Refugee mental health in Switzerland: understanding the care gap

People who have fled war and persecution carry a heavy psychological burden — and in Switzerland, as in most host countries, the services that could help them are hard to reach. This article summarises what peer-reviewed research says about the size of the problem, why access is so difficult, and what kind of response researchers recommend.

How common are mental health problems among refugees?

The most comprehensive estimate comes from a 2020 systematic review and meta-analysis in PLOS Medicine. Blackmore and colleagues pooled 26 studies covering 5,143 adult refugees and asylum seekers in 15 countries, including Switzerland. Only studies that used clinical interviews and validated instruments were included.

The pooled prevalence rates were:

• Post-traumatic stress disorder (PTSD): 31.46%
• Depression: 31.5%
• Anxiety disorders: 11%
• Psychosis: 1.51%

In other words, roughly one in three adult refugees meets criteria for PTSD, and roughly one in three for depression. The authors conclude that these rates are “high and persistent” and that mental health care is needed well beyond the first period of resettlement.

Trauma experienced before and during flight is only part of the story. After arrival, many refugees face post-migration stressors — separation from family, discrimination, uncertain residence status and difficulty finding work. A 2023 study by Spaaij and colleagues notes that these post-migration living difficulties contribute significantly to the development and persistence of mental disorders.

The Swiss care gap

Switzerland has specialised treatment centres for traumatised refugees, but they are often overloaded. A 2020 survey published in BMC Psychiatry asked 867 psychotherapists and psychiatrists in outpatient practice about treating refugees and asylum seekers:

• 43% had treated between one and nine refugees or asylum seekers in the previous 12 months, and a further 13% had treated ten or more.
• Interpreters were needed for almost every second patient with a refugee background.
• The funding of interpreters, and of treatment in general, were reported as the biggest hurdles to treating more people.

The same study found that few patients were turned away for capacity reasons (2–5%), with median waiting times of two to three weeks for new patients in general outpatient practice. The authors argue that general practitioners and therapists could relieve specialised centres — if barriers such as interpreter funding were addressed.

The SPIRIT network, which coordinates refugee mental health work in several cantons, cites waiting times of nine to twelve months for specialised therapy.

Barriers beyond capacity

Availability of therapists is only one barrier. In a qualitative study in the European Journal of Psychotraumatology, Kiselev and colleagues interviewed Syrian refugees and asylum seekers, Swiss health professionals and other stakeholders in German-speaking Switzerland. They identified:

• Language barriers
• Gatekeeper-associated problems in reaching the right service
• Lack of resources
• Lack of awareness of mental health and of available services
• Fear of stigma
• A mismatch between the Swiss health system and the needs refugees perceive

Notably, participants perceived the socio-cultural barriers as more pronounced than the structural ones. More therapy places alone would therefore not close the gap. Services also need to be culturally and linguistically accessible, easy to find and free of stigma.

What closing the gap requires

The World Health Organization has developed a family of scalable psychological interventions for exactly this situation. The best known is Problem Management Plus (PM+), a brief, transdiagnostic programme that trained non-specialists can deliver. Because helpers can share the language and background of the people they support, PM+ addresses several barriers at once.

Researchers caution that scaling up such interventions requires more than training helpers. A 2023 qualitative study on scaling up PM+ in Switzerland identified the following preconditions:

1. Sustainable funding
2. A stepped-care approach, in which brief interventions are the first step and people with more severe needs are referred to specialists
3. Quality control during delivery

This is the model the Swiss SPIRIT programme is implementing across nine cantons. Read more in SPIRIT: how Switzerland is scaling psychological support for refugees and Problem Management Plus (PM+) explained.

Key takeaways

• Mental disorders, especially PTSD and depression, affect a large share of refugees, and post-migration stress keeps them going.
• In Switzerland, the main obstacles are interpreter funding, language, stigma and navigating the system, not only a lack of therapists.
• Evidence supports low-threshold, peer-delivered interventions embedded in stepped care, with clear referral pathways to specialised treatment.