Over the last decade there has been a steady increase in the numbers of forcibly displaced people worldwide (UNHCR, 2024b). People seeking asylum are those who have been displaced or migrated to another country and have made a claim to be “recognised as a refugee under the Refugee Convention and receive protection and assistance” (Home Office, 2024). The reasons why people seek asylum are varied and often complex, but examples of drivers include war and conflict, human rights abuses, persecution, and natural disasters (Hassan, 2022). In 2024, there were 8.4 million people seeking asylum worldwide, which was a 21.8% increase on the previous year (UNHCR, 2024a).
The challenges that people seeking asylum and refugees face can have a negative impact on their mental health. Evidence suggests that they experience higher rates of major depressive disorder, post-traumatic stress disorder, bipolar affective disorder and psychosis compared to the general population (Patanè et al., 2022). They can be exposed to risk factors pre-migration or at any point on the migration journey. However, even once they have escaped the threats in their home country, the post-migration living situation in their host country can contribute to poor mental health outcomes (Nowak et al., 2023). Inadequate housing is often a key issue but other factors such as uncertain immigration status, unemployment, financial hardship, family concerns, loneliness and discrimination can also worsen mental health (Nowak et al., 2023).
The provision of housing for people seeking asylum is something that all host countries need to consider. In some places, people live in camp settings for many years while waiting for permanent settlement. In other cases, people seeking asylum are held in immigration detention centres while they await a decision on their asylum claim. These centres are usually prison-like in nature and place significant restrictions on residents’ movements as well as isolating them from wider society. There is strong evidence that being in immigration detention, and increased length of time in detention, is associated with worse mental health (von Werthern et al., 2018).
In the United Kingdom, the government has adopted policies of housing people in a range of alternative settings such as disused military barracks and hotels. This topic has been the subject of heated political debate (UK Parliament, 2025) and there have been public demonstrations about the use of hotels for this purpose. At the same time, experts working in the field and medical professionals have expressed myriad concerns about the negative health impacts of some of the temporary accommodation sites used to house people seeking asylum (Burnett et al., 2024; Mental Health Foundation, 2025; Phillimore et al., 2025; Royal College of Psychiatrists, 2024; Spira et al.).
A systematic review published in 2023 examined the impact of housing on physical and mental health in refugee and asylum-seeking populations (Brake et al., 2023). It found that lack of control over their housing, not having a safe space to live, and lack of privacy were key factors negatively impacting on mental health (Brake et al., 2023). Importantly, this review only included studies conducted in high-income countries and focused on both people seeking asylum as well as refugees. While they may still face many barriers to accessing adequate housing, people with refugee status tend to have greater levels of protection and more agency over where they live.
Here, I summarise a systematic review that focused specifically on the relationship between housing and mental health among people seeking asylum (Spira et al., 2025). Note that I refer to “people seeking asylum” instead of “asylum seekers” throughout this article, as the latter is considered by some to be dehumanising terminology (Refugee Council).
People seeking asylum may be held in immigration detention centres which can have profound impacts on mental health.
Methods
Spira and colleagues undertook a systematic review of the scientific and grey literature that had been published on this topic since a previous review conducted in 2017 (Ziersch & Due, 2018). The authors asked the following questions:
- Primary research question: What is the relationship between housing and the mental health of people seeking asylum?
- Secondary research question: What are the relevant aspects of housing that impact the mental health of people seeking asylum?
Studies were only included if their participants were seeking asylum; people from other migrant populations, including refugees, were excluded. Studies were also included if they made any consideration of housing, any consideration of mental health, were published between January 2017 and May 2023, and were written in the English language. Quantitative, qualitative and mixed-methods studies were included.
Ten databases were searched. Both title/abstract and full text screening were undertaken independently by two reviewers. The quality of included studies was assessed by one author using the Mixed Methods Appraisal Tool.
The authors performed a narrative synthesis of the findings due to a high level of heterogeneity among the included studies.
