different barriers highlight the complexity of access barriers. The generalizability might be limited. CONCLUSION: Self-reported access barriers among refugees and asylum seekers are multidimensional. Access barriers occur within the health care system as well as within the refugees’ and asylum seekers’ community. A rise in awareness, acceptability, and availability of mental health services is needed to ensure adequate care. Furthermore, cultural and religious differences between the providers and the refugees and asylum seekers should be considered.