A systematic review of global mental health service utilisation in young refugees and asylum seekers

BACKGROUND: Despite the high prevalence of mental health difficulties in young refugees and asylum seekers, evidence suggests that they underutilise mental health services. It is important that we understand their use of, and access to, mental health services. AIMS: To examine quantitative evidence on mental health service utilisation and access among young refugees and asylum seekers. METHOD: We searched MEDLINE, PsycINFO, Embase, Global Health and The International Bibliography of the Social Sciences. Searches were supplemented by reference list screening and forward-and-backward citation tracking of included studies. Results were synthesised narratively. Our review was pre-registered on PROSPERO (no. CRD42024540885) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Twenty-two studies were included. We found an overall pattern of underutilisation of services by young refugees in comparison with majority population peers, particularly for out-patient services and psychotropic medication. In contrast, there was evidence of increased emergency service use. Service use was particularly decreased for those from low- and middle-income countries, and increased in unaccompanied minors. Service use for trauma-related disorders and schizophrenia was most common, and less likely for neurodevelopmental disorders. Only one study contained data on access-related factors, which identified language as a potential barrier. CONCLUSIONS: There is a disparity between the mental health needs and service use of young refugees, suggesting a need for greater efforts to increase access and use in this population. Future research should explore barriers and facilitators, and build on primary research examining service use in asylum seekers and unaccompanied minors, because both remain underrepresented within the literature.