Results
Of the 42 full texts screened, 21 were excluded. Studies were most commonly excluded because they grouped data for refugees and people seeking asylum together, or because they did not consider the link between housing and mental health. This left 21 studies that were included in the review. All studies were conducted in countries in the Global North except one conducted in Mexico. Different forms of housing were studied, including collective/shared housing (n=13), community housing (n=8), private housing (n=7), refugee camps (n=3), detention centres (on-shore) (n=3), detention centres (off-shore) (n=2), and hotels (n=1). Twelve studies used qualitative methods including interviews, ethnography and auto-photography. Nine studies used quantitative methods, with data sources ranging from mental health service outcome measures, national surveys and longitudinal studies. Seventeen studies only included people seeking asylum and four studies included mixed samples of people seeking asylum in addition to refugees or accommodation centre staff. Most studies focused on adults seeking asylum but some focused on specific subgroups including parents, women, pregnant women, torture survivors or children and young people.
The authors organised the synthesis of the findings as such:
1. What is happening?
a. Poor living conditions
- Factors such as lack of space, poor hygiene, fear of disease, overcrowding, loud noises, cold and damp were associated with worse mental health outcomes; exacerbating pre-existing mental health difficulties or being associated with the emergence of new difficulties.
b. Mental health difficulties
- Anxiety, depression, PTSD, self-harm, suicidal ideation and sleep difficulties were the most common mental health difficulties reported by people seeking asylum living in unsuitable housing.
c. Impact of different types of housing
- Collective housing and detention settings were associated with worse mental health outcomes compared to private and community housing settings.
2. Why is it happening?
a. Lack of autonomy
- Not being able to choose where they live, restrictions on access to catering facilities, lack of privacy and concerns about not providing suitable living environments for their children were factors that impacted negatively on mental health.
b. Feeling unsafe
- Sharing accommodation with strangers and experiences of violence contributed towards a sense of feeling unsafe, that in turn negatively impacted on mental health, especially among vulnerable women and children.
c. Lack of support
- Social isolation, lack of access to community support systems, frequent transfers between accommodation sites, language barriers, stigma and not being able to access public transport were linked to poor mental health.
- Furthermore, poor communication and relationships with accommodation staff, as well as lack of access to health and other professionals in some housing options, were contributing factors.
d. Coping strategies
- Internal resources (including faith and hope) and external resources (including social support and connections with the local community) were cited as strategies used by people seeking asylum to offset some of the negative mental health impact of unsuitable housing.
A lack of autonomy, safety and support were cited as relevant aspects of housing that impact on the mental health of people seeking asylum
Conclusions
This review highlighted the importance of adequate housing for the mental health of people seeking asylum. The evidence suggested that collective housing and detention settings are the most detrimental to mental health. The authors concluded by making policy recommendations for the provision of safe housing arrangements, especially the avoidance of detention. They also recommended that clinicians supporting people seeking asylum try to address social isolation/exclusion and foster coping strategies to manage the mental health impact of unsuitable housing.
Collective housing and detention settings were found to be the most detrimental to the mental health of people seeking asylum
Strengths and limitations
A strength of this review is that it addresses an important gap in the literature pertaining to a population that the authors describe as “hard to reach” (although the term “underserved” may be more appropriate). It is also a strength that people seeking asylum were studied distinctly from other migrant groups. While this approach means that some important evidence may have been excluded (as people seeking asylum are frequently studied in mixed samples with refugees), it is helpful to study people seeking asylum separately, as their legal status and rights to services often leave them with less autonomy over their housing situation. The review included both quantitative and qualitative studies, providing deeper insights into the potential reasons underlying the observed associations between housing and mental health. Finally, having two authors independently screen studies reduced the risk of bias.
A limitation of this review is that it only included studies published since 2017, so readers need to retrieve previous reviews on this topic to identify studies published before this time. Only English language studies were included, which may be an issue given that many people seeking asylum live in countries where English is not the predominate language (UNHCR, 2024a). In addition, only one author assessed the quality of included studies and the results of the quality assessment for each study was not reported.
