Mental health
The relation between flight and mental health
Refugees and asylum seekers are particularly vulnerable to mental health challenges and severe distress due to exposure to traumatic events and extremely stressful factors before, during, and after their flight. The reasons for fleeing and the journey itself often involve frightening and dangerous situations, including violence, threats, extortion, abuse, and the possiblity of death. Life after fleeing can also be extremely difficult and stressful. These experiences affect mental health and well-being both in the short and long term.
Even though most refugees are strong, resilient, and overcome their experiences admirably, it can be very challenging to move forward in life. Severe experiences can also lead to trauma, which affects emotions and reactions, manifests as physical pain, and impacts social life, work capacity, memory, sleep patterns, etc. According to the WHO, refugees with trauma are at a higher risk of developing serious mental disorders than the general population and face difficulties meeting expectations in their new environments.
Refugees who cannot meet the requirements for permanent residence due to mental health issues can apply for an exemption, which Refugees Welcome can assist with.
Trauma and PTSD
A trauma is a wound on the psyche resulting from one or more extremely frightening experiences. In some cases, it can develop into a chronic stress disorder, where the nervous system remains on high alert, even though danger has passed. This is known as PTSD (Post-Traumatic Stress Disorder). The Danish Refugee Council estimates that between 30-50% of refugees in Denmark live with trauma, often as a result of war, violence, disasters, and torture. According to the Danish Institute for Human Rights, at least 45% of asylum seekers in Denmark have been subjected to torture, with Syrian refugees making up the largest group.
Trauma and PTSD can manifest as intense anxiety, panic, fear of death, flashbacks, concentration difficulties, nightmares, sleep disturbances, heightened sensitivity to certain stimuli, and constant fear of ending up in dangerous situations again. PTSD often results in heavy reactions, such as sudden outbursts of anger, which the person struggles to understand and control, leading many to isolate themselves.
Exile stress, aggravation, and loneliness
Not only past experiences make refugees vulnerable to mental health challenges. In their new life in Denmark, many refugees experience intense stress, uncertainty, and fear related to intransparent asylum and integration rules, temporary residence permits, long waiting times for case processing, prolonged family separation, threats of deportation, and more. This can severely harm their mental health, leading to retraumatization, chronic stress reactions, and serious conditions such as anxiety and depression.
For instance, a study from the University of Copenhagen showed that refugee fathers who experienced prolonged waiting time for family reunification were twice as likely to be diagnosed with a psychiatric disorder compared to those who were not separated from their families. Worrying about family members in their home country and feeling guilty for having survived and found safety are also common mental burdens.
The inability to contribute or meet expectations is another major barrier to the well-being and mental health of many refugees I Denmark. The come here with skills and a desire to be active, contributing citizens. However, the particular burdens they carry can be exacerbated by the political and social demands placed on them. According to Morten Sodemann, chief physician at the Migrant Health Clinic in Odense, unachievable integration demands — such as language requirements with high performance pressure — can in fact retraumatize refugees who, due to PTSD, are unable to learn but are still expected to do so.
The healthcare system and civil society work together to support refugees living with trauma, mental illness, and distress, but statistics show the need is greater than the supply. For example, a 2021 report by the Danish Health Authority revealed that people from Middle Eastern and North African backgrounds are twice as likely to feel depressed, unhappy, or down — and most of them are refugees from Syria, Iraq, and Lebanon. Refugees are not only more likely to suffer from mental illness and poor well-being but are also significantly more lonely than the rest of the population. Loneliness, often called “the silent killer,” can lead to social isolation, poor physical health, low quality of life, depression, and early death.
Rights and Access to Mental Health Services
All refugees have the right to a healthy and dignified life, and according to the UN Refugee Agency (UNHCR) countries receiving refugees should ensure equal access to healthcare. However, despite the high prevalence of trauma and distress among refugees, mental health services are not a serious part of the support package when establishing a life in Denmark.
The Asylum Phase:
At asylum centers, newly arrived children undergo a psychological screening, and adults are offered a standardized health interview and examination. Only a few are referred for further treatment, and if psychiatric care is needed, it can only be obtained by applying for approval from the Immigration Service. Read more about health in the asylum centres here. Health records from asylum centers are not necessarily transferred to municipalities, meaning important health data, such as trauma or torture history, can be lost when refugees move from the asylum system to a general practitioner in the new home municipality.
A 2018 report from the National Audit Office indicated that 51% of refugees in asylum centers were registered with mental health issues, but this information was only passed on to municipalities in 5% of cases.
The Integration Phase:
Municipalities are no longer required to offer health screenings to newly arrived refugees, including screenings for trauma, torture, rape, violence, or mental illness. This was abolished in 2013, and only a few municipalities continue to offer it voluntarily. The screenings were never very effective, as doctors lacked specialized knowledge in this area.
Although municipalities are required to offer repatriation assistance, employment and self-sufficiency programs, and Danish language courses, they are not obliged to safeguard refugees’ mental health. As in the general healthcare system, there is also a significant variation between municipalities in how they manage this healthcare task.
