[Editorial] Mental health for refugees

Mental health for refugees Article Info Publication History: Published June 2026 DOI: 10.1016/j.langlo.2026.103974 External LinkAlso available on ScienceDirect External Link Copyright: © 2026 The Author(s). Published by Elsevier Ltd. Linked Articles - Mental health care for unaccompanied young refugees in Germany through a stepped care approach versus enhanced usual care: a cluster-randomised hybrid effectiveness–implementation trialThe Lancet Global HealthMay 13, 2026 - Effectiveness and cost-effectiveness of a stepped care framework for psychological interventions for reducing common mental health symptoms in Jordan: a single-blind randomised clinical trialThe Lancet Global HealthApril 28, 2026 Download started OkGlobal instability forcibly displaced 117 million people as of mid-2025, including 36 million refugees and 8 million asylum-seekers. Conflict, persecution, and other interpersonal traumatic events place refugees at an elevated risk of developing mental disorders such as depression, anxiety, and post-traumatic stress disorder. Access to treatment is often limited by under-resourced health systems in host countries, language and cultural barriers, stigma and discrimination, and legal precarity. Given rising geopolitical tensions, as well as enduring and emerging conflicts, refugees' mental health cannot be overlooked any longer. Apart from conventional psychosocial interventions such as trauma-focused cognitive behavioural therapy, various innovative approaches have been developed to address refugees’ mental health. For example, a digital problem-solving intervention for young Ukrainian refugees and a group-based, self-help intervention for female refugees in Uganda have both shown benefit. This issue of The Lancet Global Health adds evidence for another innovative approach rarely tested among refugees—stepped care. Stepped care is a patient-centred model that starts with low-intensity, low-cost interventions and escalates those who do not see symptom improvement to more intensive interventions. Rather than a one-size-fits-all approach, stepped care offers a personalised healing pathway that allows flexibility to step up or down to interventions of different intensity. It is well suited to low-resource settings because the initial low-intensity interventions can be delivered through task-sharing by non-specialists and are often easy to integrate within existing community-based services to broaden access. Stepped care has shown positive effects in the two randomised controlled trials published in this issue: one focusing on young refugees in Germany and the other enrolling Jordanians or refugees residing in Jordan. Nonetheless, these findings also bear some uncertainties. In the German trial, stepped care reduced post-traumatic stress symptoms and depressive symptoms among unaccompanied young refugees, but treatment retention was low, with a dropout rate of 41%. Similarly, although stepped care is effective and likely to be cost-effective in Jordan, the explorative subgroup analysis did not replicate the positive impact among non-Jordanian refugees. Altogether, these findings indicate that stepped care may hold promise for refugees’ mental health, but its impact will remain marginal and short-lived if structural, determinants are not transformed. A holistic, system-based approach of refugee resettlement including integration into the local community, safe and stable housing, opportunities for employment, and access to health and education services, will amplify and sustain the effects of mental health interventions. Meanwhile, we must recognise that refugees are not a homogeneous group, and many experience intersecting vulnerabilities such as being a child, an older adult, female, pregnant, identifying as a sexual minority, or living with pre-existing health conditions or disabilities. The compounded exposure to vulnerabilities requires a tailored approach that accounts for personal and socioeconomic circumstances instead of focusing solely on clinical symptoms. For example, unaccompanied young refugees, who are simultaneously facing developmental challenges (such as identity formation and education disruption), separation from caregivers or orphanhood, and travelling alone to a new country, are at a much higher risk of developing mental health issues than refugee children living with family or non-refugee children. Tailored mental health services including priority screening and early intervention, attention to developmental and relational stressors, culturally sensitive therapy, trust-building, and group-based or peer-based support are likely to engage unaccompanied young refugees and yield sustainable benefits. Being a refugee is itself a profound determinant of health, and no amount of psychotherapy and pharmacotherapy can fully resolve the distress and anxiety caused by exclusion, financial instability, and insecurity. National and international health policies must recognise and respond to the mental health needs of refugees, especially those who have multiple intersecting vulnerabilities. Global leaders, policy makers, and advocates must work together to prevent stigmatising political attacks and discrimination against refugees. A failure to do so will only compound the challenges faced by refugees and further sow discord, entrench injustice, and divide society. Stepped care and other innovative interventions cannot realise their full potential unless we tackle the root causes of mental health and ensure refugees’ basic human rights and opportunities for social participation.