The review highlighted several important limitations of the available evidence base. There was a dearth of evidence from countries in the Global South, where many people seek asylum (UNHCR, 2024a). There was considerable heterogeneity in the mental health measures used in quantitative studies, which ranged from formal tools such as the Harvard Trauma Questionnaire, to the prevalence of diagnosed mental disorders, to the incidence of self-harm reported by accommodation staff. This limited the ability to draw comparisons across studies. In addition, there was limited detail provided on the cultural validation of screening tools used in each context. The reporting of housing also varied considerably; some studies categorised housing simply as “stable” and “unstable”, which is reductionistic and again limits the comparability with other studies. Finally, study sample sizes were generally small (range 2 to 2,399) and potential confounding factors were not always accounted for. This means that the observed associations between housing and mental health outcomes may have actually been the result of factors such as pre-existing mental disorders or other post-migration stressors such as prolonged uncertainty surrounding immigration status, discrimination, or family support (Nowak et al., 2023). The findings should therefore be considered in light of these limitations.
Perhaps a key limitation of any review examining the social determinants of mental health in forced migrant populations is the propensity to become rapidly outdated. The housing options and living conditions for people seeking asylum are to a great extent at the whim of political decision makers, meaning that the situations they face can change dramatically in a short space of time. This does not reduce the importance of conducting systematic reviews of the literature; on the contrary, it indicates a need for ongoing research and more frequent synthesis of the evidence base regarding the living conditions and rights of people seeking asylum and their mental health impacts.
Housing options for people seeking asylum can change rapidly at the whim of political decision makers. This indicates a need for ongoing research with frequent synthesis of the evidence base regarding the impact of living conditions on mental health.
Implications for practice
The findings of this review support the development of policies that reduce the exposure of people seeking asylum to living conditions that are harmful to their mental health. Focus should be placed on ensuring sanitary conditions that are free of damp, access to essential facilities (including those for cooking), and reducing restrictions on residents’ movements. Residents should have the opportunity to integrate into their local communities and access healthcare. Safety must be a priority, particularly for women and children, and violence prevention strategies should be employed. Policy makers should heed the findings of this review and calls from other organisations to limit the use of accommodation centres that are harmful for mental health, including immigration detention and quasi-detention settings. There are some groups of people (such as children, pregnant women, people with mental disorders and those who have experienced torture, sexual or gender-based violence) who UK medical professionals have argued should not be subject to immigration detention (Royal College of Midwives, 2017; Royal College of Psychiatrists, 2021; Stevens et al., 2023).
Clinicians may feel helpless to ameliorate the adverse mental health impacts associated with their patients’ housing situation, but they can do some useful things, for example, signposting patients to organisations that support with community-building and occupational or educational opportunities. They also have an important role in identifying and acting on safeguarding concerns for children and vulnerable adults. Finally, at the level of service provision, clinicians may consider what strategies their service could adopt to reduce barriers to healthcare access for people seeking asylum, especially those who are socially isolated.
No doubt, this review also calls for more research into this topic, especially in the countries housing the most people seeking asylum, and with larger sample sizes. This work should be done in collaboration with people with lived experience of seeking asylum, to ensure the research is relevant and ethical, and improve the likelihood of real-world impact.
People seeking asylum should not be housed in detention centres, but instead should have access to housing that is sanitary, safe and allow access to local communities.
Statement of interests
Grace Crowley is supported by a Wellcome doctoral fellowship (324090/Z/25/Z). She is also a member of the Royal College of Psychiatrists Working Group for Mental Health and Forced Migration.
Links
Primary paper
Spira, J., Katsampa, D., Wright, H., & Komolafe, K. (2025). The relationship between housing and asylum seekers’ mental health: A systematic review. Social Science & Medicine, 117814.
Other references
Brake, T. M., Dudek, V., Sauzet, O., & Razum, O. (2023). Psychosocial Attributes of Housing and Their Relationship With Health Among Refugee and Asylum-Seeking Populations in High-Income Countries: Systematic Review. Public Health Rev, 44, 1605602.
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