The fee for interpretation was introduced by the Danish Parliament in 2018 and presents yet another barrier for refugees access to mental health services. It has faced massive criticism from the Danish Medical Association. Together, these barriers prevent many trauma cases from being identified in a timely manner, allowing them to become chronic and cause significant harm to individuals and families. The traumatized refugees who do receive rehabilitation treatment, have lived in Denmark an average of 15 years before accessing the care they need.
Accessing Treatment:
People with chronic stress disorders or PTSD, or experiences of torture, qualify for rehabilitation treatment. This is accessed through their general doctor, who refers the person to a specialist or specialised clinic. All regions in the country have special services for traumatised refugees. However, according to a report from the Danish Institute for Human Rights, many general doctors are hesitant to discuss trauma, which is one reason many refugees don’t receive timely treatment — a problem which the two immigrant medical clinics in Odense and Hvidovre are doing a great job to rectify. The specialized rehabilitation treatment of traumatized refugees and torture victims is carried out, among others, by DIGNTIY Danish Center against Torture and OASIS.
Rejected Asylum Seekers and Undocumented Individuals:
Asylum seekers, both during the processing of their case and after a potential rejection, do not have full access to healthcare. They are only entitled to necessary, urgent, and pain-relieving treatment (under the special NUS principle). They can only access doctors through nurses at the health clinics in the centers. However, the uncertainty, waiting time, and poor conditions at the deportation centers can severely worsen the mental health of the residents.
Particularly at the Ellebæk prison, the conditions actively contribute to the deterioration of mental health: prolonged confinement, solitary confinement, and violent behavior among prison staff severely affect the detainees, who exhibit serious signs of mental illness, including self-harm, depression, anxiety, and suicidal thoughts and attempts. The Council of Europe’s Committee for the Prevention of Torture has repeatedly issued severe and sharp criticism of Ellebæk and other deportation centers for these reasons.
Undocumented individuals living in the country cannot access regular healthcare services. However, they can seek help at the Red Cross health clinics in Copenhagen, Aarhus, Odense, and Aalborg.
Where Can You Find Help?
If you are a refugee in Denmark and need help with your mental health, there are several places where help is available.
Doctor and Hospital:
PTSD and trauma require clinical treatment, which your doctor can refer you to. Through the doctor, you can access clinics where the staff has specialized knowledge of trauma, including trauma resulting from flight and torture. These trauma clinics also provide professional interpreters.
Contact your doctor if you experience problems with sleep, concentration, memory, sudden mood swings, or intense emotional reactions. Be as honest as possible about how you feel. This will make it easier for the doctor to understand the type of help you need. If you cannot afford an interpreter, in some cases, it is possible to get permanent approval for a free interpreter through your doctor.
If you have an urgent need for psychological help, you should immediately contact your doctor or the emergency doctor outside of your doctor’s office hours. Call 112 if you are in acute danger of suicide.
Other Services (most links are to websites in Danish):
• At SIND Counseling, you can have online or phone conversations with volunteer psychologists and other professionals. It is free and confidential. You can also call if you are a relative of someone with mental health challenges. Call the counseling service at: +45 70 23 27 50.
• Through DIGNITY’s self-help site, you will find exercises that help with living with PTSD. The site is available in Danish, English, Farsi, and Arabic.
• Through the Danish Red Cross’s self-help site, you will find information and exercises on crisis, stress, grief, sleep, family, and self-care. The site is available in Danish, English, and Ukrainian.
• At Refugees Welcome, you can get help applying for exemptions from certain requirements for permanent residency if you have severe mental or physical disabilities.
Communities and Psychosocial Support:
If you are struggling with poor well-being, stress, and loneliness, you can find relief in community programs for refugees. The Danish Red Cross and the Danish Refugee Council have volunteers who understand your situation and can help you with daily life, finding peace, and access activities for you alone or with your family.
• The Danish Refugee Council offers counseling, activities for children and families, everyday guidance, and psychosocial group sessions.
• The Danish Red Cross offers social network and community groups, language training, family support, etc.
• Together, the two organisations run the “Venner Viser Vej” program, where refugees are matched with a volunteer friend or family who helps improve well-being, expand social networks, and manage everyday life in Denmark.
• On Socialkompasset, you can search for local social activities and initiatives across the country that can help you thrive better.
Do You Know a Refugee with Mental Health Challenges?
As a contact person or acquaintance of a refugee experiencing mental health challenges, you can make a big difference by listening and offering emotional support, and by helping to access professional help. Ask how the person is doing, but be careful not to pry or cross personal boundaries. Let the person talk, listen actively, and show care. Be clear about what you cannot help with (e.g., “I am not a psychologist, so I cannot help with that”). Be aware of your own boundaries – listening to traumatic experiences can be very overwhelming.
When the person is struggling, they will likely find it difficult to act on their own. Therefore, you can offer to help with practical tasks, such as contacting a family member or calling the doctor if needed. If the relationship is very trusting, you can offer to accompany the person to the doctor or to a community program – this can make an otherwise uncomfortable situation much easier to manage.
If you need advice and guidance on how to support vulnerable refugees, you can get in touch with the Danish Refugee Councils Center for Vulnerable Refugees.